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. 2016 Jun 1;94(6):1342-7.
doi: 10.4269/ajtmh.15-0337. Epub 2016 Mar 28.

Forty Years of Dengue Surveillance at a Tertiary Pediatric Hospital in Bangkok, Thailand, 1973-2012

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Forty Years of Dengue Surveillance at a Tertiary Pediatric Hospital in Bangkok, Thailand, 1973-2012

Ananda Nisalak et al. Am J Trop Med Hyg. .

Abstract

Long-term observational studies can provide valuable insights into overall dengue epidemiology. Here, we present analysis of dengue cases at a pediatric hospital in Bangkok, Thailand, during a 40-year period from 1973 to 2012. Data were analyzed from 25,715 hospitalized patients with laboratory-confirmed dengue virus (DENV) infection. Several long-term trends in dengue disease were identified including an increase in mean age of hospitalized cases from an average of 7-8 years, an increase after 1990 in the proportion of post-primary cases for DENV-1 and DENV-3, and a decrease in the proportion of dengue hemorrhagic fever and dengue shock syndrome cases in primary and post-primary cases over time. Exploratory mechanistic analysis of these observed trends considered changes in diagnostic methods, demography, force of infection, and Japanese encephalitis vaccination as possible explanations. Thailand is an important setting for studying DENV transmission as it has a "mature" dengue epidemiology with a strong surveillance system in place since the early 1970s. We characterized changes in dengue epidemiology over four decades, and possible impact of demographic and other changes in the human population. These results may inform other countries where similar changes in transmission and population demographics may now or may soon be occurring.

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Figures

Figure 1.
Figure 1.
Time series of monthly dengue cases. (A–F) DENV-1, DENV-2, DENV-3, DENV-4, serotype unavailable and all cases. DENV = dengue virus.
Figure 2.
Figure 2.
Ratio of Queen Sirikit National Institute of Child Health (QSNICH) and Thailand Ministry of Public Health (MOPH) dengue cases.
Figure 3.
Figure 3.
Mean age of primary and post-primary cases by serotype, and for untyped and all cases. Primary mean age for each group is shown in dark purple, red, light green, dark blue, orange, and black, respectively. Secondary mean age for each group is shown in light purple, light pink, dark green, light blue, brown, and gray, respectively. D1 = DENV-1; D2 = DENV-2; D3 = DENV-3; D4 = DENV-4.
Figure 4.
Figure 4.
Percentage of dengue cases those were post-primary over time by serotype. DENV-1 to DENV-4, serotype unavailable and all cases.
Figure 5.
Figure 5.
Catalytic model output of post-primary (second infections) proportion under a decrease in force of infection (FOI), known birth rates in Bangkok, and three times as many post-primary than primary infections being observed. Black dots reflect the model without Japanese encephalitis (JE) vaccination and blue dots reflect the model with JE vaccination. Estimates are shown from 1988 onward since estimates for FOI for the population ≤ 15 years old were possible for their whole lifespan.
Figure 6.
Figure 6.
Proportion of primary and post-primary dengue cases that were dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) over time.
Figure 7.
Figure 7.
Proportion of dengue cases that were dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) for primary and post-primary cases in different age groups.

References

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    1. Nisalak A, Endy TP, Nimmannitya S, Kalayanarooj S, Thisayakorn U, Scott RM, Burke DS, Hoke CH, Innis BL, Vaughn DW. Serotype-specific dengue virus circulation and dengue disease in Bangkok, Thailand from 1973 to 1999. Am J Trop Med Hyg. 2003;68:191–202. - PubMed
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