Center for Health and Wellbeing, School of Public and International Affairs, Princeton University, Princeton, New Jersey, United States of America.
Department of Urban Affairs at the School of Architecture, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Nuevo Léon, México.
PLoS Negl Trop Dis. 2023 Aug 9;17(8):e0011537. doi: 10.1371/journal.pntd.0011537. eCollection 2023 Aug.
Severe dengue occurrence has been attributed to increasing age and different dengue virus (DENV) serotypes that cause secondary infections and immune-enhancing phenomena. Therefore, we examined if the effect of age on dengue severity was mediated by infectivity status while controlling for sex and region. Further, we assessed the spatial clustering of dengue severity for individuals with primary and secondary infection across Mexican municipalities. Health data from 2012 to 2017 was retrieved from Mexico's Ministry of Health. A mediation analysis was performed using multiple logistic regression models based on a directed acyclic graph. The models were explored for the direct effect of age on dengue severity and its indirect impact through secondary infection. In addition, severe dengue clusters were determined in some Northeastern and Southeastern municipalities through spatial analysis. We observed a nonlinear trend between age and severe dengue. There was a downward trend of severe dengue for individuals between 0 and 10 years and an upward trend above 10 years. The effect of age on dengue severity was no longer significant for individuals between 10 and 60 years after introducing infectivity status into the model. The mediating role of infectivity status in the causal model was 17%. Clustering of severe dengue among individuals with primary infection in the Northeastern region may point to the high prevalence of DENV-3 in the region. Public health efforts may prevent secondary infection among infants and the aged. In addition, there should be a further investigation into the effect of DENV-3 in individuals with primary disease.
严重登革热的发生归因于年龄的增长和不同的登革病毒（DENV）血清型，这些病毒会导致二次感染和免疫增强现象。因此，我们研究了年龄对登革热严重程度的影响是否通过感染状态来介导，同时控制了性别和地区。此外，我们评估了在墨西哥各城市中，原发性和继发性感染的个体中登革热严重程度的空间聚类。我们从墨西哥卫生部检索了 2012 年至 2017 年的健康数据。使用基于有向无环图的多项逻辑回归模型进行了中介分析。探索了年龄对登革热严重程度的直接影响及其通过二次感染的间接影响。此外，通过空间分析确定了一些东北和东南部城市中严重登革热的聚类。我们观察到年龄与严重登革热之间存在非线性趋势。在 0 至 10 岁之间，严重登革热的个体呈下降趋势，而在 10 岁以上的个体中呈上升趋势。在引入感染状态后，年龄对登革热严重程度的影响对于 10 至 60 岁之间的个体不再显著。感染状态在因果模型中的中介作用为 17%。东北地区原发性感染个体中严重登革热的聚类可能表明该地区 DENV-3 的高流行率。公共卫生措施可能预防婴儿和老年人的二次感染。此外，应该进一步研究 DENV-3 在原发性疾病个体中的影响。
