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. 2023 Dec 11:22:100337.
doi: 10.1016/j.lansea.2023.100337. eCollection 2024 Mar.

The burden of dengue and force of infection among children in Kerala, India; seroprevalence estimates from Government of Kerala-WHO Dengue study

Pillaveetil Sathyadas Indu  1 , Thekkumkara Surendran Anish  1 , Sujatha Chintha  1 , Gnanaseelan Kanakamma Libu  1 , Lawrence Tony  1 , Nalinakshan Sudha Siju  1 , Easwaran Sreekumar  2   3 , Asokan Santhoshkumar  4 , Reghukumar Aravind  5 , Karunakaran Lalithabai Saradadevi  6 , Sahadevan Sunija  7 , Jaichand Johnson  7 , Madhukumar Geethakumari Anupriya  2 , Thomas Mathew  8 , Kalathil Joseph Reena  9 , Vasu Meenakshy  9 , Premaletha Namitha  1 , Narendran Pradeep Kumar  10 , Roop Kumari  11 , Ahmed Jamsheed Mohamed  12 , Bhupender Nagpal  12 , Swarup Sarkar  12 , Rajeev Sadanandan  13 , Raman Velayudhan  14
Affiliations

The burden of dengue and force of infection among children in Kerala, India; seroprevalence estimates from Government of Kerala-WHO Dengue study

Pillaveetil Sathyadas Indu et al. Lancet Reg Health Southeast Asia. .

Abstract

Background: Dengue shows high geographic heterogeneity within and across endemic countries. In the context of increasing burden and predicted outbreaks due to climate change, understanding the heterogeneity will enable us to develop region specific targeted interventions, including vaccination. World Health Organisation (WHO) suggests standard methodologies to study the burden and heterogeneity at national and subnational levels. Regional studies with robust and standard methodology to capture heterogeneity are scarce. We estimated the seroprevalence of dengue in children aged 9-12 years and the force of infection in Kerala, India, from where Zika cases also have been reported recently.

Methods: We conducted a school-based cross-sectional survey in 38 clusters; selected by stratified random sampling, representing rural, urban, high burden and low-burden administrative units. Validation of Indirect IgG ELISA was done by Plaque Reduction Neutralization Test (PRNT90) using the local isolates of all four serotypes. Force of infection (FOI) was estimated using the WHO-FOI calculator. We conducted a follow-up survey among a subsample of seronegative children, to estimate the rate of sero-conversion.

Results: Among 5236 children tested, 1521 were positive for anti-dengue IgG antibody. The overall seroprevalence in the state was 29% (95% CI 24.1-33.9). The validity corrected seroprevalence was 30.9% in the overall sample, 46.9% in Thiruvananthapuram, 26.9% in Kozhikkode and 24.9% in Kollam. Age-specific seroprevalence increased with age; 25.7% at 9 years, 29.5% at 10 years, 30.9% at 11 years and 33.9% at 12 years. Seroprevalence varied widely across clusters (16.1%-71.4%). The estimated force of infection was 3.3/100 person-years and the seroconversion rate was 4.8/100 person-years. 90% of children who tested positive were not aware of dengue infection. All the four serotypes were identified in PRNT and 40% of positive samples had antibodies against multiple serotypes.

Interpretation: The study validates the WHO methodology for dengue serosurveys and confirms its feasibility in a community setting. The overall seroprevalence in the 9-12 year age group is low to moderate in Kerala; there are regional variations; high burden and low burden clusters co-exist in the same districts. The actual burden of dengue exceeds the reported numbers. Heterogeneity in prevalence, the high proportion of inapparent dengue and the hyperendemic situation suggest the need for region-specific and targeted interventions, including vaccination.

Funding: World Health Organization.

Keywords: Burden of dengue: force of infection; Govt of Kerala-WHO Dengue study; Seroconversion in dengue; Seroprevalence of dengue; Serprevalence of dengue in children; Validation of IgG against PRNT, Plaque Reduction Neutralisation Test.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Administrative unit level dengue seroprevalence among 9–12 year old children.
Fig. 2
Fig. 2
Plaque Reduction Neutralization Assay (PRNT90) using the local DENV isolates.
Fig. 3
Fig. 3
Age specific seroprevalence of IgG antibodies against dengue virus.
See this image and copyright information in PMC

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