The Burden of Acute Febrile Illness Attributable to Dengue Virus Infection in Sri Lanka: A Single-Center 2-Year Prospective Cohort Study (2016-2019)

Hasitha Tissera, Preshila Samaraweera, Melanie de Boer, Sanjay Gandhi, Ludovic Malvaux, Shailesh Mehta, Paba Palihawadana, Valerie Vantomme, Robert Paris, Alexander Schmidt, Hasitha Tissera, Preshila Samaraweera, Melanie de Boer, Sanjay Gandhi, Ludovic Malvaux, Shailesh Mehta, Paba Palihawadana, Valerie Vantomme, Robert Paris, Alexander Schmidt

Abstract

We performed a 2-year prospective cohort study to determine the incidence of dengue in Angoda, Colombo district, Sri Lanka (NCT02570152). The primary objective was to determine the incidence of acute febrile illness (AFI) because of laboratory confirmed dengue (LCD). Secondary objectives were to determine AFI incidence because of non-LCD, describe AFI symptoms, and estimate AFI incidence because of LCD by dengue virus (DENV)-type and age group. Participants from households with at least one minor and one adult (≤50 years) were enrolled and followed with scheduled weekly visits and, in case of AFI, unscheduled visits. Blood was collected for DENV detection at AFI visits, and symptoms recorded during the 7-day period following AFI onset. A total of 2,004 participants were enrolled (971 children, and 1,033 adults). A total of 55 LCD episodes were detected (overall incidence of 14.2 per 1,000 person-years). Incidence was the highest among children < 5 years (21.3 per 1,000 person-years) and 5-11 years (22.7 per 1,000 person-years), compared with adults ≥ 18 years (9.2 per 1,000 person-years). LCD was mostly (83.6%) caused by DENV-2 (n = 46), followed by DENV-1 (n = 6) and DENV-3 (n = 3). Common symptoms of LCD were headache, fatigue, myalgia, loss of appetite, and arthralgia. Incidence of AFI because of non-LCD was 47.3 per 1,000 person-years. In conclusion, this study reports the LCD incidence for a DENV-2 dominated epidemic that is comparable to the incidence of suspected dengue reported passively for 2017, one of the worst outbreaks in recent history.

Figures

Figure 1.
Figure 1.
Study design. * At least every other week. ** As per investigator judgment. This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
Plain language summary. This figure appears in color at www.ajtmh.org.

References

    1. World Health Organization , 2009. Dengue Guidelines for Diagnosis, Treatment, Prevention and Control: New Edition. Report No.: WHO/HTM/NTD/DEN/2009.1. Geneva, Switzerland: WHO. Available at: . Accessed February 2, 2021.
    1. Stanaway JD. et al., 2016. The global burden of dengue: an analysis from the Global Burden of Disease Study 2013. Lancet Infect Dis 16: 712–723.
    1. World Health Organization , 2020. Dengue and Severe Dengue. Geneva, Switzerland: WHO. Available at: . Accessed February 2, 2021.
    1. World Health Organization , 2020. Global Strategy for Dengue Prevention and Control. 2012–2020. Geneva, Switzerland: WHO. Available at: . Accessed February 2, 2021.
    1. Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG, Moyes CL, Farlow AW, Scott TW, Hay SI, 2012. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis 6: e1760.
    1. Bhatt S. et al., 2013. The global distribution and burden of dengue. Nature 496: 504–507.
    1. International Council for Harmonization , 2016. ICH Harmonised Guideline Integrated Addendum to ICH E6(R1): Guideline for Good Clinical Practice ICH E6(R2) ICH Consensus Guideline. Geneva, Switzerland: ICH. Available at: . Accessed April 26, 2021.
    1. U.S. National Library of Medicine , 2015. A Cohort Study to Determine the Incidence of Dengue Fever and to Build Capacity for Dengue Vaccine Trials in Dengue-endemic Regions of South Asia. Available at: . Accessed February 9, 2021.
    1. Tissera HA. et al., 2020. Severe dengue epidemic, Sri Lanka, 2017. Emerg Infect Dis 26: 682–691.
    1. International Federation of Red Cross and Red Crescent Societies (IFRC) , 2018. Sri Lanka/Dengue DREF Final Report (MDRLK007). Report No.: MDRLK007. Geneva, Switzerland: IFRC. Available at: . Accessed February 9, 2021.
    1. Jeewandara C. et al., 2015. Change in dengue and Japanese encephalitis seroprevalence rates in Sri Lanka. PLoS One 10: e0144799.
    1. Tam CC, Tissera H, de Silva AM, de Silva AD, Margolis HS, Amarasinge A, 2013. Estimates of dengue force of infection in children in Colombo, Sri Lanka. PLoS Negl Trop Dis 7: e2259.
    1. Tissera H, Amarasinghe A, de Silva AD, Kariyawasam P, Corbett KS, Katzelnick L, Tam C, Letson GW, Margolis HS, de Silva AM, 2014. Burden of dengue infection and disease in a pediatric cohort in urban Sri Lanka. Am J Trop Med Hyg 91: 132–137.
    1. Kulatilaka TA, Jayakuru WS, 1998. Control of dengue/dengue haemorrhagic fever in Sri Lanka. Dengue Bull 22: 53–61.
    1. Ministry of Health - Epidemiology Unit - Sri Lanka , 2019. Distribution of Notification (H399). Dengue Cases by Month. Colombo, Sri Lanka: Ministry of Health. Available at: . Accessed February 9, 2021.
    1. Messer WB, Gubler DJ, Harris E, Sivananthan K, de Silva AM, 2003. Emergence and global spread of a dengue serotype 3, subtype III virus. Emerg Infect Dis 9: 800–809.
    1. Kanakaratne N, Wahala WM, Messer WB, Tissera HA, Shahani A, Abeysinghe N, de Silva AM, Gunasekera M, 2009. Severe dengue epidemics in Sri Lanka, 2003–2006. Emerg Infect Dis 15: 192–199.
    1. Bodinayake CK. et al., 2018. Evaluation of the WHO 2009 classification for diagnosis of acute dengue in a large cohort of adults and children in Sri Lanka during a dengue-1 epidemic. PLoS Negl Trop Dis 12: e0006258.
    1. Raut R. et al., 2019. Dengue type 1 viruses circulating in humans are highly infectious and poorly neutralized by human antibodies. Proc Natl Acad Sci USA 116: 227–232.
    1. Tissera HA. et al., 2011. New dengue virus type 1 genotype in Colombo, Sri Lanka. Emerg Infect Dis 17: 2053–2055.
    1. Tomashek KM. et al., 2017. Clinical and epidemiologic characteristics of dengue and other etiologic agents among patients with acute febrile illness, Puerto Rico, 2012–2015. PLoS Negl Trop Dis 11: e0005859.
    1. Low JGH. et al., 2011. The early clinical features of dengue in adults: challenges for early clinical diagnosis. PLoS Negl Trop Dis 5: e1191.
    1. Tukasan C, Furlan NB, Estofolete CF, Nogueira ML, da Silva NS, 2017. Evaluation of the importance of fever with respect to dengue prognosis according to the 2009 WHO classification: a retrospective study. BMC Infect Dis 17: 6.

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