Dengue incidence and length of viremia by RT-PCR in a prospective observational community contact cluster study from 2005–2009 in Indonesia.

Autor: Riswari, Silvita Fitri, Velies, Dyana Safitri, Lukman, Nurhayati, Jaya, Ungke Anton, Djauhari, Hofiya, Ma'roef, Chairin Nisa, Myint, Khin Saw Aye, Widjaja, Susana, der Ven, Andre van, Alisjahbana, Bachti, Mast, Quirijn de, Kosasih, Herman
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Zdroj: PLoS Neglected Tropical Diseases; 2/6/2023, Vol. 16 Issue 2, p1-16, 16p
Abstrakt: Background: Dengue has become a major global health threat since being recognized three centuries ago. Important gaps remain in understanding the transmission dynamics of dengue virus (DENV) infection. This study reports the results of a prospective observational cluster study that investigated the incidence of symptomatic and asymptomatic infections and length of viremia among close community contacts of hospitalized DENV-infected patients. Methodology/principal findings: Between 2005 and 2009, dengue-confirmed cases (n = 97) admitted to Hasan Sadikin Hospital in Bandung, Indonesia, were enrolled as index cases. Subsequently, twenty close community contacts (n = 1928) living with and around the index cases were included and followed up for up to 14 days. Body temperature was measured daily; blood samples were collected every 3–4 days and when reported fever. DENV infection was confirmed using Reverse Transcriptase–Polymerase Chain Reaction (RT-PCR), IgM rapid test, and Enzyme-linked Immunosorbent Assay (ELISA). Among the 1928 community contacts, a total of 72 (3.7%) acute DENV infections were diagnosed, which equates to an incidence of 636 cases per 1,000 person-years (95% Confidence interval (CI) 588 to 687 cases per 1,000 person-years). Twenty-nine cases (40%) were symptomatic (22 dengue fever (DF) & 7 dengue hemorrhagic fever (DHF)), and 43 (60%) were asymptomatic. Primary and secondary DENV infections were detected in 18 (25%) and 54 (75%) subjects. Among the RT-PCR positives, viremia was observed as early as seven days before fever onset and converted to negative as late as seven days after the onset of fever. Conclusions: DENV infections are common among close community contacts of hospitalized dengue patients. The high number of asymptomatic infections and the observation that viremia precedes the onset of fever for up to seven days highlight the importance of unrecognized dengue transmission and the need for improved transmission control. Author summary: Data regarding a complete course of dengue viremia, especially in pre-febrile and asymptomatic cases, are limited. These data can be obtained from community cluster studies that enroll and follow up with the neighborhood and household members of dengue-confirmed index cases. Using this approach, we assessed the presence of dengue viremia before the development of fever and the incidence of symptomatic and asymptomatic dengue cases within the community contacts. We found that there are 1.5 asymptomatic dengue infections for each symptomatic case. Furthermore, dengue virus in blood was detected in eight out of sixteen post-enrollment dengue subjects before the onset of fever. The maximum period was up to seven days, longer than previously reported. Viremic subjects play a crucial role in dengue transmission by mosquitoes. Our data indicate that the significance of unnoticed virus transmission supports the need for comprehensive and sustainable vector control interventions. With the active surveillance embedded in the study design, we calculated the incidence of dengue infection to be 636 cases per 1,000 person-years of follow-up, 930 times higher than the national incidence rate around the same study period, showing the real burden of disease in a hyperendemic area and confirming the underestimation of Indonesian incidence data. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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