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Early rigorous control interventions can largely reduce dengue outbreak magnitude: experience from Chaozhou, China.

ABSTRACT: Dengue fever is a severe public heath challenge in south China. A dengue outbreak was reported in Chaozhou city, China in 2015. Intensified interventions were implemented by the government to control the epidemic. However, it is still unknown the degree to which intensified control measures reduced the size of the epidemics, and when should such measures be initiated to reduce the risk of large dengue outbreaks developing?We selected Xiangqiao district as study setting because the majority of the indigenous cases (90.6%) in Chaozhou city were from this district. The numbers of daily indigenous dengue cases in 2015 were collected through the national infectious diseases and vectors surveillance system, and daily Breteau Index (BI) data were reported by local public health department. We used a compartmental dynamic SEIR (Susceptible, Exposed, Infected and Removed) model to assess the effectiveness of control interventions, and evaluate the control effect of intervention timing on dengue epidemic.A total of 1250 indigenous dengue cases was reported from Xiangqiao district. The results of SEIR modeling using BI as an indicator of actual control interventions showed a total of 1255 dengue cases, which is close to the reported number (n = 1250). The size and duration of the outbreak were highly sensitive to the intensity and timing of interventions. The more rigorous and earlier the control interventions implemented, the more effective it yielded. Even if the interventions were initiated several weeks after the onset of the dengue outbreak, the interventions were shown to greatly impact the prevalence and duration of dengue outbreak.This study suggests that early implementation of rigorous dengue interventions can effectively reduce the epidemic size and shorten the epidemic duration.

SUBMITTER: Liu T

PROVIDER: S-EPMC5541667 | biostudies-other | 2017 Aug

REPOSITORIES: biostudies-other

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Project description:BackgroundThe reported incidence of dengue fever increased dramatically in recent years in China. This study aimed to investigate and to assess the effectiveness of intervention implemented in a dengue outbreak in Ningbo City, Zhejiang Province, China.MethodsData of a dengue outbreak were collected in Ningbo City in China by a field epidemiological survey according to a strict protocol and case definition. Serum specimens of all cases were collected for diagnosis and the virological characteristics were detected by using polymerase chain reaction (PCR) and gene sequencing. Vector surveillance was implemented during the outbreak to collect the larva and adult mosquito densities to calculate the Breteau Index (BI) and human biting rate (HBR), respectively. Data of monthly BI and light-trap density in 2018 were built to calculate the seasonality of the vector. A transmission mathematical model was developed to dynamic the incidence of the disease. The parameters of the model were estimated by the data of the outbreak and vector surveillance data in 2018. The effectiveness of the interventions implemented during the outbreak was assessed by the data and the modelling.ResultsFrom 11 August to 8 September, 2018, a dengue outbreak was reported with 27 confirmed cases in a population of 5536-people community (community A) of Ningbo City. Whole E gene sequences were obtained from 24 cases and were confirmed as dengue virus type 1 (DENV-1). The transmission source of the outbreak was origin from community B where a dengue case having the same E gene sequence was onset on 30 July. Aedes albopictus was the only vector species in the area. The value of BI and HBR was 57.5 and 12 per person per hour respectively on 18 August, 2018 and decreased dramatically after interventions. The transmission model fitted well (χ2 = 6.324, P = 0.388) with the reported cases data. With no intervention, the total simulated number of the cases would be 1728 with a total attack rate (TAR) of 31.21% (95%CI: 29.99%- 32.43%). Case isolation and larva control (LC) have almost the same TAR and duration of outbreak (DO) as no intervention. Different levels of reducing HBR (rHBR) had different effectiveness with TARs ranging from 1.05% to 31.21% and DOs ranging from 27 days to 102 days. Adult vector control (AVC) had a very low TAR and DO. "LC+AVC" had a similar TAR and DO as that of AVC. "rHBR100%+LC", "rHBR100%+AVC", "rHBR100%+LC+AVC" and "rHBR100%+LC+AVC+Iso" had the same effectiveness.ConclusionsWithout intervention, DENV-1 could be transmitted rapidly within a short period of time and leads to high attack rate in community in China. AVC or rHBR should be recommended as primary interventions to control rapid transmission of the dengue virus at the early stage of an outbreak.

