title: Rural-urban comparisons of dengue seroprevalence in Malaysia.
abstract: Each year an estimated 390 million dengue infections occur worldwide. In Malaysia, dengue is a growing public health concern but estimate of its disease burden remains uncertain. We compared the urban-rural difference of dengue seroprevalence and determined age-specific dengue seroprevalence in Malaysia.
  
  
  
  We undertook analysis on 11,821 subjects from six seroprevalence surveys conducted in Malaysia between 2001 and 2013, which composed of five urban and two rural series.
  
  
  
  Prevalence of dengue increased with age in both urban and rural locations in Malaysia, which exceeded 90 % among those aged 70 years or beyond. The age-specific rates of the 5 urban surveys overlapped without clear separation among them, while prevalence was lower in younger subjects in rural series than in urban series, the trend reversed in older subjects. There were no differences in the seroprevalence by gender, ethnicity or region. Poisson regression model confirmed the prevalence have not changed in urban areas since 2001 but in rural areas, there was a significant positive time trend such that by year 2008, rural prevalence was as high as in urban areas.
  
  
  
  Dengue seroprevalence has stabilized but persisted at a high level in urban areas since 2001, and is fast stabilizing in rural areas at the same high urban levels by 2008. The cumulative seroprevalence of dengue exceeds 90 % by the age of 70 years, which translates into 16.5 million people or 55 % of the total population in Malaysia, being infected by dengue by 2013.
authors.affiliation: Clinical Research Centre, c/o Third Floor, Dermatology Block, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
authors.forename: Cheng Hoon
authors.initials: CH
authors.lastname: Chew
authors.affiliation: Clinical Research Centre, c/o Third Floor, Dermatology Block, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
authors.forename: Yuan Liang
authors.identifier: 0000-0003-4834-9175
authors.initials: YL
authors.lastname: Woon
authors.affiliation: National Public Health Laboratory, Lot 1853, Kg. Melayu, 47000, Sungai Buloh, Selangor, Kuala Lumpur, Malaysia.
authors.forename: Faridah
authors.initials: F
authors.lastname: Amin
authors.affiliation: Clinical Research Centre, c/o Third Floor, Dermatology Block, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
authors.forename: Tassha H
authors.initials: TH
authors.lastname: Adnan
authors.affiliation: National Public Health Laboratory, Lot 1853, Kg. Melayu, 47000, Sungai Buloh, Selangor, Kuala Lumpur, Malaysia.
authors.forename: Asmah Hani
authors.initials: AH
authors.lastname: Abdul Wahab
authors.affiliation: National Public Health Laboratory, Lot 1853, Kg. Melayu, 47000, Sungai Buloh, Selangor, Kuala Lumpur, Malaysia.
authors.forename: Zul Edzhar
authors.initials: ZE
authors.lastname: Ahmad
authors.affiliation: Clinical Research Centre, c/o Third Floor, Dermatology Block, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
authors.forename: Mohd Adam
authors.initials: MA
authors.lastname: Bujang
authors.affiliation: Clinical Research Centre, c/o Third Floor, Dermatology Block, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
authors.forename: Abdul Muneer
authors.initials: AM
authors.lastname: Abdul Hamid
authors.affiliation: UKM Medical Molecular Biology Institute, UKM Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
authors.forename: Rahman
authors.initials: R
authors.lastname: Jamal
authors.affiliation: Klinik Alam Medic, 41, Jalan Perdana ¾, Taman Puchong Perdana, 47100, Puchong, Selangor, Kuala Lumpur, Malaysia.
authors.forename: Wei Seng
authors.initials: WS
authors.lastname: Chen
authors.affiliation: Kepala Batas Hospital, Jalan Bertam 2, 13200, Kepala Batas, Penang, Malaysia.
authors.forename: Chee Peng
authors.initials: CP
authors.lastname: Hor
authors.affiliation: Stats Consulting Pte Ltd, D7-3-1, Block D7, Pusat Perdagangan Dana 1, Jalan PJU 1A/46, PJU 1A, 47301, Petaling Jaya, Selangor, Malaysia.
authors.forename: Lena
authors.initials: L
authors.lastname: Yeap
authors.affiliation: Stats Consulting Pte Ltd, D7-3-1, Block D7, Pusat Perdagangan Dana 1, Jalan PJU 1A/46, PJU 1A, 47301, Petaling Jaya, Selangor, Malaysia.
authors.forename: Ling Ping
authors.initials: LP
authors.lastname: Hoo
authors.affiliation: Clinical Research Centre, c/o Third Floor, Dermatology Block, Hospital Kuala Lumpur, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
authors.forename: Pik Pin
authors.initials: PP
authors.lastname: Goh
authors.affiliation: ClinResearch Pte Ltd, D7-3-1, Block D7, Pusat Perdagangan Dana 1, Jalan PJU 1A/46, PJU 1A, 47301, Petaling Jaya, Selangor, Malaysia. limteckonn@gmail.com.
authors.forename: Teck Onn
authors.initials: TO
authors.lastname: Lim
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D015995:Prevalence; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data*; D016036:Seroepidemiologic Studies; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Dengue; Malaysia; Seroprevalence; Urban rural difference