Abstract
Routine national notifications of dengue cases typically do not reflect the true dengue situation due to large proportion of unreported cases. Serosurveys, when conducted periodically, could shed light on the true dengue infections in the population. To determine the magnitude of dengue infections of the adult population in Singapore following the outbreak in 2007, we performed a cross-sectional study on blood donor samples from December 2009 to February 2010. The residual blood of 3,995 donors (aged 16–60 years) was screened for the presence of dengue-specific immunoglobulin G (IgG) and IgM using enzyme-linked immunosorbent assay (ELISA) kits. The age-weighted IgG prevalence of residents was 50.8% (N = 3,627, 95% confidence interval [CI] = 49.4–52.3%). Dengue IgG prevalence increased with age, with the lowest in 16–20 years age group (16.1%) and the highest in 56–60 years age group (86.6%). Plaque reduction neutralization test (PRNT) on samples of young resident adults (aged 16–30 years) revealed lower prevalence of neutralizing antibodies to each serotype, ranging from 5.4% to 20.3% compared with the older age groups. The level of exposure to dengue among the young adults is relatively low despite the endemicity of the disease in Singapore. It partially explains the population’s susceptibility to explosive outbreaks and the high incidence rate among young adults.
Highlights
Dengue is an important mosquito-borne viral infection caused by four closely related serotypes of dengue virus (DENV-1, DENV-2, DENV-3, and DENV-4)
The level of exposure to dengue among the young adults is relatively low despite the endemicity of the disease in Singapore
1,885 (52%, 95% confidence interval (95% CI) = 50.3–53.6%) had dengue immunoglobulin G (IgG), indicating past DENV infection (Table 2)
Summary
Dengue is an important mosquito-borne viral infection caused by four closely related serotypes of dengue virus (DENV-1, DENV-2, DENV-3, and DENV-4). During the past 50 years, global dengue incidences have increased by 30-fold. This fast-growing infectious disease is projected to cause some [50–100] million new infections annually in more than 100 endemic countries, leading to half a million hospitalizations.[1,2,3]. A nationwide Aedes mosquito control program that incorporated source reduction, public health education, and law enforcement was introduced in the 1970s This active control program led to a period of low dengue incidence over the decade.[8] In the late 1980s, Singapore experienced a resurgence of dengue cases despite the low Aedes premise index of around 1.9 Incidence rate rose from 16.7 cases per 100,000 population in 1987 to 322.5 in the 2005 epidemic. To provide a holistic view on the level of exposure to dengue in the adult population of Singapore following the 2007 outbreak, we conducted a cross-sectional study using the residual blood samples collected from healthy blood donors from December 2009 to February 2010
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