Four dengue virus serotypes found circulating during an outbreak of dengue fever and dengue haemorrhagic fever in Jakarta, Indonesia, during 2004

Abstract

Periodic outbreaks of dengue have emerged in Indonesia since 1968, with the severity of resulting disease increasing in subsequent years. In early 2004, a purported dengue outbreak erupted across the archipelago, with over 50,000 cases and 603 deaths reported. To confirm the disease aetiology and to provide an epidemiological framework of this epidemic, an investigation was conducted in ten hospitals within the capital city of Jakarta. Clinical and laboratory findings were determined from a cohort of 272 hospitalised patients. Exposure to dengue virus was determined in 180 (66.2%) patients. When clinically assessed, 100 (55.6%) of the 180 patients were classified as having dengue fever (DF), 31 (17.2%) as DF with haemorrhagic manifestations and 49 (27.2%) as dengue haemorrhagic fever (DHF). Evidence from haemagglutination inhibition assays suggested that 33/40 (82.5%) of those with DHF from which laboratory evidence was available suffered from a secondary dengue infection. All four dengue viruses were identified upon viral isolation, with DEN-3 being the most predominant serotype recovered, followed by DEN-4, DEN-2 and DEN-1. In summary, the 2004 outbreak of dengue in Jakarta, Indonesia, was characterised by the circulation of multiple virus serotypes and resulted in a relatively high percentage of a representative population of hospitalised patients developing DHF.

Molecular surveillance of Dengue in Sukabumi, West Java province, Indonesia

“…The predominance of DENV-2 has been described previously in other cities in Indonesia, namely Yogyakarta in 1995 [23] and Bandung in 2002 [24]. This DENV-2 predominance is different from the data from a more recent survey in Jakarta in 2004, in which DENV-3 was found to be the predominant serotype [21]. The interesting finding was the absence of DENV-3 in this study.…”

“…However, if this age distribution really reflects the actual cases in the community, this finding is different from that of dengue cases described in other cities in Indonesia, i.e., in Jayapura in 1993 [19] and in Palembang in 1998 [20], in which the largest proportions of dengue cases were found in the under-15 years of age group. Interestingly, a similar age distribution was observed during an outbreak in Jakarta in 2004 [21]. The changing proportion of dengue cases in young adults and adolescents has also been described in other places in Indonesia [22].…”

Dengue Diagnosis: Challenges and Opportunities

“…However virus isolation remains very useful and relevant as a diagnostic tool, especially for monitoring of dengue epidemiology and evolution as well as determining its antigenic drift. This technique has shown to be more effective than PCR, however, degree of efficiency can be approached only if sera samples are collected before onset of fever [14,18]. Specificity of this technique is only 63% when compared with PCR whose specificity is 100% [19].…”

Dengue Virus Serotypes of Children Diagnosed with Dengue Hemorrhagic Fever at Syarif Hidayatullah and Fatmawati General Hospital Jakarta

“…Each serotype provides specific lifetime immunity, but only a short term cross-immunity. All serotypes can cause severe and fatal disease [8,9].…”

“…In Indonesia, serotype DEN-3 is dominant, and it is assumed this serotype causes severe clinical manifestations in patients [3,9].…”