Dengue Outbreaks in High-Income Area, Kaohsiung City, Taiwan, 2003–2009 - - Emerging Infectious Disease journal - CDC

full-text ►
Dengue Outbreaks in High-Income Area, Kaohsiung City, Taiwan, 2003–2009 - - Emerging Infectious Disease journal - CDC

Research

Dengue Outbreaks in High-Income Area, Kaohsiung City, Taiwan, 2003–2009

Article Contents

• Materials and Methods
• Results
• Discussion
• Acknowledgment
• References
• Figure 1
• Figure 2
• Figure 3
• Figure 4
• Figure 5
• Table 1
• Table 2
• Table 3
• Table 4
• Suggested Citation

Chia-Hsien Lin , Karin L. Schiøler, Martin R. Jepsen, Chi-Kung Ho, Shu-Hua Li, and Flemming Konradsen

Author affiliations: University of Copenhagen, Copenhagen, Denmark (C.-H. Lin, K.L. Schiøler, M.R. Jepsen, F. Konradsen); National Taiwan University, Taipei, Taiwan (C.-H. Lin); Kaohsiung City Government, Kaohsiung City, Taiwan (C.-K. Ho, S.-H. Li); Kaohsiung Medical University, Kaohsiung City (C.-K. Ho); and National Sun Yat-Sen University, Kaohsiung City (S.-H. Li)

Suggested citation for this article

Abstract

Kaohsiung City, a modern metropolis of 1.5 million persons, has been the focus of dengue virus activity in Taiwan for several decades. The aim of this study was to provide a temporal and spatial description of dengue virus epidemiology in Kaohsiung City by using data for all laboratory-confirmed dengue cases during 2003–2009. We investigated age- and sex-dependent incidence rates and the spatiotemporal patterns of all cases confirmed through passive or active surveillance. Elderly persons were at particularly high risk for dengue virus–related sickness and death. Of all confirmed cases, ≈75% were detected through passive surveillance activities; case-patients detected through active surveillance included immediate family members, neighbors, and colleagues of confirmed case-patients. Changing patterns of case clustering could be due to the effect of unmeasured environmental and demographic factors.

Dengue virus disease or dengue virus–like disease has circulated in southern Taiwan since the late nineteenth century (1); transmission initially occurred as intermittent epidemics with intervals of several years to decades (2–6). However, for the past decade, dengue virus epidemics have occurred annually in Taiwan, and the main focus of activity has been in Kaohsiung City, a modern metropolis of 1.5 million persons. Kaohsiung City was the epicenter of the 2002 dengue virus epidemic, which with 2,820 confirmed cases and several hundred cases of dengue hemorrhagic fever (DHF), was one of the largest ever recorded in Taiwan (3). During 2002–2011, Kaohsiung City has had annual outbreaks of variable scales, resulting in ≈6,800 confirmed cases (3).
Cocirculation of >2 of the 4 dengue virus serotypes (DENV-1–4) has been reported in Kaohsiung City, and the molecular characteristics of the serotypes have been well documented for several epidemics, indicating the possible origin and transmission dynamics of the causative strains (2–9). The spatiotemporal patterns of disease transmission during the 2002 DENV-2 epidemic also have been investigated, and findings indicate several possible mechanisms by which the virus might have dispersed after being introduced into the population (10,11). Furthermore, Lin et al. (12) examined the relationship between disease-related illness and death and the distribution of primary and secondary infections for dengue virus cases reported across Taiwan during 2002–2007.
We provide a detailed description of the epidemiology of dengue virus infection in Kaohsiung City during 2003–2009; the description is based on routine disease and vector surveillance data provided by the Department of Health, Kaohsiung City Government. The temporal case distribution is compared with available climate data and the index of peridomestic adult vectors, Aedes aegypti and Ae. albopictus mosquitoes, and case characteristics are examined across the age and sex of patients and across the surveillance method (active vs. passive). In addition, the study provides an assessment of spatiotemporal case clusters, identifying possible hot spots for dengue virus transmission in Kaohsiung City during the 7-year study period.