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The Incidence, Characteristics, and Presentation of Dengue Virus Infections during Infancy

Infants are a vulnerable and unique population at risk for dengue in endemic areas. This report describes the incidence and presenting clinical features of infant dengue virus (DENV) infections from a prospective community-based study performed between January 2007 and May 2009 in the Philippines. DENV3 was the predominant infecting serotype over a wide spectrum of disease severity, ranging from inapparent infection to dengue hemorrhagic fever (DHF). In 2007, the incidence of inapparent DENV infections during infancy was 103 per 1,000 persons person-years and 6-fold higher than symptomatic dengue. The age-specific incidence of infant DHF was 0.5 per 1,000 persons over the age of 3–8 months, and it disappeared by age 9 months. A febrile seizure, macular rash, petechiae, and lower platelet count were presenting clinical features associated with DENV infection among infants with acute undifferentiated febrile illnesses. Community-based studies can help to delineate the incidence rates, disease spectrum, and clinical features of DENV infections during infancy.

Received September 11, 2009. Accepted for publication November 16, 2009.

The authors thank Linda Dexter-Fraser and Ronald Banez for protocol supervision and study coordination, Butsaya Thaisomboonsuk for supervising the neutralization and HAI assays, Analisa Bautista for supervising the dengue ELISA assays, Edelwisa Segubre-Mercado for supervising the dengue RT-PCR assays, and Veronica Tallo for supervising data entry and management.

Financial support: The study was supported by National Institutes of Health Grant U01 AI065654. The contents of this publication are solely the responsibility of the authors and do not necessarily reflect the official views of the National Institutes of Health or the U.S. Department of Defense.

Authors' addresses: Rosario Z. Capeding, Research Institute for Tropical Medicine, Departments of Microbiology and Medicine, FCC, Alabang, Muntinlupa City, Metro Manila, Philippines, E-mail: lerosecap{at}yahoo.com.ph. Job D. Brion and Mercydina M. Caponpon, San Pablo City Health Office, Mabini Extension, San Pablo City, Laguna, Philippines, E-mails: jdbrion{at}yahoo.com and drdinamendoza{at}yahoo.com. Robert V. Gibbons, Richard G. Jarman, and In-Kyu Yoon, Armed Forces Research Institute of Medical Sciences, Department of Virology, Bangkok, Thailand, E-mails: robert.gibbons{at}afrims.org, richard.jarman{at}afrims.org, and InKyu.Yoon{at}afrims.org. Daniel H. Libraty, Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worcester, MA, E-mail: daniel.libraty{at}umassmed.edu.

*Address correspondence to Daniel H. Libraty, Center for Infectious Disease and Vaccine Research, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655. E-mail: daniel.libraty{at}umassmed.edu

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