Incidence of dengue virus infection in school-aged children in Puerto Rico: a prospective seroepidemiologic study

Abstract

Dengue is a potentially fatal acute febrile illness caused by the mosquito-borne dengue viruses (DENV-1 to -4). To estimate DENV seroincidence in school-aged children, a 1-year prospective cohort study was conducted in Patillas, Puerto Rico; 10- to 18-year-olds (N = 345) were randomly selected from 13 public schools. At enrollment, 49.8% of the entire cohort had DENV immunoglobulin G (IgG) anti-DENV antibodies, and there were individuals with neutralizing antibodies specific to each of the four DENV. The mean age of participants with incident DENV infection was 13.4 years. The 1-year seroincidence rate was 5.6%, and 61.1% of infections were inapparent. Having IgG anti-DENV at enrollment was associated with seroincidence (risk ratio = 6.8). Acute febrile illnesses during the study period were captured by a fever diary and an enhanced and passive surveillance system in the municipios of Patillas and Guayama. In summary, at enrollment, nearly one-half of the participants had a prior DENV infection, with the highest incidence in the 10- to 11-year-olds, of which most were inapparent infections, and symptomatic infections were considered mild.

Figure 1.

Map of the participating schools and neighborhoods of Patillas, Puerto Rico in 2007 and 2008. Black boxes with flags represent participating schools. The heavy black solid line represents the borders of the municipality of Patillas. The light solid black lines represent the border for each Patillas neighborhood. The dotted black lines represent major roads. The letters represent the school designation, and the numbers represent neighborhood designations. Neighborhood 8 (Inset) is the urban center of Patillas, where four of the participating public schools (E–H) are located.