title: The changing incidence of dengue haemorrhagic fever in Indonesia: a 45-year registry-based analysis.
abstract: BACKGROUND
  Increases in human population size, dengue vector-density and human mobility cause rapid spread of dengue virus in Indonesia. We investigated the changes in dengue haemorrhagic fever (DHF) incidence in Indonesia over a 45-year period and determined age-specific trends in annual DHF incidence.
  
  
  METHODS
  Using an on-going nationwide dengue surveillance program starting in 1968, we evaluated all DHF cases and related deaths longitudinally up to 2013. Population demographics were used to calculate annual incidence and case fatality ratios (CFRs). Age-specific data on DHF available from 1993 onwards were used to assess trends in DHF age-distribution. Time-dependency of DHF incidence and CFRs was assessed using the Cochrane-Armitage trend test.
  
  
  RESULTS
  The annual DHF incidence increased from 0.05/100,000 in 1968 to ~ 35-40/100,000 in 2013, with superimposed epidemics demonstrating a similar increasing trend with the highest epidemic occurring in 2010 (85.70/100,000; p < 0.01). The CFR declined from 41% in 1968 to 0.73% in 2013 (p < 0.01). Mean age of DHF cases increased during the observation period. Highest incidence of DHF was observed among children aged 5 to 14 years up to 1998, but declined thereafter (p < 0.01). In those aged 15 years or over, DHF incidence increased (p < 0.01) and surpassed that of 5 to 14 year olds from 1999 onwards.
  
  
  CONCLUSIONS
  Incidence of DHF over the past 45 years in Indonesia increased rapidly with peak incidence shifting from young children to older age groups. The shifting age pattern should have consequences for targeted surveillance and prevention.
authors: Department of Child Health, Division of Infection and Tropical Pediatrics, Cipto Mangunkusumo Hospital, Medical Faculty University of Indonesia, Jl, Diponegoro No,71, Jakarta, Indonesia. karyanti@doctor.com.
authors: Mulya Rahma
authors: MR
authors: Karyanti
authors: Cuno S P M
authors: CS
authors: Uiterwaal
authors: Rita
authors: R
authors: Kusriastuti
authors: Sri Rezeki
authors: SR
authors: Hadinegoro
authors: Maroeska M
authors: MM
authors: Rovers
authors: Hans
authors: H
authors: Heesterbeek
authors: Arno W
authors: AW
authors: Hoes
authors: Patricia
authors: P
authors: Bruijning-Verhagen
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003716:Dengue Virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D005260:Female; D006801:Humans; D015994:Incidence; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D012042:Registries; D018571:Sentinel Surveillance; D019595:Severe Dengue / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D055815:Young Adult