Abstract
Dengue, caused by the four serotypes of dengue virus (DENV), is the most prevalent mosquito-borne viral disease of humans. To examine the incidence and transmission of dengue, the authors performed a prospective community-based cohort study in 5,545 children aged 2–14 years in Managua, Nicaragua, between 2004 and 2010. Children were provided with medical care through study physicians who systematically recorded medical consult data, and yearly blood samples were collected to evaluate DENV infection incidence. The incidence of dengue cases observed was 16.1 cases (range 3.4–43.5) per 1,000 person-years (95% CI: 14.5, 17.8), and a pattern of high dengue case incidence every other year was observed. The incidence of DENV infections was 90.2 infections (range 45.2–105.3) per 1,000 person-years (95% CI: 86.1, 94.5). The majority of DENV infections in young children (<6 years old) were primary (60%) and the majority of infections in older children (≥9 years of age) were secondary (82%), as expected. The incidence rate of second DENV infections (121.3 per 1,000 person-years; 95% CI: 102.7, 143.4) was significantly higher than the incidence rate of primary DENV infections (78.8 per 1,000 person-years; 95% CI: 73.2, 84.9). The rigorous analytic methodology used in this study, including incidence reporting in person-years, allows comparison across studies and across different infectious diseases. This study provides important information for understanding dengue epidemiology and informing dengue vaccine policy.
Highlights
Dengue is the most common mosquito-borne viral infection worldwide, causing an estimated 40 million cases and 500,000 hospitalizations annually [1]
The observed rate of dengue virus infections is similar to the rates reported in Asian cohort studies, while the rate of dengue cases was lower than that observed in Asian cohort studies
The rate of dengue cases varied more than the rate of dengue virus infections, and a clear pattern of high dengue case incidence every other year was observed
Summary
Dengue is the most common mosquito-borne viral infection worldwide, causing an estimated 40 million cases and 500,000 hospitalizations annually [1]. Most infections with the four dengue virus serotypes (DENV1-4) occur in urban and semi-urban areas of tropical and sub-tropical countries, where DENV is transmitted by Aedes aegypti and Ae. albopictus mosquitoes [2]. Exposure to one serotype of DENV provides lifelong immunity to that serotype, but does not confer lasting protection to the other three serotypes; prior infection with a different DENV serotype is the single greatest risk factor for development of severe disease [4]. Waste and water management, and behavioral factors controlled dengue in the United States, and the Pan American Ae. aegypti eradication campaign in the 1950’s and ’60’s greatly reduced DENV transmission in Latin America [5].
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