Force of dengue infection estimates and 95% CIs by JE vaccination status.

<p>Model 1: constant force of infection; Model 2: different forces of infection above and below 6 years. <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002259#pntd-0002259-g002" target="_blank">Figure 2</a> footnote: * Estimates from a model adjusting for JE vaccination status.</p

Observed prevalence by age (with 95% CIs) and model-predicted values.

<p>Blue line: Model 1 (constant force of infection); Red line: Model 2 (different forces of infection above and below 6 years).</p

Reported and estimated number of clincial dengue cases in Puerto Rico, 2005–2010 (with 95% CI).

<p>Panel A: Reported and Estimated Dengue Inpatients; Panel B: Reported and Estimated Dengue Outpatients. Notes: MA = Medically Attended patient classification sub-model which includes all patients who either had a completed Dengue Case Information Form (DCIF), or had some indication in their medical records (such as specimens sent to a laboratory for dengue testing) as potentially having a clinical case of dengue. DO = In this patient classification sub-model, labeled “DCIF Only (DO),” we included only those patients (in or out) definitively recorded as potential dengue case on a DCIF. See text for further details. The 95% CI (confidence interval) is the range between the 2.5% and 97.5% confidence estimates.</p

Ratio of dengue infections to notified cases by age in Colombo Municipal Council, 2009.

<p>Blue line: Model 1 (constant force of infection); Red line: Model 2 (different forces of infection above and below 6 years).</p

Number and percentage of children positive for flavivirus antibodies, Colombo, Sri Lanka, 2008–9.

<p>Number and percentage of children positive for flavivirus antibodies, Colombo, Sri Lanka, 2008–9.</p

Estimates of dengue overall multiplier for inpatients in Puerto Rico: 2005 to 2010^a.

<p>Estimates of dengue overall multiplier for inpatients in Puerto Rico: 2005 to 2010<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0006650#t002fn001" target="_blank">^a</a>.</p

Reported and estimated rate of medically attended dengue per 1,000 general population in Puerto Rico (2005 to 2010).

<p>Reported and estimated rate of medically attended dengue per 1,000 general population in Puerto Rico (2005 to 2010).</p

Schematic of model to estimate multipliers to correct for under-reporting of outpatient and hospitalized dengue cases.

<p>Notes; Multiplier D (only) is used for the inpatient module. Multiplier D and Multiplier E are used for the outpatient module. See text for further details. PDSS = Passive dengue surveillance system. EDSS = Enhanced dengue surveillance system. CDC-DB = U.S. Centers for Disease Control and Prevention, Dengue Branch (stationed in San Juan, Puerto Rico).</p

Sensitivity analysis: Relative importance of individual multipliers in calculating the overall multiplier for reported dengue inpatients: Puerto Rico, 2010.

<p>Notes: a: Graph plots relative importance of the individual multipliers used to calculate the overall multiplier. The wider the plotted range (i.e., bar), the greater the change in the overall multiplier. b: Results calculated for MA = Medically Attended patient classification sub-model which includes all patients who either had a completed Dengue Case Information Form (DCIF), or had some indication in their medical records (such as specimens sent to a laboratory for dengue testing) as potentially having a clinical case of dengue. PDSS = Passive dengue surveillance system. EDSS = Enhance dengue surveillance system. IgM = Immunoglobulin M. Test indicates presence of dengue IgM antibodies using an antibody capture enzyme-linked immunosorbent assay. PCR = Polymerase chain reaction. Test indicates evidence of dengue RNA using by a Reverse transcription polymerase chain reaction (RT-PCR) test. See main text for detailed description of individual multipliers and how they are used to calculate the overall multiplier.</p

Dengue Infection in Children in Ratchaburi, Thailand: A Cohort Study. I. Epidemiology of Symptomatic Acute Dengue Infection in Children, 2006–2009

<div><h3>Background</h3><p>There is an urgent need to field test dengue vaccines to determine their role in the control of the disease. Our aims were to study dengue epidemiology and prepare the site for a dengue vaccine efficacy trial.</p> <h3>Methods and Findings</h3><p>We performed a prospective cohort study of children in primary schools in central Thailand from 2006 through 2009. We assessed the epidemiology of dengue by active fever surveillance for acute febrile illness as detected by school absenteeism and telephone contact of parents, and dengue diagnostic testing. Dengue accounted for 394 (6.74%) of the 5,842 febrile cases identified in 2882, 3104, 2717 and 2312 student person-years over the four years, respectively. Dengue incidence was 1.77% in 2006, 3.58% in 2007, 5.74% in 2008 and 3.29% in 2009. Mean dengue incidence over the 4 years was 3.6%. Dengue virus (DENV) types were determined in 333 (84.5%) of positive specimens; DENV serotype 1 (DENV-1) was the most common (43%), followed by DENV-2 (29%), DENV-3 (20%) and DENV-4 (8%). Disease severity ranged from dengue hemorrhagic fever (DHF) in 42 (10.5%) cases, dengue fever (DF) in 142 (35.5%) cases and undifferentiated fever (UF) in 210 (52.5%) cases. All four DENV serotypes were involved in all disease severity. A majority of cases had secondary DENV infection, 95% in DHF, 88.7% in DF and 81.9% in UF. Two DHF (0.5%) cases had primary DENV-3 infection.</p> <h3>Conclusion</h3><p>The results illustrate the high incidence of dengue with all four DENV serotypes in primary school children, with approximately 50% of disease manifesting as mild clinical symptoms of UF, not meeting the 1997 WHO criteria for dengue. Severe disease (DHF) occurred in one tenth of cases. Data of this type are required for clinical trials to evaluate the efficacy of dengue vaccines in large scale clinical trials.</p> </div