Geographic variation in dengue seroprevalence and force of infection in the urban paediatric population of Indonesia

Abstract

Understanding the heterogeneous nature of dengue transmission is important for prioritizing and guiding the implementation of prevention strategies. However, passive surveillance data in endemic countries are rarely adequately informative. We analyzed data from a cluster-sample, cross-sectional seroprevalence study in 1–18 year-olds to investigate geographic differences in dengue seroprevalence and force of infection in Indonesia. We used catalytic models to estimate the force of infection in each of the 30 randomly selected sub-districts. Based on these estimates, we determined the proportion of sub-districts expected to reach seroprevalence levels of 50%, 70% and 90% by year of age. We used population averaged generalized estimating equation models to investigate individual- and cluster-level determinants of dengue seropositivity. Dengue force of infection varied substantially across Indonesia, ranging from 4.3% to 30.0% between sub-districts. By age nine, 60% of sub-districts are expected to have a seroprevalence ≥70%, rising to 83% by age 11. Higher odds of seropositivity were associated with higher population density (OR = 1.54 per 10-fold rise in population density, 95% CI: 1.03–2.32) and with City (relative to Regency) administrative status (OR = 1.92, 95% CI: 1.32–2.79). Our findings highlight the substantial variation in dengue endemicity within Indonesia and the importance of understanding spatial heterogeneity in dengue transmission intensity for optimal dengue prevention strategies including future implementation of dengue vaccination programmes.

Spatiotemporal Variability in Dengue Transmission Intensity in Jakarta, Indonesia

“…find that the force of infection estimate obtained with model 1 variant PS fitted to average annual case notification data reported between 2008 and 2017 in Jakarta province (0.130 (95%CrI: 0.129-0.131)) is similar to the estimate obtained from seroprevalence data collected in 2014 in 30 urban subdistricts of Indonesia (0.14 (95%CI: 0.133-0.147))(5,25).We observed significant spatiotemporal heterogeneity in force of infection within Jakarta province, with long-term spatial clustering of both high and low transmission intensity subdistricts. Our analysis identified a hot-spot of dengue transmission in the southeast of Jakarta province and clustering of low transmission intensity in the region of Central Jakarta.Subdistrict population density was found to have a weak association with dengue transmission intensity, explaining approximately 5% of the variation in subdistrict force of infection estimates during the period of 2008-2017, with higher average annual force of infection associated with greater population densities (for details see SI sections 3.5 and Figure S8).…”

Spatiotemporal variability in dengue transmission intensity in Jakarta, Indonesia

“…collected in 2014 in 30 urban subdistricts of Indonesia (0.14 (95%CI: 0.133-0.147)) [5,25]. We observed significant spatiotemporal heterogeneity in force of infection within Jakarta province, with long-term spatial clustering of both high and low transmission intensity subdistricts.…”

“…Blue dashed line and shading shows the median and 95% credible interval province-level average annual force of infection in 2008-2017. FOI: force of infection.Boundaries were obtained from Wikimedia Commons under a CC-BY 3.0 NL license and converted to shapefile format using QGIS(25,26).…”

Paediatric dengue infection in Cirebon, Indonesia: a temporal and spatial analysis of notified dengue incidence to inform surveillance

“…These studies have shown that geographical information systems (GIS) techniques could provide helpful evidence for designing and implementing surveillance and targeted control measures. A recent study demonstrated evidence for spatial variation in dengue seroprevalence among Indonesian children at the national level [30]. However, this study did not clearly visualize and capture the variation within districts and was limited to urban settings.…”