Reply to Akbar et al

Authors

In Kyu Yoon, Armed Forces Research Institute of Medical Sciences, Thailand
Alan L. Rothman, University of Rhode Island
Darunee Tannitisupawong, Armed Forces Research Institute of Medical Sciences, Thailand
Anon Srikiatkhachorn, University of Massachusetts Chan Medical School
Richard G. Jarman, Armed Forces Research Institute of Medical Sciences, Thailand
Jared Aldstadt, University at Buffalo, The State University of New York
Ananda Nisalak, Armed Forces Research Institute of Medical Sciences, Thailand
Mammen P. Mammen, Armed Forces Research Institute of Medical Sciences, Thailand
Suwich Thammapalo, Thailand Ministry of Public Health
Sharone Green, University of Massachusetts Chan Medical School
Daniel H. Libraty, University of Massachusetts Chan Medical School
Robert V. Gibbons, Armed Forces Research Institute of Medical Sciences, Thailand
Arthur Getis, San Diego State University
Timothy Endy, State University of New York System
James W. Jones, Armed Forces Research Institute of Medical Sciences, Thailand
Constantianus J.M. Koenraadt, Wageningen University & Research
Amy C. Morrison, University of California, Davis
Thanyalak Fansiri, Armed Forces Research Institute of Medical Sciences, Thailand
Chusak Pimgate, Armed Forces Research Institute of Medical Sciences, Thailand
Thomas W. Scott, University of California, Davis

Document Type

Article

Date of Original Version

8-1-2012

Abstract

Background. The understanding of dengue virus (DENV) transmission dynamics and the clinical spectrum of infection are critical to informing surveillance and control measures. Geographic cluster studies can elucidate these features in greater detail than cohort studies alone. Methods. A 4-year longitudinal cohort and geographic cluster study was undertaken in rural Thailand. Cohort children underwent pre-/postseason serology and active school absence-based surveillance to detect inapparent and symptomatic dengue. Cluster investigations were triggered by cohort dengue and non-dengue febrile illnesses (positive and negative clusters, respectively). Results. The annual cohort incidence of symptomatic dengue ranged from 1.3% to 4.4%. DENV-4 predominated in the first 2 years, DENV-1 in the second 2 years. The inapparent-to-symptomatic infection ratio ranged from 1.1:1 to 2.9:1. Positive clusters had a 16.0% infection rate, negative clusters 1.1%. Of 119 infections in positive clusters, 59.7% were febrile, 20.2 were afebrile with other symptoms, and 20.2% were asymptomatic. Of 16 febrile children detected during cluster investigations who continued to attend school, 9 had detectable viremia. Conclusions. Dengue transmission risk was high near viremic children in both high-and low-incidence years. Inapparent infections in the cohort overestimated the rate of asymptomatic infections. Ambulatory children with mild febrile viremic infections could represent an important component of dengue transmission. © 2012 behalf of the Infectious Diseases Society of America.

Publication Title, e.g., Journal

Journal of Infectious Diseases

Volume

206

Issue

3

Citation/Publisher Attribution

Yoon, In Kyu, Alan L. Rothman, Darunee Tannitisupawong, Anon Srikiatkhachorn, Richard G. Jarman, Jared Aldstadt, Ananda Nisalak, Mammen P. Mammen, Suwich Thammapalo, Sharone Green, Daniel H. Libraty, Robert V. Gibbons, Arthur Getis, Timothy Endy, James W. Jones, Constantianus J. Koenraadt, Amy C. Morrison, Thanyalak Fansiri, Chusak Pimgate, and Thomas W. Scott. "Reply to Akbar et al." Journal of Infectious Diseases 206, 3 (2012). doi: 10.1093/infdis/jis357.