Rural-urban comparisons of dengue seroprevalence in Malaysia

Abstract

BackgroundEach year an estimated 390 million dengue infections occur worldwide. In Malaysia, dengue is a growing public health concern but estimate of its disease burden remains uncertain. We compared the urban-rural difference of dengue seroprevalence and determined age-specific dengue seroprevalence in Malaysia.MethodsWe undertook analysis on 11,821 subjects from six seroprevalence surveys conducted in Malaysia between 2001 and 2013, which composed of five urban and two rural series.ResultsPrevalence of dengue increased with age in both urban and rural locations in Malaysia, which exceeded 90 % among those aged 70 years or beyond. The age-specific rates of the 5 urban surveys overlapped without clear separation among them, while prevalence was lower in younger subjects in rural series than in urban series, the trend reversed in older subjects. There were no differences in the seroprevalence by gender, ethnicity or region. Poisson regression model confirmed the prevalence have not changed in urban areas since 2001 but in rural areas, there was a significant positive time trend such that by year 2008, rural prevalence was as high as in urban areas.ConclusionDengue seroprevalence has stabilized but persisted at a high level in urban areas since 2001, and is fast stabilizing in rural areas at the same high urban levels by 2008. The cumulative seroprevalence of dengue exceeds 90 % by the age of 70 years, which translates into 16.5 million people or 55 % of the total population in Malaysia, being infected by dengue by 2013.

Spatial and epidemiologic features of dengue in Sabah, Malaysia

“…Our findings suggest that high density, urbanised areas are not necessarily the primary drivers of ongoing epidemics in Sabah, and that factors other than population size may drive the risk in rural areas. Recent studies in other areas of Malaysia have also shown that dengue infection can occur at equivalent rates in both rural and urban areas (37, 38). It could be that the threshold human density required to maintain transmission may be lower than previously thought, although human movement (which may relate to population density) between urban and rural areas is also likely to have influenced the patterns we observed (39, 40).…”

Factors Associated with Dengue Virus Infection and Reinfection in Asymptomatic Children in Two Colombian Municipalities

“…20,34 Although the transmission of dengue is mainly in urban areas, in Colombia, the rapid and disorganized growth of the municipalities has allowed the mixing between rural and urban population to favor the spread of the mosquitoes, thus homogenizing the risk of DENV infection between the zones. 35 The increasing circulation of the mosquitoes and the virus and the sustained increase in these cases generates a high burden of the disease in Colombia. For example, DALYs lost for 2010 epidemic were 1,198 per million inhabitants with a total financial cost of U.S. $167.8 million, U.S. $129.9 million for 2011, and U.S. $131.7 million for 2012, 10 considering that these amounts were based on the individuals who were attended to or diagnosed, and the values can change if the contribution of the asymptomatic infections in the transmission dynamics are included.…”

Challenges in dengue research: A computational perspective

“…In contrast, regions where transmission has been historically low or where dengue serotypes were only recently introduced are more likely to show wave‐like, increasing patterns of incidence (Figure c,f). Spatial heterogeneities are also common in reported data, highlighting that the success of dengue viruses can be dictated by numerous demographic and ecological determinants (Figure f; Adams & Kapan, ; Beebe, Cooper, Mottram, & Sweeney, ; Campbell, Haldeman, Lehnig, Munayco, & Halsey, ; Chew, Woon, Amin, Adnan, & Abdul Wahab, ; Cummings et al., ; Lourenço & Recker, ; Lourenço & Recker, ).…”