Dengue viral infection in Indonesia: Epidemiology, diagnostic challenges, and mutations from an observational cohort study

• Published in: PLoS neglected tropical diseases Vol. 13; no. 10; p. e0007785
• Main Authors: Utama, I Made Susila, Lukman, Nurhayati, Sukmawati, Dewi Dian, Alisjahbana, Bachti, Alam, Anggraini, Murniati, Dewi, Utama, I Made Gede Dwi Lingga, Puspitasari, Dwiyanti, Kosasih, Herman, Laksono, Ida, Karyana, Muhammad, Karyanti, Mulya Rahma, Hapsari, M. M. D. E. A. H., Meutia, Ninny, Liang, C Jason, Wulan, Wahyu Nawang, Lau, Chuen-Yen, Parwati, Ketut Tuti Merati
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 21.10.2019; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Adults; Aetiology; Algorithms; Annealing; Antibiotics; Biology and life sciences; Child; Child, Preschool; Cities and towns; Clinical Laboratory Techniques - methods; Cohort analysis; Cohort Studies; Cohorts; Dengue; Dengue - diagnosis; Dengue - epidemiology; Dengue - physiopathology; Dengue - virology; Dengue fever; Dengue Virus - classification; Dengue Virus - genetics; Development and progression; Diagnosis; Diagnostic errors; Diagnostic systems; Earth Sciences; Ecology and Environmental Sciences; Epidemics; Epidemiology; Etiology; Etiology (Medicine); Female; Fever; Genetic aspects; Genotype; Geographic Mapping; Health Policy; Hospitalization; Hospitals; Human diseases; Humans; Identification; Incidence; Indonesia - epidemiology; Infection; Infections; Infectious diseases; Laboratories; Male; Medicine and Health Sciences; Mortality; Mutation; Observational studies; Optimization; Pathogenic microorganisms; Pathogens; People and Places; Phylogeny; Policies; Public Health; Public health movements; R&D; Research & development; Research and Analysis Methods; Serogroup; Serotypes; Serotyping; Tropical diseases; Vector-borne diseases; Viral diseases; Viral infections; Virology; Viruses; Young Adult; Indonesia; Jakarta Indonesia; Bali Indonesia; United States > US; Maryland; India
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0007785

Dengue virus (DENV) infection is a major cause of acute febrile illness in Indonesia. Diagnostic inaccuracy may occur due to its varied and non-specific presentation. Characterization of DENV epidemiology, clinical presentation, and virology will facilitate appropriate clinical management and public health policy. A multicenter observational cohort study was conducted in Indonesia to assess causes of acute fever requiring hospitalization. Clinical information and specimens were collected at enrollment, 14-28 days, and 3 months from 1,486 children and adults. Total of 468 (31.9%) cases of DENV infection were confirmed by reference laboratory assays. Of these, 414 (88.5%) were accurately diagnosed and 54 had been misdiagnosed as another infection by sites. One hundred initially suspected dengue cases were finally classified as 'non-dengue'; other pathogens were identified in 58 of those cases. Mortality of DENV infection was low (0.6%). Prior DENV exposure was found in 92.3% of subjects >12 years. DENV circulated year-round in all cities, with higher incidence from January to March. DENV-3 and DENV-1 were the predominant serotypes. This study identified DENV-1 with TS119(C→T) substitution in the serotyping primer annealing site, leading to failure of serotype determination. DENV is a common etiology of acute febrile illness requiring hospitalization in Indonesia. Diagnostic accuracy at clinical sites merits optimization since misdiagnosis of DENV infection and over-estimation of dengue can negatively impact management and outcomes. Mutation at the annealing site of the serotyping primer may confound diagnosis. Clinicians should consider following diagnostic algorithms that include DENV confirmatory testing. Policy-makers should prioritize development of laboratory capacity for diagnosis of DENV.