Dengue Infection in Children in Ratchaburi, Thailand: A Cohort Study. I. Epidemiology of Symptomatic Acute Dengue Infection in Children, 2006-2009
Dengue Infection in Children in Ratchaburi, Thailand: A Cohort Study. I. Epidemiology of Symptomatic Acute Dengue Infection in Children, 2006-2009
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DOI：
10.1371/journal.pntd.0001732
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发表时间：
2012-07-01
影响因子：
3.8
通讯作者：
Letson, G. William
中科院分区：
文献类型：
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作者：
Sabchareon, Arunee;Sirivichayakul, Chukiat;Letson, G. William
背景：迫切需要实地试验登革热疫苗，以确定其在疾病控制中的作用。我们的目的是研究登革热流行病学，并为登革热疫苗功效试验准备场地。方法和发现：我们对2006年至2009年泰国中部小学的儿童进行了一项前瞻性队列研究。我们通过对急性发热性疾病的活动性发热监测（通过学校缺勤和父母电话联系检测）以及登革热诊断检测来评估登革热的流行病学。4年间，在2882、3104、2717和2312名学生年共发现的5842例发热病例中，登革热占394例（6.74%）。2006年、2007年、2008年和2009年登革热发病率分别为1.77%、3.58%、5.74%和3.29%。4年平均登革热发病率为3.6%。阳性标本333份（84.5%）检测登革病毒（DENV）型；DENV血清型1 （DENV-1）最常见（43%），其次是DENV-2（29%）、DENV-3（20%）和DENV-4（8%）。疾病严重程度从登革出血热（DHF） 42例（10.5%），登革热（DF） 142例（35.5%）和未分化热（UF） 210例（52.5%）。所有四种DENV血清型均涉及所有疾病严重程度。大多数病例继发DENV感染，DHF为95%，DF为88.7%，UF为81.9%。2例DHF（0.5%）为原发性DENV-3感染。结论：结果表明，所有四种DENV血清型的登革热在小学生中发病率较高，约50%的疾病表现为UF的轻度临床症状，不符合1997年世卫组织登革热标准。十分之一的病例出现严重疾病（DHF）。为了在大规模临床试验中评估登革热疫苗的疗效，临床试验需要这类数据。
Background: There is an urgent need to field test dengue vaccines to determine their role in the control of the disease. Our aims were to study dengue epidemiology and prepare the site for a dengue vaccine efficacy trial.Methods and Findings: We performed a prospective cohort study of children in primary schools in central Thailand from 2006 through 2009. We assessed the epidemiology of dengue by active fever surveillance for acute febrile illness as detected by school absenteeism and telephone contact of parents, and dengue diagnostic testing. Dengue accounted for 394 (6.74%) of the 5,842 febrile cases identified in 2882, 3104, 2717 and 2312 student person-years over the four years, respectively. Dengue incidence was 1.77% in 2006, 3.58% in 2007, 5.74% in 2008 and 3.29% in 2009. Mean dengue incidence over the 4 years was 3.6%. Dengue virus (DENV) types were determined in 333 (84.5%) of positive specimens; DENV serotype 1 (DENV-1) was the most common (43%), followed by DENV-2 (29%), DENV-3 (20%) and DENV-4 (8%). Disease severity ranged from dengue hemorrhagic fever (DHF) in 42 (10.5%) cases, dengue fever (DF) in 142 (35.5%) cases and undifferentiated fever (UF) in 210 (52.5%) cases. All four DENV serotypes were involved in all disease severity. A majority of cases had secondary DENV infection, 95% in DHF, 88.7% in DF and 81.9% in UF. Two DHF (0.5%) cases had primary DENV-3 infection.Conclusion: The results illustrate the high incidence of dengue with all four DENV serotypes in primary school children, with approximately 50% of disease manifesting as mild clinical symptoms of UF, not meeting the 1997 WHO criteria for dengue. Severe disease (DHF) occurred in one tenth of cases. Data of this type are required for clinical trials to evaluate the efficacy of dengue vaccines in large scale clinical trials.