Nationally-representative serostudy of dengue in Bangladesh allows generalizable disease burden estimates
- Institut Pasteur, France
- icddr,b, Bangladesh
- University of California, San Francisco, United States
- Institute of Epidemiology, Disease Control and Research, Bangladesh
- Centers for Disease Control and Prevention, United States
- Johns Hopkins Bloomberg School of Public Health, United States
Abstract
Serostudies are needed to answer generalizable questions on disease risk. However, recruitment is usually biased by age or location. We present a nationally-representative study for dengue from 70 communities in Bangladesh. We collected data on risk factors, trapped mosquitoes and tested serum for IgG. Out of 5,866 individuals, 24% had evidence of historic infection, ranging from 3% in the north to >80% in Dhaka. Being male (aOR:1.8, [95%CI:1.5-2.0]) and recent travel (aOR:1.3, [1.1-1.8]) were linked to seropositivity. Using catalytic models, we estimate that 40 million [34.3-47.2] people have been infected with 2.4 million ([1.3-4.5]) annual infections. Had we visited only 20 communities, seropositivity estimates would have ranged from 13% to 37%, highlighting the lack of representativeness generated by small numbers of communities. Our findings have implications for both the design of serosurveys and tackling dengue in Bangladesh.
Data availability
All data generated or analysed during this study are included in the manuscript and supporting files with the exception of precise coordinate information of households.
Article and author information
Author details
Isabel Rodriguez-Barraquer
Funding
Centers for Disease Control and Prevention
- Henrik Salje
- Emily Gurley
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Reviewing Editor
- Ben Cooper, Mahidol Oxford Tropical Medicine Research Unit, Thailand
Ethics
Human subjects: This study was approved by the icddr,b ethical review board. (protocol number PR-14058). The U.S. Centers for Disease Control and Prevention relied on icddr,b's ethical review board approval. All adult participants provided written, informed consent after receiving detailed explanation of the study and procedures. Parents/guardians of all child participants were asked to provide written, informed consent on their behalf.
Version history
- Received: October 15, 2018
- Accepted: April 4, 2019
- Accepted Manuscript published: April 8, 2019 (version 1)
- Version of Record published: May 13, 2019 (version 2)
- Version of Record updated: May 16, 2019 (version 3)
Copyright
This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
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Nationally-representative serostudy of dengue in Bangladesh allows generalizable disease burden estimates
eLife 8:e42869.
https://doi.org/10.7554/eLife.42869
Further reading
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Background:
Circulating omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) have been associated with various chronic diseases and mortality, but results are conflicting. Few studies examined the role of omega-6/omega-3 ratio in mortality.
Methods:
We investigated plasma omega-3 and omega-6 PUFAs and their ratio in relation to all-cause and cause-specific mortality in a large prospective cohort, the UK Biobank. Of 85,425 participants who had complete information on circulating PUFAs, 6461 died during follow-up, including 2794 from cancer and 1668 from cardiovascular disease (CVD). Associations were estimated by multivariable Cox proportional hazards regression with adjustment for relevant risk factors.
Results:
Risk for all three mortality outcomes increased as the ratio of omega-6/omega-3 PUFAs increased (all Ptrend <0.05). Comparing the highest to the lowest quintiles, individuals had 26% (95% CI, 15–38%) higher total mortality, 14% (95% CI, 0–31%) higher cancer mortality, and 31% (95% CI, 10–55%) higher CVD mortality. Moreover, omega-3 and omega-6 PUFAs in plasma were all inversely associated with all-cause, cancer, and CVD mortality, with omega-3 showing stronger effects.
Conclusions:
Using a population-based cohort in UK Biobank, our study revealed a strong association between the ratio of circulating omega-6/omega-3 PUFAs and the risk of all-cause, cancer, and CVD mortality.
Funding:
Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institute of Health under the award number R35GM143060 (KY). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
