Burden of Dengue Infection and Disease in a Pediatric Cohort in Urban Sri Lanka

Hasitha Tissera Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico

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Ananda Amarasinghe Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico

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Aruna Dharshan De Silva Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico

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Pradeep Kariyawasam Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico

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Kizzmekia S. Corbett Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico

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Leah Katzelnick Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico

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Clarence Tam Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico

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G. William Letson Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico

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Harold S. Margolis Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico

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Aravinda M. de Silva Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka; Genetech Research Institute, Colombo, Sri Lanka; Public Health Department, Colombo Municipal Council, Colombo, Sri Lanka; Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; London School of Hygiene and Tropical Medicine, London, United Kingdom; Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, South Korea; Department of Zoology, University of Cambridge, Cambridge, United Kingdom; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; El Paso County Public Health, Colorado Springs, Colorado; Dengue Branch, Centers for Disease Control and Prevention, San Juan, Puerto Rico

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Dengue is the most significant arthropod-borne viral infection of humans. Persons infected with dengue viruses (DENV) have subclinical or clinically apparent infections ranging from undifferentiated fever to dengue hemorrhagic fever/shock syndrome. Although recent studies estimated that the Indian subcontinent has the greatest burden of DENV infection and disease worldwide, we do not have reliable, population-based estimates of the incidence of infection and disease in this region. The goal of this study was to follow-up a cohort of 800 children living in a heavily urbanized area of Colombo, Sri Lanka to obtain accurate estimates of the incidence of DENV infection and disease. Annual blood samples were obtained from all children to estimate dengue seroprevalence at enrollment and to identify children exposed to new DENV infections during the study year. Blood was also obtained from any child in whom fever developed over the course of the study year to identify clinically apparent DENV infections. At enrollment, dengue seroprevalence was 53.07%, which indicated high transmission in this population. Over the study year, the incidence of DENV infection and disease were 8.39 (95% confidence interval = 6.56–10.53) and 3.38 (95% confidence interval = 2.24–4.88), respectively, per 100 children per year. The ratio of clinically inapparent to apparent infections was 1.48. These results will be useful for obtaining more accurate estimates of the burden of dengue in the region and for making decisions about testing and introduction of vaccines.

Author Notes

* Address correspondence to Aravinda M. de Silva, CB # 7292, Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, E-mail: desilva@med.unc.edu or Hasitha Tissera, Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo 10, Sri Lanka, E-mails: dr_korelege@yahoo.co.uk or chepid@sltnet.lk

Financial support: This study was supported by the Pediatric Dengue Vaccine Initiative through grant no. 23197 and partially supported by the National Institutes of Health (University of North Carolina Virology Training Grant T32AI007419 and Initiative for Minority Student Development grant no. 5R25GM055336 to Kizzmekia S. Corbett).

Authors' addresses: Hasitha Tissera, Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka, E-mail: dr_korelege@yahoo.co.uk. Ananda Amarasinghe, Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka, and International Vaccine Institute, Pediatric Dengue Vaccine Initiative, Seoul, South Korea, E-mail: ana_amarasinghe@yahoo.co.uk. Aruna Dharshan De Silva, Genetech Research Institute, Colombo, Sri Lanka, E-mail: dslv90@yahoo.com. Pradeep Kariyawasam, Colombo Municipal Council, Public Health Department, Colombo, Sri Lanka, E-mail: munici@slt.lk. Kizzmekia S. Corbett and Aravinda M. de Silva, Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, E-mails: kscorbet@email.unc.edu and aravinda_desilva@med.unc.edu or desilva@med.unc.edu. Leah Katzelnick, Department of Zoology, University of Cambridge, Cambridge, United Kingdom, E-mail: lck33@cam.ac.uk. Clarence Tam, London School of Hygiene and Tropical Medicine, London, United Kingdom, E-mail: clarence.tam@lshtm.ac.uk. G. William Letson, Center for Global Public Health, Colorado School of Public Health, Aurora, CO, E-mail: bwletson@gmail.com. Harold S. Margolis, Dengue Branch, Centers for Disease Control and Prevention, San Juan, PR, E-mail: hsm1@cdc.gov.

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