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. 2014 Feb 1;179(3):353-60.
doi: 10.1093/aje/kwt256. Epub 2013 Nov 5.

Revisiting Rayong: shifting seroprofiles of dengue in Thailand and their implications for transmission and control

Revisiting Rayong: shifting seroprofiles of dengue in Thailand and their implications for transmission and control

Isabel Rodríguez-Barraquer et al. Am J Epidemiol. .

Abstract

Dengue virus has traditionally caused substantial morbidity and mortality among children less than 15 years of age in Southeast Asia. Over the last 2 decades, a significant increase in the mean age of cases has been reported, and a once pediatric disease now causes substantial burden among the adult population. An age-stratified serological study (n = 1,736) was conducted in 2010 among schoolchildren in the Mueang Rayong district of Thailand, where a similar study had been conducted in 1980/1981. Serotype-specific forces of infection (λ(t)) and basic reproductive numbers (R0) of dengue were estimated for the periods 1969-1980 and 1993-2010. Despite a significant increase in the age at exposure and a decrease in λ(t) from 0.038/year to 0.019/year, R0 changed only from 3.3 to 3.2. Significant heterogeneity was observed across subdistricts and schools, with R0 ranging between 1.7 and 6.8. These findings are consistent with the idea that the observed age shift might be a consequence of the demographic transition in Thailand. Changes in critical vaccination fractions, estimated by using R0, have not accompanied the increase in age at exposure. These results have implications for dengue control interventions because multiple countries in Southeast Asia are undergoing similar demographic transitions. It is likely that dengue will never again be a disease exclusively of children.

Keywords: basic reproductive number; critical vaccination fraction; demography; dengue; force of infection; transmission dynamics.

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Figures

Figure 1.
Figure 1.
Age-specific dengue seroprevalence in Mueang Rayong district, Thailand, according to the A) 1980, and B) 2010 serosurveys. Numbers on the top of each bar indicate the number of samples in each age group. Whereas the 1980 serosurvey showed that 96% of the population had been exposed to dengue by age 11 years, the 2010 serosurvey showed that only 82% of the population was exposed by age 18 years. DENV-1, DENV-2, DENV-3, and DENV-4 refer to dengue virus serotypes 1–4, respectively, and ≥2 DENV refers to 2 or more dengue virus serotypes.
Figure 2.
Figure 2.
Age-specific dengue seroprevalence in Mueang Rayong district, Thailand, according to the 1980 and 2010 serosurveys. Solid lines show the fits of the constant λ(t) (serotype-specific forces of infection) models. Dashed lines show the fits of the time-varying λ(t) model. Bars represent 95% confidence intervals. Results show a significant increase in the age at exposure to dengue virus. DENV-1, DENV-2, DENV-3, and DENV-4 refer to dengue virus serotypes 1–4, respectively, and ≥2 DENV refers to 2 or more dengue virus serotypes.
Figure 3.
Figure 3.
Serotype-specific estimates of A) λ(t) (serotype-specific forces of infection), and B) R0 (basic reproductive number) for dengue for the periods 1969–1980 and 1993–2010 in Mueang Rayong district, Thailand. DENV-1, DENV-2, DENV-3, and DENV-4 refer to dengue virus serotypes 1–4, respectively. Although the force of infection has decreased by approximately 50%, changes in R0 have been significantly smaller.
Figure 4.
Figure 4.
Estimated λ(t) (serotype-specific forces of infection) for the 9 subdistricts of Mueang Rayong, Thailand, represented in the 2010 serological study. Locator map on the upper left corner shows the location of Mueang Rayong district (black point) within Thailand. Results show significant heterogeneity in λ(t) among subdistricts. A) Tha Pradu, B) Choeng Noen, C) Noen Phra, D) Taphong, E) Phe, F) Klaeng, G) Na Ta Khuan, H) Ka Chet, and I) Map Ta Phut. Credible intervals of our estimates are provided in Web Table 1, available at http://aje.oxfordjournals.org/.
Figure 5.
Figure 5.
Heterogeneity of R0 (basic reproductive number) and critical vaccination fraction estimates between subdistricts of Mueang Rayong, Thailand. Estimates obtained from the 2010 serological study. Solid line represents the equation V (critical vaccination fraction)formula image. Squares represent the V and R0 estimates for the 9 subdistricts included in the serosurvey. A) Tha Pradu, B) Choeng Noen, C) Noen Phra, D) Taphong, E) Phe, F) Klaeng, G) Na Ta Khuan, H) Ka Chet, and I) Map Ta Phut. Darker shades represent higher R0.

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