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A two-year study using a cluster investigation method was conducted in West Jakarta, Indonesia to demonstrate the detection of dengue cases prior to onset of clinical illness. The clusters consisted of family members and neighbors of 53 hospitalized dengue index cases. Among 785 adult and child volunteers enrolled, 17 (2.2%) post-enrollment dengue (PED) infections were identified. Eight PED cases were asymptomatic and nine were symptomatic. Symptomatic cases included eight with dengue fever and one with dengue hemorrhagic fever (DHF) (grade II). Among the eight asymptomatic PED cases, viremia was detected in two. Eleven volunteers had acute dengue infections at the time of enrollment. Four of the 11 developed DHF, resulting in a total of five DHF cases detected during the investigation. This study design can serve as a benchmark for future investigations that seek to define early immunologic events following dengue infections that contribute to the development of DHF.
Received September 20, 2004. Accepted for publication December 23, 2004.
Acknowledgments: We thank the nurses and physicians in the Internal Medicine Department at Sumber Waras Hospital (Soesilowati Soerachmad, Hansa Wulur, and Fajar Kurniawan Frans J. V. Pangalila); and the Viral Diseases laboratory staff (Sri Hartati and Dasep Purwaganda) for conducting the serologic testing; Yurike S. Tobing and Akterono Dwi for conducting tissue culture and virus isolation; Gustiani and Ungke Anton Jaya for molecular testing; Agus Rachmat for assistance with geographic information system mapping; and Andy Whitehurst for editorial assistance with the manuscript.
Financial support: This work was supported by the U.S. Naval Medical Research Center (Silver Spring, MD) work unit 63002A810SD0012 and the Military Infectious Diseases Research Program.
Disclaimer: The opinions and assertions herein are not considered as official or views of the U.S. Navy or the Naval Service at large.
Disclosure: None of the authors have a financial or personal conflict of interest related to this study. The corresponding author had full access to all data in the study and final responsibility for the decision to submit this publication.
Authors’ addresses: Charmagne G. Beckett, Curtis G. Hayes, and Kevin R. Porter, Naval Medical Research Center, Silver Spring, MD 20910. E-mails: beckettc{at}nmrc.navy.mil and porterk{at}nmrc.navy.mil. Herman Kosasih, Indra Faisal, Nurhayati, Ratna Tan, Susana Wid-jaja, Erlin Listiyaningsih, Chairin Ma’roef, and Suharyono Wuryadi, Viral Diseases Program, American Embassy Jakarta Unit 8132, U.S. Naval Medical Research Unit No. 2, FPO, AP 96520-8132, Telephone: 62-21-421-4457, Fax: 62-21-424-4507, E-mail: viro{at}namru2.org. Michael J. Bangs, Navy Disease Vector Ecology and Control Center, Silverdale, WA 98315. Tatang K. Samsi, Pediatrics Department, Sumber Waras Hospital, Jakarta, Indonesia. Djoko Yuwono, National Institute of Health Research and Development, Jakarta, Indonesia.
Reprint requests: Robiyati, Kompleks, Publications Department, U.S. Naval Medical Research Unit No. 2, P2M-PLP/LITBANGKES, Jl. Percetakan Negara No. 29, Jakarta Pusat, Indonesia.
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