Heterogeneity of dengue transmission in an endemic area of Colombia

Abstract

Population based serological surveys are the gold-standard to quantify dengue (DENV) transmission. The purpose of this study was to estimate the age-specific seroprevalence and the force of infection of DENV in an endemic area of Colombia. Between July and October 2014, we conducted a household based cross-sectional survey among 1.037 individuals aged 2 to 40 years living in 40 randomly selected locations in urban Piedecuesta, Santander, Colombia. In addition, we also enrolled 246 indviduals living in rural “veredas”. Participants were asked to answer a questionnaire that included demographic, socioeconomic and environmental questions and to provide a 5 ml blood sample. Sera were tested using the IgG indirect ELISA (Panbio) kit to determine past DENV infection. The overall DENV seroprevalence was 70% (95% CI = 67%-71%), but was significantly higher in urban (81%, 95% CI = 78%-83%) as compared to rural (21%, 95% CI = 17%-27%) locations. Age was a major predictor of seropositivity, consistent with endemic circulation of the virus. Using catalytic models we estimated that on average, 12% (95%CI = 11%-13%) of susceptible individuals living in the city are infected by DENV each year. Beyond age, the only predictor of seropositivity in urban locations was prior history of dengue diagnosed by a physician (aPR 1.15, 95% CI = 0.98–1.35). Among participants living in rural settings, those that reported traveling outside of their vereda were more likely to be seropositive (aPR 3.60, 95%CI = 1.54–8.42) as well as those who were born outside of Santander department (aPR = 2.77, 95%CI = 1.20–6.37). These results are consistent with long term endemic circulation of DENV in Piedecuesta, with large heterogeneities between urban and rural areas located just a few kilometers apart. Design of DENV control interventions, including vaccination, will need to consider this fine scale spatial heterogeneity.

Estimating the annual dengue force of infection from the age of reporting primary infections across urban centres in endemic countries

“…Our city FOI estimates, aggregated over 5 years and generated from catalytic models, were comparable to a 2016 estimate in Cebu (central Philippines) [ 23 ] and revealed a long-term spatial heterogeneity in dengue transmission intensity, similarly shown in China [ 24 ] and Colombia [ 25 ]. We found catalytic models fit with sero-reversion parameters resulted in superior model fits despite sero-reversion being very low across sampled cities.…”

Pooled Cohort Profile: ReCoDID Consortium’s Harmonized Acute Febrile Illness Arbovirus Meta-Cohort

“…Piedecuesta's household-based dynamic cohort sought to estimate age-specific dengue cohort conducted annual visits to the participants' residences to collect blood samples to determine dengue seroconversion (losses to follow-up: 6.5% and 3.2% during the first and second year, respectively), a strategy that allowed for the estimate of attack rates to be calculated for chikungunya (22%) and ZIKV (34%) during the outbreaks of 2015 and 2016, respectively (12).…”

“How about me giving blood for the COVID vaccine and not being able to get vaccinated?” A cognitive interview study on understanding of and agreement with broad consent for future use with cohort participants and guardians in Colombia and Nicaragua

“…In Nicaragua, we recruited participants from a current list of parents of participants in the “Prospective hospital-based study of dengue classification, case management, and diagnosis in Nicaragua” study, assembled between 2015-2018. Inclusion criteria for the Colombia [16] and Nicaragua [17] cohort studies are described elsewhere. To capture the diversity in how cohort participants perceive broad consent language in the IC, we tried to include parents and participants of different genders and parents that had and had not completed primary school.…”