Epidemic dengue transmission in southern Sumatra, Indonesia

An outbreak of dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) in the city of Palembang, south Sumatra, Indonesia was investigated to (i) validate epidemic occurrence, (ii) confirm dengue virus aetiology and associated serotype(s), (iii) provide a demonstrable mea...

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Published in:	Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 95; no. 3; pp. 257 - 265
Main Authors:	Corwin, Andrew Lee, Larasati, Ria Purwita, Bangs, Michael J., Wuryadi, Suharyono, Arjoso, Sumarjati, Sukri, Nono, Listyaningsih, Erlin, Hartati, Sri, Namursa, Rozali, Anwar, Zarkasih, Chandra, Surya, Loho, Benny, Ahmad, Holani, Campbell, James R., Porter, Kevin R.
Format:	Journal Article
Language:	English
Published:	Oxford Elsevier Ltd 01-05-2001 Royal Society of Tropical Medicine and Hygiene Elsevier
Subjects:	Adolescent Adult Age Distribution age-groups Aged Arboviroses Biological and medical sciences Child Child, Preschool climate Cross-Sectional Studies Dengue - epidemiology Dengue - transmission dengue fever Dengue fevers dengue haemorrhagic fever dengue shock syndrome Disease Outbreaks epidemic Female Human viral diseases Humans Indonesia Indonesia - epidemiology Infant Infant, Newborn Infectious diseases Male Medical sciences Middle Aged Rain serotypes Temperature time trends Tropical medicine Tropical viral diseases Urban Health - statistics & numerical data Viral diseases Asia Indonesia time trends dengue fever dengue shock syndrome dengue haemorrhagic fever epidemic serotypes age-groups climate Indonesia Infection Epidemic Human Viral disease Dengue Arbovirus disease Transmission Epidemiology
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Summary:	An outbreak of dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) in the city of Palembang, south Sumatra, Indonesia was investigated to (i) validate epidemic occurrence, (ii) confirm dengue virus aetiology and associated serotype(s), (iii) provide a demonstrable measure of community impact, and (iv) identify causative relationship (if any) with climatic El Niño Southern Oscillation (ENSO) influences. Trend analysis based on a 6-year retrospective review of hospital records demonstrates a 3-fold increase in clinical cases for the outbreak period (January–April 1998), relative to historical records. In the 2 hospitals surveyed, the monthly mean number of outbreak-related dengue cases over 4 months was 833 (range 650–995 cases/month); the mean monthly value for the previous 72 months was 107 (range 14–779 cases/month). An apparent trend in epidemic transmission was observed, evolving from a 5-year cyclic phenomenon to an annual occurrence, often indistinguishable from one year to the next. The proportional distribution of clinical outbreak cases into DF, DHF and DSS diagnostic categories was 24%, 66%, and 10%, respectively. The population aged 10–19 years accounted for the largest (35%) proportion of hospitalized DHF cases, followed by children aged 5–9 years (25%) and children aged 4 years (16%). Serum samples obtained during acute illness from 221 hospitalized patients were examined using serology, RT-PCR, and virus isolation in cell culture: 59% of samples had laboratory evidence of a dengue infection. All 4 dengue virus serotypes (DEN 1–4) were identified in epidemic circulation, with DEN 3 predominating (43%). DEN 1 was the principal serotype associated with less severe dengue illness, suggesting that virulence may be, in part, a function of infecting serotype. The climatic influence of ENSO on rainfall and temperature in the months leading up to and during the outbreak was dramatic, and is likely to contribute to favourable outbreak conditions.
Bibliography:	istex:9E015FE8BBDA97260FE969FF9BD5522ED9266521 Address for correspondence: Captain A. L. Corwin, US NAM-RU-2, American Embassy Jakarta, Unit 8132 NAMRU TWO, FPO AP 96520-8132, USA; fax +62 21 424 4507. ark:/67375/HXZ-QDRWV8KD-Q ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0035-9203 1878-3503
DOI:	10.1016/S0035-9203(01)90229-9