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EPIDEMIOLOGY OF DENGUE AND DENGUE HEMORRHAGIC FEVER IN A COHORT OF ADULTS LIVING IN BANDUNG, WEST JAVA, INDONESIA

A prospective study of dengue fever (DF) and dengue hemorrhagic fever (DHF) was conducted in a cohort of adult volunteers from two textile factories located in West Java, Indonesia. Volunteers in the cohort were bled every three months and were actively followed for the occurrence of dengue (DEN) disease. The first two years of the study showed an incidence of symptomatic DEN disease of 18 cases per 1,000 person-years and an estimated asymptomatic/ mild infection rate of 56 cases per 1,000 person-years in areas of high disease transmission. In areas where no symptomatic cases were detected, the incidence of asymptomatic or mild infection was 8 cases per 1,000 person-years. Dengue-2 virus was the predominant serotype identified, but all four serotypes were detected among the cohort. Four cases of DHF and one case of dengue shock syndrome (DSS) were identified. Three of the four DHF cases were due to DEN-3 virus. The one DSS case occurred in the setting of a prior DEN-2 virus infection, followed by a secondary infection with DEN-1 virus. To our knowledge, this is the first report of a longitudinal cohort study of naturally acquired DF and DHF in adults.

Received March 14, 2004. Accepted for publication September 14, 2004.

Acknowledgments: We thank Sri Hadiwijaya, Dasep Purwaganda, Ungke Antonjaya, Gustiani, Yurike Tobing, Akterono Dwi Budiyati, Antonius Arditya Pradana, Agus Rahmat, and Haditya Leo Mukri for the technical assistance with the study. We also thank Professor Anna Alisjahbana and the World Health Organization Maternal Child Health Collaborating Center for their assistance in data storage and analysis. We are deeply grateful to Drs. Scott Halstead and Curtis Hayes for data reviews and suggestions for the study, and to Terrisita Porter for her assistance in the preparation of this manuscript.

Financial support: This research was supported by the Military Infectious Diseases Research Program and the Naval Medical Research Center for Work unit 62787A 870S.

Disclaimer: The opinions and assertions contained herein are not to be construed as official or as reflecting the views of the Navy services at large.

Authors’ addresses: Kevin R. Porter, Viral Diseases Department, Naval Medical Research Center, Building 503, Room 3A14A, 503 Robert Grant Avenue, Silver Spring, MD 20910, Telephone: 301-319-7450, Fax: 301-319-7451, E-mail: porterk{at}nmrc.navy.mil. Charmagne G. Beckett, Herman Kosasih, Ratna Irsiana Tan, Susana Widjaja, Erlin Listiyaningsih, Chairin Nisa Ma’roef, and James L. McArdle, American Embassy Jakarta, U. S. Navy Medical Research Unit No. 2, Unit 8132, FPO, APO 96520-8132. Bachti Alisjahbana, Pandji Irani Fianza Rudiman, Ida Parwati, Primal Sudjana, Hadi Jusuf, and Djoko Yuwono, Internal Medicine, Medical Faculty, Padjadjaran University Hasan Sadikin Hospital, Bandung, Indonesia and Jalan Pasirkaliki No. 35 Bandung, 40161, Jawa Barat, Indonesia. Suharyono Wuryadi, National Institutes of Health Research and Development, Ministry of Health, Jakarta, Indonesia.

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