Abstract
Dengue is the most important vector-borne viral disease worldwide and a major cause of childhood fever burden in Sri Lanka, which has experienced a number of large epidemics in the past decade. Despite this, data on the burden and transmission of dengue virus in the Indian Subcontinent are lacking. As part of a longitudinal fever surveillance study, we conducted a dengue seroprevalence survey among children aged <12 years in Colombo, Sri Lanka. We used a catalytic model to estimate the risk of primary infection among seronegative children. Over 50% of children had IgG antibodies to dengue virus and seroprevalence increased with age. The risk of primary infection was 14.1% per year (95% CI: 12.7%–15.6%), indicating that among initially seronegative children, approximately 1 in 7 experience their first infection within 12 months. There was weak evidence to suggest that the force of primary infection could be lower for children aged 6 years and above. We estimate that there are approximately 30 primary dengue infections among children <12 years in the community for every case notified to national surveillance, although this ratio is closer to 100∶1 among infants. Dengue represents a considerable infection burden among children in urban Sri Lanka, with levels of transmission comparable to those in the more established epidemics of Southeast Asia.
Highlights
Dengue is considered to be the most important mosquito-borne viral disease affecting humans today [1]
Little is known about the epidemiology of dengue and the transmission of dengue viruses among children in Sri Lanka, in whom the risk of severe forms of the disease, including dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), is considerably higher
By studying how antibody prevalence changes with age, the force of infection can be estimated, a key measure of population transmission that quantifies the risk of a first infection among dengue-naive individuals
Summary
Dengue is considered to be the most important mosquito-borne viral disease affecting humans today [1]. Between 50–100 million cases occur worldwide each year, resulting in an estimated 500,000 hospitalizations and 20,000 deaths; approximately twothirds of the world’s population lives in areas colonized by Aedes mosquitos, the principal vector for dengue viruses [2]. Dengue viruses thrive in urban areas that support large Aedes populations and close contact between infectious vectors and susceptible human hosts [1,3]. Sri Lanka has had a history of over 40 years of dengue, since the early 2000s, progressively large epidemics have occurred at regular intervals. Dengue transmission in Sri Lanka is endemic, but unusually large epidemics were experienced in 2004 and 2009 with the peak transmission occurring in June, following the southwesterly monsoon. We estimate the risk of dengue primary infection among dengue-naive individuals using data from a seroprevalence survey in the paediatric population of Colombo, Sri Lanka
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