The Burden of Acute Febrile Illness Attributable to Dengue Virus Infection in Sri Lanka: A Single-Center 2-Year Prospective Cohort Study (2016–2019)

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  • 1 Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka;
  • | 2 National Dengue Control Unit, Ministry of Health, Colombo, Sri Lanka;
  • | 3 GSK, Rockville, Maryland;
  • | 4 GSK, GSK House, Worli, Mumbai, India;
  • | 5 GSK, Rixensart, Belgium;
  • | 6 GSK, Wavre, Belgium

We performed a 2-year prospective cohort study to determine the incidence of dengue in Angoda, Colombo district, Sri Lanka (NCT02570152). The primary objective was to determine the incidence of acute febrile illness (AFI) because of laboratory confirmed dengue (LCD). Secondary objectives were to determine AFI incidence due to non-LCD, describe AFI symptoms, and estimate AFI incidence because of LCD by dengue virus (DENV)-type and age group. Participants from households with at least one minor and one adult (≤50 years) were enrolled and followed with scheduled weekly visits and, in case of AFI, unscheduled visits. Blood was collected for DENV detection at AFI visits, and symptoms recorded during the 7-day period following AFI onset. A total of 2,004 participants were enrolled (971 children, and 1,033 adults). A total of 55 LCD episodes were detected (overall incidence of 14.2 per 1,000 person-years). Incidence was the highest among children < 5 years (21.3 per 1,000 person-years) and 5–11 years (22.7 per 1,000 person-years), compared with adults ≥ 18 years (9.2 per 1,000 person-years). LCD was mostly (83.6%) caused by DENV-2 (N = 46), followed by DENV-1 (N = 6) and DENV-3 (N = 3). Common symptoms of LCD were headache, fatigue, myalgia, loss of appetite, and arthralgia. Incidence of AFI because of non-LCD was 47.3 per 1,000 person-years. In conclusion, this study reports the LCD incidence for a DENV-2 dominated epidemic that is comparable to the incidence of suspected dengue reported passively for 2017, one of the worst outbreaks in recent history.

Author Notes

Address correspondence to Melanie de Boer, GSK, 14200 Shady Grove Rd., Rockville, MD 20850. E-mail: melanie.x.de-boer@gsk.com

Funding support: GlaxoSmithKline Biologicals SA funded this study (NCT02570152) and was involved in all stages of study conduct, including analysis of the data. GlaxoSmithKline Biologicals SA also covered all costs associated with the development and publication of this manuscript.

Disclosures: The institution of H. T. and P. S. was funded by the GSK group of companies to conduct the study. P. S. received personal fees by the Ministry of Health for the position of co-investigator. M. d. B., S. G., L. M., S. M., and V. V. are employees of the GSK group of companies, and M. d. B., L. M., and S. M. also hold shares in the GSK group of companies. R. P. and A. S. were employees of the GSK group of companies and held shares in the GSK group of companies at the time of study conduct. P. P. has no conflict of interest.

Authors’ addresses: Hasitha Tissera and Paba Palihawadana, Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka, E-mails: dr_korelege@yahoo.co.uk and dr.paba@gmail.com. Preshila Samaraweera, National Dengue Control Unit, Ministry of Health, Colombo, Sri Lanka, E-mail: preshilas@gmail.com. Melanie de Boer, Robert Paris, and Alexander Schmidt, GSK, Rockville, MD, E-mails: melanie.x.de-boer@gsk.com, robparis2003@yahoo.com, and as337y@gmail.com. Sanjay Gandhi, GSK, GSK House, Worli, Mumbai, India, E-mail: sanjay.t.gandhi@gsk.com. Ludovic Malvaux and Valerie Vantomme, GSK, Rixensart, Belgium, E-mails: ludovic.x.malvaux@gsk.com and valerie.vantomme@gsk.com. Shailesh Mehta, GSK, Wavre, Belgium, E-mail: shailesh.i.mehta@gsk.com.

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