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. 2019 Feb 6;19(1):155.
doi: 10.1186/s12889-019-6426-9.

Heterogeneities in dengue spatial-temporal transmission in Brazilian cities and its influence on the optimal age of vaccination

Luciana L Cardim  1 , Suani T R Pinho  2 , M Gloria Teixeira  1 , M Conceição N Costa  1 , M Lourdes Esteva  3 , Claudia P Ferreira  4
Affiliations

Heterogeneities in dengue spatial-temporal transmission in Brazilian cities and its influence on the optimal age of vaccination

Luciana L Cardim et al. BMC Public Health. .

Abstract

Background: The development of a safe and effective vaccine is considered crucial for dengue transmission control since vetor control has been failed; some potential candidates are currently in test, and in this context theoretical studies are necessary to evaluate vaccination strategies such as the age groups that should be vaccinated, the percentage of the population at risk, and the target geographic regions to make dengue control feasible and optimal.

Methods: A partial differential model is used to mimics dengue transmission in human population in order to estimate the optimal vaccination age, using data collected from dengue reported cases in ten cities of Brazil from 2001 to 2014. For this purpose, the basic reproduction number of the disease was minimized assuming a single-dose vaccination strategy, equal vaccine efficacy for all circulating serotypes, and no vaccine failure. Numerical methods were used to assess the optimal vaccination age and its confidence age range.

Results: The results reveal complex spatial-temporal patterns associated to the disease transmission, highlighting the heterogeneity in defining the target population for dengue vaccination. However, the values obtained for the optimal age of vaccination, as targeting individuals under 13 years old, are compatible with the ones reported in similar studies in Brazil. The results also show that the optimal age for vaccination in general does not match with the age of the highest number of cases.

Conclusions: The variation of the optimal age for vaccination across the country reflects heterogeneities in dengue spatial-temporal transmission in Brazilian cities, and can be used to define the target population and cities to optimize vaccination strategies in a context of high cost and low quantity of available vaccine.

Keywords: Age profile; Mathematical model; Vaccination strategies.

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Conflict of interest statement

Ethics approval and consent to participate

The ethics committee of Instituto de Saúde Coletiva da Universidade Federal da Bahia (CEP/ISC) with reference number 1.099.503 aproved the study done. Also, the used data from DATASET (reference 15) are secondary data which are public available (registered data).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Places where data were collected. Map of Brazil with the cities studied highlighted: Rio de Janeiro (State of Rio de Janeiro), Ribeirão Preto and Campinas (State of São Paulo) and Belo Horizonte (State of Minas Gerais) belong to southwest region of Brazil; Fortaleza (State of Ceará), Natal (State of Rio Grande do Norte) and Maceió (State of Alagoas) belong to northeast region; Goiânia (State of Goiás), Cuiabá (State of Mato Grosso) and Campo Grande (State of Mato Grosso do Sul) belong to the midwest region (Source: cartographic base of Brazil in Brazilian Institute of Geography and Statistics (IBGE) [23])
Fig. 2
Fig. 2
Distribution of dengue cases by age and time. Age distribution of Dengue cases from 2001 to 2014 for: a) the whole country; b) Goiânia (in the Midwest Region); c) Fortaleza (in the Northeast Region); d) Rio de Janeiro (in the Southeast Region)
Fig. 3
Fig. 3
Age distribution of cases, and evaluation of the optimum age for Dengue vaccination. An example of the applied procedure of estimation of optimal age and its confidence interval: a) the proportion of dengue cases by age a; b) H(a) as a function of age a; c) the derivative of H(a) with respect to age a. The data correspond to dengue cases in Maceio in 2014. The dotted line connecting the data is a linear interpolation, and the symbol (+) corresponds to simulated curves. The optimal age is 8.0 years, and the confidence interval is [6.7,9.3]
Fig. 4
Fig. 4
Box plot of the optimal age for Dengue vaccination. Box plot of the optimal age for the studied cities from 2001 to 2014; the letters Fo, Na, Ma, BH, RJ, Ca, RP, CG, Cu and Go are the abbreviations for Fortaleza, Natal, Maceió, Belo Horizonte, Rio de Janeiro, Campinas, Ribeirão Preto, Campo Grande, Cuiabá, Goiânia, respectively. The bold lines correspond to the median values of the optimal vaccination age shown in Table 1. The boxes represent the dispersion and the skewness of the optimal ages along the studied period except the outliers, which are marked by circles. The intervals between minimum and maximum values of the optimal ages are determined by the dashed lines ends
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