Abstract
BackgroundStratifying dengue risk within endemic countries is crucial for allocating limited control interventions. Current methods of monitoring dengue transmission intensity rely on potentially inaccurate incidence estimates. We investigated whether incidence or alternate metrics obtained from standard, or laboratory, surveillance operations represent accurate surrogate indicators of the burden of dengue and can be used to monitor the force of infection (FOI) across urban centres.MethodsAmong those who reported and resided in 13 cities across the Philippines, we collected epidemiological data from all dengue case reports between 2014 and 2017 (N 80,043) and additional laboratory data from a cross-section of sampled case reports (N 11,906) between 2014 and 2018. At the city level, we estimated the aggregated annual FOI from age-accumulated IgG among the non-dengue reporting population using catalytic modelling. We compared city-aggregated FOI estimates to aggregated incidence and the mean age of clinically and laboratory diagnosed dengue cases using Pearson’s Correlation coefficient and generated predicted FOI estimates using regression modelling.ResultsWe observed spatial heterogeneity in the dengue average annual FOI across sampled cities, ranging from 0.054 [0.036–0.081] to 0.249 [0.223–0.279]. Compared to FOI estimates, the mean age of primary dengue infections had the strongest association (ρ −0.848, p value<0.001) followed by the mean age of those reporting with warning signs (ρ −0.642, p value 0.018). Using regression modelling, we estimated the predicted annual dengue FOI across urban centres from the age of those reporting with primary infections and revealed prominent spatio-temporal heterogeneity in transmission intensity.ConclusionsWe show the mean age of those reporting with their first dengue infection or those reporting with warning signs of dengue represent superior indicators of the dengue FOI compared to crude incidence across urban centres. Our work provides a framework for national dengue surveillance to routinely monitor transmission and target control interventions to populations most in need.
Highlights
Stratifying dengue risk within endemic countries is crucial for allocating limited control interventions
We show the mean age of those reporting with their first dengue infection or those reporting with warning signs of dengue represent superior indicators of the dengue force of infection (FOI) compared to crude incidence across urban centres
Our work provides a framework for national dengue surveillance to routinely monitor transmission and target control interventions to populations most in need
Summary
Stratifying dengue risk within endemic countries is crucial for allocating limited control interventions. Without specific therapeutics or a widely available vaccine, costly vector control interventions remain the predominant method of dengue control [4]. To appropriately deploy these limited interventions, dengue national surveillance operations in endemic countries must accurately monitor force of infection (FOI) over space and time. In countries where dengue is a notifiable disease, national surveillance efforts typically collate dengue case reports over specified time periods to generate incidence estimates. This readily available data can be used to inform the deployment of limited control interventions, maximise their impacts. Surveys are labourintensive and difficult to conduct routinely over large geographical areas, so have limited use for routine surveillance proposes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
