Nisalak Ananda, Clapham Hannah E, Kalayanarooj Siripen, Klungthong Chonticha, Thaisomboonsuk Butsaya, Fernandez Stefan, Reiser Julia, Srikiatkhachorn Anon, Macareo Louis R, Lessler Justin T, Cummings Derek A T, Yoon In-Kyu
Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
Am J Trop Med Hyg. 2016 Jun 1;94(6):1342-7. doi: 10.4269/ajtmh.15-0337. Epub 2016 Mar 28.
Long-term observational studies can provide valuable insights into overall dengue epidemiology. Here, we present analysis of dengue cases at a pediatric hospital in Bangkok, Thailand, during a 40-year period from 1973 to 2012. Data were analyzed from 25,715 hospitalized patients with laboratory-confirmed dengue virus (DENV) infection. Several long-term trends in dengue disease were identified including an increase in mean age of hospitalized cases from an average of 7-8 years, an increase after 1990 in the proportion of post-primary cases for DENV-1 and DENV-3, and a decrease in the proportion of dengue hemorrhagic fever and dengue shock syndrome cases in primary and post-primary cases over time. Exploratory mechanistic analysis of these observed trends considered changes in diagnostic methods, demography, force of infection, and Japanese encephalitis vaccination as possible explanations. Thailand is an important setting for studying DENV transmission as it has a "mature" dengue epidemiology with a strong surveillance system in place since the early 1970s. We characterized changes in dengue epidemiology over four decades, and possible impact of demographic and other changes in the human population. These results may inform other countries where similar changes in transmission and population demographics may now or may soon be occurring.
长期观察性研究可为登革热总体流行病学提供有价值的见解。在此，我们呈现了泰国曼谷一家儿科医院1973年至2012年这40年间登革热病例的分析情况。对25715例实验室确诊为登革病毒（DENV）感染的住院患者的数据进行了分析。确定了登革热疾病的几个长期趋势，包括住院病例的平均年龄从平均7 - 8岁有所增加，1990年后DENV - 1和DENV - 3的小学高年级后病例比例有所上升，以及随着时间推移，原发性和小学高年级后病例中登革出血热和登革休克综合征病例的比例有所下降。对这些观察到的趋势进行的探索性机制分析考虑了诊断方法、人口统计学、感染强度和日本脑炎疫苗接种的变化等可能的解释。泰国是研究登革病毒传播的重要场所，因为自20世纪70年代初以来，它就拥有“成熟”的登革热流行病学以及强大的监测系统。我们描述了四十年来登革热流行病学的变化，以及人口结构和其他人口变化可能产生的影响。这些结果可能会为其他正在或即将出现类似传播和人口结构变化的国家提供参考。
