Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 179, Issue 3, Pages 353-360Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwt256
Keywords
basic reproductive number; critical vaccination fraction; demography; dengue; force of infection; transmission dynamics
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Funding
- National Institute of General Medical Sciences Models of Infectious Disease Agent Study [1U54GM088491-0109]
- Bill and Melinda Gates Foundation Vaccine Modeling Initiative
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Dengue virus has traditionally caused substantial morbidity and mortality among children less than 15 years of age in Southeast Asia. Over the last 2 decades, a significant increase in the mean age of cases has been reported, and a once pediatric disease now causes substantial burden among the adult population. An age-stratified serological study (n 1,736) was conducted in 2010 among schoolchildren in the Mueang Rayong district of Thailand, where a similar study had been conducted in 1980/1981. Serotype-specific forces of infection ((t)) and basic reproductive numbers (R-0) of dengue were estimated for the periods 19691980 and 19932010. Despite a significant increase in the age at exposure and a decrease in (t) from 0.038/year to 0.019/year, R-0 changed only from 3.3 to 3.2. Significant heterogeneity was observed across subdistricts and schools, with R-0 ranging between 1.7 and 6.8. These findings are consistent with the idea that the observed age shift might be a consequence of the demographic transition in Thailand. Changes in critical vaccination fractions, estimated by using R-0, have not accompanied the increase in age at exposure. These results have implications for dengue control interventions because multiple countries in Southeast Asia are undergoing similar demographic transitions. It is likely that dengue will never again be a disease exclusively of children.
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