Long-term persistence of monotypic dengue transmission in small size isolated populations, French Polynesia, 1978-2014

Effects of boosting and waning in highly exposed populations on dengue epidemic dynamics

Sequential infection with multiple dengue virus (DENV) serotypes is thought to induce enduring protection against dengue disease. However, long-term antibody waning has been observed after repeated DENV infection. Here, we provide evidence that highly immune Nicaraguan children and adults (n = 4478) experience boosting and waning of antibodies during and after major Zika and dengue epidemics. We develop a susceptible-infected-recovered-susceptible (SIRS-type) model that tracks immunity by titer rather than number of infections to show that boosts in highly immune individuals can contribute to herd immunity, delaying their susceptibility to transmissible infection. In contrast, our model of lifelong immunity in highly immune individuals, as previously assumed, results in complete disease eradication after introduction. Periodic epidemics under this scenario can only be sustained with a constant influx of infected individuals into the population or a high basic reproductive number. We also find that Zika virus infection can boost DENV immunity and produce delays and then surges in dengue epidemics, as observed with real epidemiological data. This work provides insight into factors shaping periodicity in dengue incidence and may inform vaccine efforts to maintain population immunity.

Wavelet clustering analysis as a tool for characterizing community structure in the human microbiome

Human microbiome research is helped by the characterization of microbial networks, as these may reveal key microbes that can be targeted for beneficial health effects. Prevailing methods of microbial network characterization are based on measures of association, often applied to limited sampling points in time. Here, we demonstrate the potential of wavelet clustering, a technique that clusters time series based on similarities in their spectral characteristics. We illustrate this technique with synthetic time series and apply wavelet clustering to densely sampled human gut microbiome time series. We compare our results with hierarchical clustering based on temporal correlations in abundance, within and across individuals, and show that the cluster trees obtained by using either method are significantly different in terms of elements clustered together, branching structure and total branch length. By capitalizing on the dynamic nature of the human microbiome, wavelet clustering reveals community structures that remain obscured in correlation-based methods.

Considering waning immunity to better explain dengue dynamics

Life-long serotype-specific immunity following dengue virus infection may not always occur, but the true extent of this effect is unknown. Analysis of more than 20 years of monotypic epidemics in the isolated French Polynesian islands revealed that whilst the risk of symptomatic dengue infection did conform to the classical paradigms of homotypic immunity and increased disease risk in heterotypic secondary infections, incorporation of waning immunity improved the ability of epidemiological models to capture the observed epidemic dynamics. Not only does this show how inclusion of waning immunity into classical models can reveal important facets of the immune response to natural dengue virus infection, it also has significant ramifications for vaccine development and implementation in dengue endemic areas.

Reconstructing long-term dengue virus immunity in French Polynesia

BACKGROUND

Understanding the underlying risk of infection by dengue virus from surveillance systems is complicated due to the complex nature of the disease. In particular, the probability of becoming severely sick is driven by serotype-specific infection histories as well as age; however, this has rarely been quantified. Island communities that have periodic outbreaks dominated by single serotypes provide an opportunity to disentangle the competing role of serotype, age and changes in surveillance systems in characterising disease risk.

METHODOLOGY

We develop mathematical models to analyse 35 years of dengue surveillance (1979-2014) and seroprevalence studies from French Polynesia. We estimate the annual force of infection, serotype-specific reporting probabilities and changes in surveillance capabilities using the annual age and serotype-specific distribution of dengue.

PRINCIPAL FINDINGS

Eight dengue epidemics occurred between 1979 and 2014, with reporting probabilities for DENV-1 primary infections increasing from 3% to 5%. The reporting probability for DENV-1 secondary infections was 3.6 times that for primary infections. We also observed heterogeneity in reporting probabilities by serotype, with DENV-3 having the highest probability of being detected. Reporting probabilities declined with age after 14 y.o. Between 1979 and 2014, the proportion never infected declined from 70% to 23% while the proportion infected at least twice increased from 4.5% to 45%. By 2014, almost half of the population had acquired heterotypic immunity. The probability of an epidemic increased sharply with the estimated fraction of susceptibles among children.

