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. 2014 Jul 26:14:412.
doi: 10.1186/1471-2334-14-412.

The changing incidence of dengue haemorrhagic fever in Indonesia: a 45-year registry-based analysis

Mulya Rahma Karyanti  1 , Cuno S P M Uiterwaal, Rita Kusriastuti, Sri Rezeki Hadinegoro, Maroeska M Rovers, Hans Heesterbeek, Arno W Hoes, Patricia Bruijning-Verhagen
Affiliations

The changing incidence of dengue haemorrhagic fever in Indonesia: a 45-year registry-based analysis

Mulya Rahma Karyanti et al. BMC Infect Dis. .

Abstract

Background: Increases in human population size, dengue vector-density and human mobility cause rapid spread of dengue virus in Indonesia. We investigated the changes in dengue haemorrhagic fever (DHF) incidence in Indonesia over a 45-year period and determined age-specific trends in annual DHF incidence.

Methods: Using an on-going nationwide dengue surveillance program starting in 1968, we evaluated all DHF cases and related deaths longitudinally up to 2013. Population demographics were used to calculate annual incidence and case fatality ratios (CFRs). Age-specific data on DHF available from 1993 onwards were used to assess trends in DHF age-distribution. Time-dependency of DHF incidence and CFRs was assessed using the Cochrane-Armitage trend test.

Results: The annual DHF incidence increased from 0.05/100,000 in 1968 to ~ 35-40/100,000 in 2013, with superimposed epidemics demonstrating a similar increasing trend with the highest epidemic occurring in 2010 (85.70/100,000; p < 0.01). The CFR declined from 41% in 1968 to 0.73% in 2013 (p < 0.01). Mean age of DHF cases increased during the observation period. Highest incidence of DHF was observed among children aged 5 to 14 years up to 1998, but declined thereafter (p < 0.01). In those aged 15 years or over, DHF incidence increased (p < 0.01) and surpassed that of 5 to 14 year olds from 1999 onwards.

Conclusions: Incidence of DHF over the past 45 years in Indonesia increased rapidly with peak incidence shifting from young children to older age groups. The shifting age pattern should have consequences for targeted surveillance and prevention.

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Figures

Figure 1
Figure 1
Trends in incidence rate of DHF cases in Indonesia from 1968 to 2013, measured in numbers of cases per 100,000 person years.
Figure 2
Figure 2
Case fatality ratios of DHF cases in Indonesia from 1968 to 2013.
Figure 3
Figure 3
Incidence (%) of DHF in the different age groups from 1993 to 2013.
Figure 4
Figure 4
Geographical mapping of Indonesian provincial incidence rates of DHF in 2010-2013.
See this image and copyright information in PMC

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Pre-publication history
    1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2334/14/412/prepub

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