More than 80pct of Indonesian Kids Had Dengue by Age 10

17-Jun-2017 Intellasia | Medpage Today | 6:00 AM Print This Post

In Indonesia, more than 80 percent of urban children ages 10 and older were infected with dengue at least once, a representative sample of Indonesian children found.

Adjusted national seroprevalence for children ages 10 to 14 was 83.1 percent (95 percent CI 77.1-89.0), which rose to 89.0 percent (95 percent CI 83.9-94.1) among children ages 15 to 18, reported Ari Prayitno, MD, of Universitas Indonesia in Jakarta, and colleagues.

Not surprisingly, seroprevalence increased even starting at a very young age, rising from 33.8 percent (95 percent CI 26.4-41.2) among children ages 1 to 4, to 69.4 percent (95 percent CI 64.4-73.3) among children ages 5 to 9, the authors wrote in PLOS Neglected Tropical Diseases.

However, the study was funded by Sanofi Pasteur, and the researchers noted that their interest was in developing a dengue vaccine, and that there were several vaccines in various stages of clinical development.

According to the World Health Organization, Indonesia has the second highest average number of dengue cases and the highest number in Asia from 2004 to 2010. Reliable disease burden estimates are “elusive,” the team said, but two studies estimated that there were approximately 58.4 million cases, with 70-80 percent of cases in the Asia-Pacific region.

Indonesia is required to report the incidence of dengue hemorrhagic fever, and the country “typically reports” the highest number of cases of this condition in the WHO Southeast Asia Region. But the incidence rates for dengue disease vary widely between provinces. Prayitno and colleagues described their study as “the first dengue antibody seroprevalence study conducted in a representative population of urban-dwelling Indonesian children.”

The authors examined 3,194 children from 30 urban subdistricts in Indonesia that each contained one main health centre. A questionnaire was administered with demographic information, knowledge about dengue symptoms, vector control, and medical history. The study included healthy children ages 1 to 18 who lived in the location for at least a year. Eligible children had blood drawn, and serum samples were tested for anti-dengue IgG antibodies.

Overall, 2,216 children tested positive for dengue, while 950 tested negative, and 28 were inconclusive. This was an age-stratified sample comprised of 672 children ages 1 to 4 years, 861 children ages 5 to 9 years, 886 children ages 10 to 14, and 775 children ages 15 to 18 years. There were 47.8 percent boys, and the mean age was 9.7.

There was a wide range of dengue seroprevalence, which increased significantly by age. At age 1, the seroprevalence was 26.4 percent (95 percent CI 15.8-37.1) and 95.3 percent (95 percent CI 89.8-100) at age 18.

In a multivariate model, age played a significant role in seroprevalence. For example, children ages 15 to 18 were more than 21 times more likely to test positive for dengue (OR 21.87) than those ages 1 to 4. The number of cases diagnosed in the household since the subject was born also played a significant role in dengue serologic status, the study showed.

The researchers also calculated that the force of infection was 13.1 percent per year in dengue-naive children.

Another of the study co-authors, Sri Rezeki Hadinegoro, PhD, also of Universitas Indonesia, said that adults are presumably infected with a similar frequency: “While a modelling approach would be required to quantify this burden, these data are strongly suggestive that dengue infections result in a significant burden of symptomatic and severe disease in urban Indonesia,” he said.

There was no clear trend in the force of infection with age, ranging from 10.2 percent to 18.5 percent per year. Not surprisingly, the highest force of primary infection was in the youngest children (1 year of age). The team also used models to estimate the median age of seroconversion, which was 4.8.

Limitations to the study, the authors noted, included potential unmeasured confounders and the fact that rural areas were excluded from the study. In addition, the study was “not designed to make national-level infection or disease burden estimates.”


Category: Health

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