Dengue seroprevalence and force of primary infection in a representative population of urban dwelling Indonesian children.
Dengue seroprevalence and force of primary infection in a representative population of urban dwelling Indonesian children.
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DOI：
10.1371/journal.pntd.0005621
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发表时间：
2017-06
影响因子：
3.8
通讯作者：
Hadinegoro SR
中科院分区：
文献类型：
--
作者：
Prayitno A;Taurel AF;Nealon J;Satari HI;Karyanti MR;Sekartini R;Soedjatmiko S;Gunardi H;Medise BE;Sasmono RT;Simmerman JM;Bouckenooghe A;Hadinegoro SR
印度尼西亚报告了世界上第二高的登革热疾病负担；这些数据来自被动监测报告，很可能被严重低估。年龄分层的血清感染率数据是过去暴露的相对公正的指标，并有助于了解传播动态。为了更好地了解印度尼西亚的登革热感染史和相关危险因素，对1-18岁的城市儿童进行了一项具有代表性的以人群为基础的横断面登革热血清阳性率研究。从2014年10月至11月，共有3210名儿童从30个地理位置分散的网络中入学。血清标本用间接酶联免疫吸附试验检测抗登革热抗体。一份问卷调查了登革热血清学状况与家庭社会人口和行为因素之间的关系。总体而言，3194个样本被测试，调整后的全国城市人口血清阳性率为69.4%[95%CI：64.4-74.3](1-4岁为33.8%[95%CI：26.4-41.2]，5-9岁为65.4%[95%CI：69.1-71.7]，10-14岁为83.1%[95%CI：77.1-89.0]，15~18岁为89.0%[95%CI：83.9~94.1]。通过线性模型估计的血清转换的中位年龄为4.8岁。使用催化模型并考虑恒定的感染力，我们估计每年有13.1%的儿童经历一次原发感染。通过分层Logistic多变量模型，受试者的年龄组(1-4vs5-9OR=4.25；1-4vs.10-14OR=12.60；1-4vs15-18OR=21.87；p<；0.0001)和自受试者出生以来在家庭中确诊的病例数量(p=0.0004)仍然与登革热血清学状态有关。这是印度尼西亚第一项针对城市儿科人口代表性样本的登革热血清阳性率研究。这项研究显示，超过80%的10岁或10岁以上的儿童至少经历过一次登革热感染。前瞻性发病率研究可能会显示登革热负担远远超过报告的发病率。从2004年到2010年，印度尼西亚向世界卫生组织报告的平均登革热病例数量位居世界第二，亚洲最高。这些被动监测报告在全国范围内差异很大，很可能严重低估了全部疾病负担，因为常常只捕获登革热出血热。有必要了解全国范围内登革热病毒传播的强度和相关的风险因素，以指导和优先采取适当的登革热预防和控制措施，特别是考虑到第一种登革热疫苗的可获得性，以及根据血清阳性率和其他指标衡量的最近在高流行率地区使用登革热疫苗的建议。按年龄分层的血清阳性率数据提供了对过去暴露的可靠估计，并可提供传播强度的信息。因此，我们在一个有代表性的印度尼西亚城市儿童样本中进行了抗登革热抗体的血清阳性率研究。我们发现总体登革热血清阳性率为69.4%，其中一半儿童在5岁前至少感染过一次。受试者的年龄和在家庭中诊断的登革热病例数量与血清状况有关。这些结果证实了印度尼西亚的登革热疾病负担很高，以及实施有效预防和控制措施的紧迫性。
Indonesia reports the second highest dengue disease burden in the world; these data are from passive surveillance reports and are likely to be significant underestimates. Age-stratified seroprevalence data are relatively unbiased indicators of past exposure and allow understanding of transmission dynamics. To better understand dengue infection history and associated risk factors in Indonesia, a representative population-based cross-sectional dengue seroprevalence study was conducted in 1–18-year-old urban children. From October to November 2014, 3,210 children were enrolled from 30 geographically dispersed clusters. Serum samples were tested for anti-dengue IgG antibodies by indirect ELISA. A questionnaire investigated associations between dengue serologic status and household socio-demographic and behavioural factors. Overall, 3,194 samples were tested, giving an adjusted national seroprevalence in this urban population of 69.4% [95% CI: 64.4–74.3] (33.8% [95% CI: 26.4–41.2] in the 1–4-year-olds, 65.4% [95% CI: 69.1–71.7] in the 5–9-year-olds, 83.1% [95% CI: 77.1–89.0] in the 10–14-year-olds, and 89.0% [95% CI: 83.9–94.1] in the 15–18-year–olds). The median age of seroconversion estimated through a linear model was 4.8 years. Using a catalytic model and considering a constant force of infection we estimated 13.1% of children experience a primary infection per year. Through a hierarchical logistic multivariate model, the subject’s age group (1–4 vs 5–9 OR = 4.25; 1–4 vs. 10–14 OR = 12.60; and 1–4 vs 15–18 OR = 21.87; p<0.0001) and the number of cases diagnosed in the household since the subject was born (p = 0.0004) remained associated with dengue serological status. This is the first dengue seroprevalence study in Indonesia that is targeting a representative sample of the urban paediatric population. This study revealed that more than 80% of children aged 10 years or over have experienced dengue infection at least once. Prospective incidence studies would likely reveal dengue burdens far in excess of reported incidence rates. Indonesia reported to the WHO the world’s second highest average number of dengue cases and the highest in Asia from 2004 to 2010. These passive surveillance reports vary widely within the country and are likely to be a severe under-estimation of the full disease burden as frequently only dengue haemorrhagic fever is captured. Understanding the intensity of dengue virus transmission and associated risk factors nationwide is necessary to guide and prioritize appropriate prevention and control measures against dengue disease, especially considering the availability of the first dengue vaccine and recent recommendations for its use in areas of high endemicity, as measured by seroprevalence and other indicators. Age-stratified seroprevalence data provide robust estimates of past exposure and can inform on transmission intensity. Therefore, we conducted a seroprevalence study of anti-dengue IgG antibodies in a representative sample of urban-dwelling Indonesian children. We found an overall dengue seroprevalence of 69.4% with half of the children having been infected at least once by the age of 5 years. Age of the subject and the number of dengue cases diagnosed in the household were associated with serostatus. These results confirm the high dengue disease burden in Indonesia and the urgency of implementation of effective prevention and control measures.