Reconstructing long-term dengue virus immunity in French Polynesia

AbstractBackgroundUnderstanding 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.MethodologyWe 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 FindingsEight 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. Reporting probabilities for DENV-2–DENV-4 were 0.1-2.6 and 0.7-2.3 times that for DENV-1, for primary and secondary infections, respectively. 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 / SignificanceBy 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.Author summaryCharacterising the true extent of dengue circulation and the level of population immunity is essential to assess the burden of disease, evaluate epidemic risk and organise prevention strategies against future epidemics. However, this is difficult in a context where most people who are infected by dengue virus (DENV) only have mild symptoms which may not be reported to surveillance systems. In this article, we develop a mathematical model to evaluate the fraction of unreported dengue infections from case data. The key idea is to introduce reporting probabilities that depend on the infecting serotype and the infection history of patients. These factors are known to contribute to variations in the severity of symptoms and hence the reporting probabilities, but have rarely been taken into account in model frameworks to study population immunity from the case data. Using the developed model, we study long-term dengue virus immunity in French Polynesia.