Project description:BackgroundThe number of dengue fever (DF) cases and the number of dengue outbreaks have increased in recent years in Zhejiang Province, China. An unexpected dengue outbreak was reported in Hangzhou in 2017 and caused more than one thousand dengue cases. This study was undertaken to evaluate the effectiveness of the actual control measures, estimate the proportion of inapparent infections during this outbreak and simulate epidemic development based on different levels of control measures taking inapparent infections into consideration.MethodsThe epidemic data of dengue cases in Hangzhou, Zhejiang Province, in 2017 and the number of the people exposed to the outbreaks were obtained from the China Information Network System of Disease Prevention and Control. The epidemic without intervention measures was used to estimate the unknown parameters. A susceptible-exposed-infectious/inapparent-recovered (SEIAR) model was used to estimate the effectiveness of the control interventions. The inapparent infections were also evaluated at the same time.ResultsIn total, 1137 indigenous dengue cases were reported in Hangzhou in 2017. The number of indigenous dengue cases was estimated by the SEIAR model. This number was predicted to reach 6090 by the end of November 2, 2017, if no control measures were implemented. The total number of reported cases was reduced by 81.33% in contrast to the estimated incidence without intervention. The number of average daily inapparent cases was 10.18 times higher than the number of symptomatic cases. The earlier and more rigorously the vector control interventions were implemented, the more effective they were. The results showed that implementing vector control continuously for more than twenty days was more effective than every few days of implementation. Case isolation is not sufficient enough for epidemic control and only reduced the incidence by 38.10% in contrast to the estimated incidence without intervention, even if case isolation began seven days after the onset of the first case.ConclusionsThe practical control interventions in the outbreaks that occurred in Hangzhou City were highly effective. The proportion of inapparent infections was large, and it played an important role in transmitting the disease during this epidemic. Early, continuous and high efficacy vector control interventions are necessary to limit the development of a dengue epidemic. Timely diagnosis and case reporting are important in the intervention at an early stage of the epidemic.

Project description:In 2015, a dengue outbreak with 1,067 reported cases occurred in Xishuangbanna, a city in China that borders Burma and Laos. To characterize the virus, the complete genome sequence was obtained and phylogenetic, mutation, substitution and recombinant analyses were performed. DENV-NS1 positive serum samples were collected from dengue fever patients, and complete genome sequences were obtained through RT-qPCR from these serum samples. Phylogenetic trees were then constructed by maximum likelihood phylogeny test (MEGA7.0), followed by analysis of nucleotide mutation and amino acid substitution. The recombination events among DENVs were also analyzed by RDP4 package. The diversity analysis of secondary structure for translated viral proteins was also performed. The complete genome sequences of four amplified viruses (YNXJ10, YNXJ12, YNXJ13, and YNXJ16) were 10,742, 10,742, 10,741, and 10,734 nucleotides in length, and phylogenetic analysis classified the viruses as cosmopolitan genotype of DENV-2. All viruses were close to DENV Singapore 2013 (KX380828.1) and the DENV China 2013 (KF479233.1). In comparison to DENV-2SS (M29095), the total numbers of base substitutions were 712 nt (YNXJ10), 809 nt (YNXJ12), 772 nt (YNXJ13), and 841 nt (YNXJ16), resulting in 109, 171, 130, and 180 amino acid substitutions in translated regions, respectively. In addition, compared with KX380828.1, there were 44, 105, 64, and 116 amino acid substitutions in translated regions, respectively. The highest mutation rate occurred in the prM region, and the lowest mutation rate occurred in the NS4B region. Most of the recombination events occurred in the prM, E and NS2B/3 regions, which corresponded with the mutation frequency of the related portion. Secondary structure prediction within the 3,391 amino acids of DENV structural proteins showed there were 7 new possible nucleotide-binding sites and 6 lost sites compared to DENV-2SS. In addition, 41 distinct amino acid changes were found in the helix regions, although the distribution of the exposed and buried regions changed only slightly. Our findings may help to understand the intrinsic geographical relatedness of DENV-2 and contributes to the understanding of viral evolution and its impact on the epidemic potential and pathogenicity of DENV.

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Early rigorous control interventions can largely reduce dengue outbreak magnitude: experience from Chaozhou, China.

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