CONCLUSION/SIGNIFICANCE

By analysing 35 years of dengue data in French Polynesia, we characterised key factors affecting the dissemination profile and reporting of dengue cases in an epidemiological context simplified by mono-serotypic circulation. Our analysis provides key estimates that can inform the study of dengue in more complex settings where the co-circulation of multiple serotypes can greatly complicate inference.

How heterogeneous is the dengue transmission profile in Brazil? A study in six Brazilian states

Dengue is a vector-borne disease present in most tropical countries, infecting an average of 50 to 100 million people per year. Socioeconomic, demographic, and environmental factors directly influence the transmission cycle of the dengue virus (DENV). In Brazil, these factors vary between regions producing different profiles of dengue transmission and challenging the epidemiological surveillance of the disease. In this article, we aimed at classifying the profiles of dengue transmission in 1,823 Brazilian municipalities, covering different climates, from 2010 to 2019. Time series data of dengue cases were obtained from six states: Ceará and Maranhão in the semiarid Northeast, Minas Gerais in the countryside, Espírito Santo and Rio de Janeiro in the tropical Atlantic coast, and Paraná in the subtropical region. To describe the time series, we proposed a set of epi-features of the magnitude and duration of the dengue epidemic cycles, totaling 13 indicators. Using these epi-features as inputs, a multivariate cluster algorithm was employed to classify the municipalities according to their dengue transmission profile. Municipalities were classified into four distinct dengue transmission profiles: persistent transmission (7.8%), epidemic (21.3%), episodic/epidemic (43.2%), and episodic transmission (27.6%). Different profiles were associated with the municipality’s population size and climate. Municipalities with higher incidence and larger populations tended to be classified as persistent transmission, suggesting the existence of critical community size. This association, however, varies depending on the state, indicating the importance of other factors. The proposed classification is useful for developing more specific and precise surveillance protocols for regions with different dengue transmission profiles, as well as more precise public policies for dengue prevention.

Dengue is one of the fastest-growing vector-borne diseases in the world. Currently, vaccines are experimental and are not very effective, so prevention depends on the control of the mosquito Aedes aegypti. Health promotion campaigns aimed at encouraging people to reduce mosquito breeding sites have limited effect. In addition, the heterogeneity of the territories that have dengue becomes a major challenge for the epidemiological surveillance of the disease. Brazil has a territory of continental size, and single standardized surveillance is not very effective for monitoring this arbovirus. Classifying types of dengue dynamics based on features of the epidemiological cycle in each location has the potential to increase the precision of surveillance and control strategies. In our study, we were able to classify areas according to different dengue transmission profiles, ranging from episodic to persistent transmission. These results can provide tools to guide actions aimed at achieving the World Health Organization’s goals of eliminating neglected tropical diseases in countries that have the virus.

The Absence of Yellow Fever in Asia: History, Hypotheses, Vector Dispersal, Possibility of YF in Asia, and Other Enigmas

Since the recent epidemics of yellow fever in Angola and Brazil as well as the importation of cases to China in 2016, there has been an increased interest in the century-old enigma, absence of yellow fever in Asia. Although this topic has been repeatedly reviewed before, the history of human intervention has never been considered a critical factor. A two-stage literature search online for this review, however, yielded a rich history indispensable for the debate over this medical enigma. As we combat the pandemic of COVID-19 coronavirus worldwide today, we can learn invaluable lessons from the historical events in Asia. In this review, I explore the history first and then critically examine in depth major hypotheses proposed in light of accumulated data, global dispersal of the principal vector, patterns of YF transmission, persistence of urban transmission, and the possibility of YF in Asia. Through this process of re-examination of the current knowledge, the subjects for research that should be conducted are identified. This review also reveals the importance of holistic approach incorporating ecological and human factors for many unresolved subjects, such as the enigma of YF absence in Asia, vector competence, vector dispersal, spillback, viral persistence and transmission mechanisms.