2017 年印度登革热感染负担：一项基于横断面人群的血清学调查。

Burden of dengue infection in India, 2017: a cross-sectional population based serosurvey.

机构信息

Indian Council of Medical Research (ICMR)-National Institute of Epidemiology, Chennai, India.

出版信息

Lancet Glob Health. 2019 Aug;7(8):e1065-e1073. doi: 10.1016/S2214-109X(19)30250-5. Epub 2019 Jun 11.

DOI:10.1016/S2214-109X(19)30250-5

PMID:31201130

Abstract

BACKGROUND

The burden of dengue virus (DENV) infection across geographical regions of India is poorly quantified. We estimated the age-specific seroprevalence, force of infection, and number of infections in India.

METHODS

We did a community-based survey in 240 clusters (118 rural, 122 urban), selected from 60 districts of 15 Indian states from five geographical regions. We enumerated each cluster, randomly selected (with an Andriod application developed specifically for the survey) 25 individuals from age groups of 5-8 years, 9-17 years, and 18-45 years, and sampled a minimum of 11 individuals from each age group (all the 25 randomly selected individuals in each age group were visited in their houses and individuals who consented for the survey were included in the study). Age was the only inclusion criterion; for the purpose of enumeration, individuals residing in the household for more than 6 months were included. Sera were tested centrally by a laboratory team of scientific and technical staff for IgG antibodies against the DENV with the use of indirect ELISA. We calculated age group specific seroprevalence and constructed catalytic models to estimate force of infection.

FINDINGS

From June 19, 2017, to April 12, 2018, we randomly selected 17 930 individuals from three age groups. Of these, blood samples were collected and tested for 12 300 individuals (5-8 years, n=4059; 9-17 years, n=4265; 18-45 years, n=3976). The overall seroprevalence of DENV infection in India was 48·7% (95% CI 43·5-54·0), increasing from 28·3% (21·5-36·2) among children aged 5-8 years to 41·0% (32·4-50·1) among children aged 9-17 years and 56·2% (49·0-63·1) among individuals aged between 18-45 years. The seroprevalence was high in the southern (76·9% [69·1-83·2]), western (62·3% [55·3-68·8]), and northern (60·3% [49·3-70·5]) regions. The estimated number of primary DENV infections with the constant force of infection model was 12 991 357 (12 825 128-13 130 258) and for the age-dependent force of infection model was 8 655 425 (7 243 630-9 545 052) among individuals aged 5-45 years from 30 Indian states in 2017.

INTERPRETATION

The burden of dengue infection in India was heterogeneous, with evidence of high transmission in northern, western, and southern regions. The survey findings will be useful in making informed decisions about introduction of upcoming dengue vaccines in India.

FUNDING

Indian Council of Medical Research.

摘要

背景

印度各地登革热病毒（DENV）感染的负担情况尚未得到充分评估。本研究旨在估算印度的年龄别血清流行率、感染率及感染人数。

方法

我们在印度 15 个邦的 60 个地区，从 240 个集群（118 个农村，122 个城市）中进行了一项基于社区的调查。我们对每个集群进行了计数，从 5-8 岁、9-17 岁和 18-45 岁这三个年龄组中，通过专门为此项调查开发的安卓应用程序（Android application）随机选择（with an Andriod application developed specifically for the survey）25 人，并从每个年龄组中至少抽取 11 人进行采样（每个年龄组中所有随机选择的 25 人都在其家中进行了访问，同意参加调查的个人都被纳入了研究）。年龄是唯一的纳入标准；为了进行计数，在家庭中居住超过 6 个月的个人都被纳入。实验室技术人员团队使用间接酶联免疫吸附试验（indirect ELISA）对血清中的 DENV 抗体 IgG 进行了检测。我们计算了各年龄组的血清流行率，并构建了催化模型来估计感染率。

发现

2017 年 6 月 19 日至 2018 年 4 月 12 日，我们从三个年龄组中随机选择了 17930 人。其中，对 12300 人的血液样本进行了采集和检测（5-8 岁组：4059 人；9-17 岁组：4265 人；18-45 岁组：3976 人）。印度登革热感染的总血清流行率为 48.7%（95%CI 43.5-54.0），呈年龄依赖性上升，5-8 岁儿童的血清流行率为 28.3%（21.5-36.2），9-17 岁儿童上升至 41.0%（32.4-50.1），18-45 岁人群上升至 56.2%（49.0-63.1）。南部（76.9% [69.1-83.2]）、西部（62.3% [55.3-68.8]）和北部（60.3% [49.3-70.5]）地区的血清流行率较高。采用恒定感染率模型估计原发性 DENV 感染人数为 12991357 人（12825128-13130258 人），采用年龄依赖性感染率模型估计为 8655425 人（7243630-9545052 人），这是 2017 年印度 30 个邦 5-45 岁人群的感染人数。