title: Forty Years of Dengue Surveillance at a Tertiary Pediatric Hospital in Bangkok, Thailand, 1973-2012.
abstract: Long-term observational studies can provide valuable insights into overall dengue epidemiology. Here, we present analysis of dengue cases at a pediatric hospital in Bangkok, Thailand, during a 40-year period from 1973 to 2012. Data were analyzed from 25,715 hospitalized patients with laboratory-confirmed dengue virus (DENV) infection. Several long-term trends in dengue disease were identified including an increase in mean age of hospitalized cases from an average of 7-8 years, an increase after 1990 in the proportion of post-primary cases for DENV-1 and DENV-3, and a decrease in the proportion of dengue hemorrhagic fever and dengue shock syndrome cases in primary and post-primary cases over time. Exploratory mechanistic analysis of these observed trends considered changes in diagnostic methods, demography, force of infection, and Japanese encephalitis vaccination as possible explanations. Thailand is an important setting for studying DENV transmission as it has a "mature" dengue epidemiology with a strong surveillance system in place since the early 1970s. We characterized changes in dengue epidemiology over four decades, and possible impact of demographic and other changes in the human population. These results may inform other countries where similar changes in transmission and population demographics may now or may soon be occurring.
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Ananda
authors.initials: A
authors.lastname: Nisalak
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts Hannah.e.clapham@gmail.com.
authors.forename: Hannah E
authors.initials: HE
authors.lastname: Clapham
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Siripen
authors.initials: S
authors.lastname: Kalayanarooj
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Chonticha
authors.initials: C
authors.lastname: Klungthong
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Butsaya
authors.initials: B
authors.lastname: Thaisomboonsuk
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Stefan
authors.initials: S
authors.lastname: Fernandez
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Julia
authors.initials: J
authors.lastname: Reiser
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Anon
authors.initials: A
authors.lastname: Srikiatkhachorn
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Louis R
authors.initials: LR
authors.lastname: Macareo
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Justin T
authors.initials: JT
authors.lastname: Lessler
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Derek A T
authors.initials: DA
authors.lastname: Cummings
authors.affiliation: Department of Virology, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand; Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts Hannah.e.clapham@gmail.com.
authors.forename: In-Kyu
authors.initials: IK
authors.lastname: Yoon
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000453:epidemiology*; D006776:Hospitals, Pediatric; D006801:Humans; D011159:Population Surveillance; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors