Estimating dengue incidence and hospitalization in Malaysia, 2001 to 2013

Abstract

BackgroundEpidemiologic measures of the dengue burden such as prevalence and incidence are important for policy-making and monitoring the progress of disease control. It is a common practice where epidemiologic and economic research estimate dengue burden based on notification data. However, a basic challenge in estimating the incidence of dengue is that a significant proportion of infected population are asymptomatic. It can be overcome by using mathematical models that relate observed prevalence and mortality to incidence. In this study, we estimate the trend of dengue incidence and hospitalization in Malaysia.MethodsThis study is based entirely on the available secondary data sources on dengue in Malaysia. The age-specific incidence of dengue between 2001 and 2013 was estimated using the prevalence and mortality estimates in an incidence-prevalence-mortality (IPM) model. Data on dengue prevalence were extracted from six sero-surveys conducted in Malaysia between 2001 and 2013; while statistics on dengue notification and Case Fatality Rate were derived from National Dengue Surveillance System. Dengue hospitalization data for the years 2009 to 2013 were extracted from the Health Informatics Centre and the volumes of dengue hospitalization for hospitals with missing data were estimated with Poisson models.ResultsThe dengue incidence in Malaysia varied from 69.9 to 93.4 per 1000 population (pkp) between 2001 and 2013.The temporal trend in incidence rate was decreasing since 2001. It has been reducing at an average rate of 2.57 pkp per year from 2001 to 2013 (p = 0.011). The age-specific incidence of dengue decreased steadily with dengue incidence reaching zero by age > 70 years. Dengue notification rate has remained stable since 2001 and the number of notified cases each year was only a small fraction of the incident cases (0.7 to 2.3%). Similarly, the dengue hospitalization was larger but still a small fraction of the incident cases (3.0 to 5.6%).ConclusionDengue incidence can be estimated with the use of sero-prevalence surveys and mortality data. This study highlights a reducing trend of dengue incidence in Malaysia and demonstrates the discrepancy between true dengue disease burden and cases reported by national surveillance system. Sero-prevalence studies with representative samples should be conducted regularly to allow better estimation of dengue burden in Malaysia.

A 15-year review of dengue hospitalizations in Singapore: Reducing admissions without adverse consequences, 2003 to 2017

“…The overall proportion of hospitalized dengue cases who died over the 15-year period was 0.29%. In Malaysia, notifications for dengue infection represent only a small fraction of dengue incident cases (0.7% to 2.3%), and the proportion of dengue hospitalizations among estimated incident cases was about 3.0% to 5.6% based on data from 2001 to 2013 [30]. The mean LOS of dengue cases admitted to a tertiary care teaching hospital in Kelantan state of Malaysia during a six-year period from 2008 to 2013 was 4.88±2.74 days (median 3, IQR 3, range 1–35 days), and 1.1% of the hospitalized cases died [31].…”

Targeted outdoor residual spraying, autodissemination devices and their combination againstAedesmosquitoes: field implementation in a Malaysian urban setting

“…Dengue is endemic in Malaysia, putting all 27.5 million inhabitants at permanent risk of infection. The annual incidence of dengue in Malaysia varied between 69.9 and 93.4 per 1000 population from 2001 to 2013 (Woon et al ., 2018). In 2009, the direct costs of dengue (medical costs and productivity loss) were over US$102 million.…”

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