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. 2012 Aug 1;206(3):389-98.
doi: 10.1093/infdis/jis357. Epub 2012 May 21.

Underrecognized mildly symptomatic viremic dengue virus infections in rural Thai schools and villages

In-Kyu Yoon  1 , Alan L Rothman, Darunee Tannitisupawong, Anon Srikiatkhachorn, Richard G Jarman, Jared Aldstadt, Ananda Nisalak, Mammen P Mammen Jr, Suwich Thammapalo, Sharone Green, Daniel H Libraty, Robert V Gibbons, Arthur Getis, Timothy Endy, James W Jones, Constantianus J M Koenraadt, Amy C Morrison, Thanyalak Fansiri, Chusak Pimgate, Thomas W Scott
Affiliations

Underrecognized mildly symptomatic viremic dengue virus infections in rural Thai schools and villages

In-Kyu Yoon et al. J Infect Dis. .

Abstract

Background: The understanding of dengue virus (DENV) transmission dynamics and the clinical spectrum of infection are critical to informing surveillance and control measures. Geographic cluster studies can elucidate these features in greater detail than cohort studies alone.

Methods: A 4-year longitudinal cohort and geographic cluster study was undertaken in rural Thailand. Cohort children underwent pre-/postseason serology and active school absence-based surveillance to detect inapparent and symptomatic dengue. Cluster investigations were triggered by cohort dengue and non-dengue febrile illnesses (positive and negative clusters, respectively).

Results: The annual cohort incidence of symptomatic dengue ranged from 1.3% to 4.4%. DENV-4 predominated in the first 2 years, DENV-1 in the second 2 years. The inapparent-to-symptomatic infection ratio ranged from 1.1:1 to 2.9:1. Positive clusters had a 16.0% infection rate, negative clusters 1.1%. Of 119 infections in positive clusters, 59.7% were febrile, 20.2% were afebrile with other symptoms, and 20.2% were asymptomatic. Of 16 febrile children detected during cluster investigations who continued to attend school, 9 had detectable viremia.

Conclusions: Dengue transmission risk was high near viremic children in both high- and low-incidence years. Inapparent infections in the cohort overestimated the rate of asymptomatic infections. Ambulatory children with mild febrile viremic infections could represent an important component of dengue transmission.

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Figures

Figure 1.
Figure 1.
Study design overview. Abbreviation: PCR, polymerase chain reaction.
Figure 2.
Figure 2.
Geographic and temporal diversity of symptomatic dengue virus infections in prospective cohort. The boundary shows the Muang district of Kamphaeng Phet; the gray area indicates the urbanized portion of the study area; the Ping River is included for reference.
Figure 3.
Figure 3.
Range of dengue virus (DENV) infection rates among contact subjects in individual positive clusters.
See this image and copyright information in PMC

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