Incidence of Dengue Virus Infection in School-Aged Children in Puerto Rico: A Prospective Seroepidemiologic Study

Abstract

Abstract. Dengue is a potentially fatal acute febrile illness caused by the mosquito-borne dengue viruses (DENV-1 to -4). To estimate DENV seroincidence in school-aged children, a 1-year prospective cohort study was conducted in Patillas, Puerto Rico; 10-to 18-year-olds (N = 345) were randomly selected from 13 public schools. At enrollment, 49.8% of the entire cohort had DENV immunoglobulin G (IgG) anti-DENV antibodies, and there were individuals with neutralizing antibodies specific to each of the four DENV. The mean age of participants with incident DENV infection was 13.4 years. The 1-year seroincidence rate was 5.6%, and 61.1% of infections were inapparent. Having IgG anti-DENV at enrollment was associated with seroincidence (risk ratio = 6.8). Acute febrile illnesses during the study period were captured by a fever diary and an enhanced and passive surveillance system in the municipios of Patillas and Guayama. In summary, at enrollment, nearly one-half of the participants had a prior DENV infection, with the highest incidence in the 10-to 11-year-olds, of which most were inapparent infections, and symptomatic infections were considered mild.

Dengue virus serological prevalence and seroconversion rates in children and adults in Medellin, Colombia: implications for vaccine introduction

“…These findings are comparable to observations made in Puerto Rico and Nicaragua,25, 31 where dengue incidence seems to increase with age, a pattern that is common in Latin American countries but which contrasts with the pattern observed in Southeast Asia 16, 28, 32, 33. Although it was outside the scope of this study, the assessment of neighborhood-specific strategies for vector control and other environmental characteristics might have been helpful for understanding the relatively homogeneous distribution of DENV prevalence and the more variable behavior for seroconversion.…”

“…Knowing the seasonality of dengue, sensitive information about the patterns of dengue distribution were captured for the study area. As in other studies, the level of attrition related to cohort studies constitutes a limitation that has been described previously 25 . Part of the large attrition seen at the first and second visits was due to a municipal urbanization relocation plan in one of the neighborhoods (Sinai), which was a slum.…”

“…Although it was outside the scope of this study, the assessment of neighborhood-specific strategies for vector control and other environmental characteristics might have been helpful for understanding the relatively homogeneous distribution of DENV prevalence and the more variable behavior for seroconversion. In Latin America, risk assessment by environmental (including entomological evaluation), socioeconomic, and health care access characteristics has been considered a useful tool to identify the dengue burden 15, 25, 34, 35. Moreover, comparing neighborhoods or other small geographic units to identify areas with dengue is key to address vector control and other targeted strategies for disease control 11, 15, 19, 25, 31…”

Dengue seroprevalence, seroconversion and risk factors in Dhaka, Bangladesh

“…The positive linear relationship between presence of DENV antibodies and age is indicative of cumulative DENV exposure in Dhaka. Many other studies have reported that DENV antibody prevalence increases with age [2, 37–43] and on-going virus transmission, over many years, is often cited as the reason for this pattern [38]. …”

“…aegypti mosquitoes. Such exposure among children has also been recorded in seroconversion among school children during epidemics in Puerto Rico [43], Peru [72], the Dominican Republic [48], Brazil [75], and Thailand [60]. …”