Abstract
BackgroundIn India, dengue disease is emerging as the most important vector borne public health problem due to rapid and unplanned urbanization, high human density and week management of the disease. Clinical cases are grossly underreported and not much information is available on prevalence and incidence of the disease.MethodologyA cross sectional, stratified, facility based, multistage cluster sampling was conducted between May 4 and June 27, 2017 in Pune city. A total of 1,434 participants were enrolled. The serum samples were tested for detection of historical dengue IgG antibodies by ELISA using the commercial Panbio Dengue IgG Indirect ELISA kit. Anti-dengue IgG-capture Panbio ELISA was used for detection of high titered antibodies to detect recent secondary infection. We used this data to estimate key transmission parameters like force of infection and basic reproductive number. A subset of 120 indirect ELISA positive samples was also tested for Plaque Reduction Neutralizing Antibodies for determining serotype-specific prevalence.FindingsOverall, 81% participants were infected with dengue virus (DENV) at least once if not more. The positivity was significantly different in different age groups. All the adults above 70 years were positive for DENV antibodies. Over 69% participants were positive for neutralizing antibodies against all 4 serotypes suggesting intense transmission of all DENV serotypes in Pune. Age-specific seroprevalence was consistent with long-term, endemic circulation of DENV. There was an increasing trend with age, from 21.6% among <36 months to 59.4% in age group 10–12 years. We estimate that 8.68% of the susceptible population gets infected by DENV each year resulting into more than 3,00,000 infections and about 47,000 to 59,000 cases per year. This transmission intensity is similar to that reported from other known hyper-endemic settings in Southeast Asia and the Americas but significantly lower than report from Chennai.ConclusionsOur study suggests that Pune city has high disease burden, all 4 serotypes are circulating, significant spatial heterogeneity in seroprevalence and suboptimal immunity in younger age groups. This would allow informed decisions to be made on management of dengue and introduction of upcoming dengue vaccines in the city.
Highlights
Dengue disease is an important emerging public health problem in countries of tropical and subtropical regions.[1,2,3] Estimated annual global burden of disease is approximately 390 million infections, 96 million clinical cases, and 20 thousand deaths, with almost 34% of total dengue cases occurring in India.[4]
Our study suggests that Pune city has high disease burden, all 4 serotypes are circulating, significant spatial heterogeneity in seroprevalence and suboptimal immunity in younger age groups
This would allow informed decisions to be made on management of dengue and introduction of upcoming dengue vaccines in the city
Summary
Dengue disease is an important emerging public health problem in countries of tropical and subtropical regions.[1,2,3] Estimated annual global burden of disease is approximately 390 million infections, 96 million clinical cases, and 20 thousand deaths, with almost 34% of total dengue cases occurring in India.[4] According to recent estimates, 2Á9 million dengue episodes and 5906 deaths, with an economic burden of $950 million occur annually in Southeast Asia (SEA) alone.[5] It is known that disease intensity and disease burden is highly variable between different places within a country or region.[6]. Clinical cases are grossly underreported and not much information is available on prevalence and incidence of the disease
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