Abstract
BackgroundEpidemiologic measures of the dengue burden such as prevalence and incidence are important for policy-making and monitoring the progress of disease control. It is a common practice where epidemiologic and economic research estimate dengue burden based on notification data. However, a basic challenge in estimating the incidence of dengue is that a significant proportion of infected population are asymptomatic. It can be overcome by using mathematical models that relate observed prevalence and mortality to incidence. In this study, we estimate the trend of dengue incidence and hospitalization in Malaysia.MethodsThis study is based entirely on the available secondary data sources on dengue in Malaysia. The age-specific incidence of dengue between 2001 and 2013 was estimated using the prevalence and mortality estimates in an incidence-prevalence-mortality (IPM) model. Data on dengue prevalence were extracted from six sero-surveys conducted in Malaysia between 2001 and 2013; while statistics on dengue notification and Case Fatality Rate were derived from National Dengue Surveillance System. Dengue hospitalization data for the years 2009 to 2013 were extracted from the Health Informatics Centre and the volumes of dengue hospitalization for hospitals with missing data were estimated with Poisson models.ResultsThe dengue incidence in Malaysia varied from 69.9 to 93.4 per 1000 population (pkp) between 2001 and 2013.The temporal trend in incidence rate was decreasing since 2001. It has been reducing at an average rate of 2.57 pkp per year from 2001 to 2013 (p = 0.011). The age-specific incidence of dengue decreased steadily with dengue incidence reaching zero by age > 70 years. Dengue notification rate has remained stable since 2001 and the number of notified cases each year was only a small fraction of the incident cases (0.7 to 2.3%). Similarly, the dengue hospitalization was larger but still a small fraction of the incident cases (3.0 to 5.6%).ConclusionDengue incidence can be estimated with the use of sero-prevalence surveys and mortality data. This study highlights a reducing trend of dengue incidence in Malaysia and demonstrates the discrepancy between true dengue disease burden and cases reported by national surveillance system. Sero-prevalence studies with representative samples should be conducted regularly to allow better estimation of dengue burden in Malaysia.
Highlights
Epidemiologic measures of the dengue burden such as prevalence and incidence are important for policy-making and monitoring the progress of disease control
The number of people infected by dengue in Malaysia varied from approximately 2.2 million in 2001 to 2.1 million in 2013, representing an annual incidence ranging between 69.9 and 93.4 pkp (Table 1)
The estimated dengue hospitalization rates were higher than the notification rates captured by the national surveillance system all dengue cases treated in hospital should have been notified and reported to the authority
Summary
Epidemiologic measures of the dengue burden such as prevalence and incidence are important for policy-making and monitoring the progress of disease control. Epidemiologic measures of the burden of dengue such as its prevalence and incidence, by age and over time, are important for policy-making and monitoring the progress of disease control. World Health Organization (WHO) reported the global incidence of dengue has increased by 30-fold in the past 50 years and estimated some 50 to 100 million new infections occurred annually, with approximately 20,000 deaths [1]. This is in contrast to other major infectious diseases such as human immunodeficiency virus (HIV), tuberculosis and malaria, where most of the affected countries routinely estimate these epidemiologic measures [14,15,16]
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