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Dengue virus circulation and association with epidemics and severe dengue disease were studied in hospitalized children with suspected dengue at the Queen Sirikit National Institute of Child Health in Bangkok, Thailand, from 1973 to 1999. Dengue serology was performed on all patients and viral isolation attempted on laboratory-confirmed patients. Acute dengue was diagnosed in 15,569 children and virus isolated from 4,846. DEN-3 was the most frequent serotype in primary dengue (49% of all isolates), DEN-2 in secondary and in dengue hemorrhagic fever (37% and 35%, respectively). The predominant dengue serotype varied by year: DEN-1 from 1990–92, DEN-2 from 1973–86 and 1988–89; DEN-3 in 1987 and 1995–99; and DEN-4 from 1993–94. Only DEN-3 was associated with severe outbreak years. Our findings illustrate the uniqueness of each serotype in producing epidemics and severe disease and underscore the importance of long-term surveillance of dengue serotypes in understanding the epidemiology of these viruses.
Received January 17, 2002. Accepted for publication August 29, 2002.
Acknowledgments: We thank the doctors and nurses at the Queen Sirikit National Institute of Child Health for their outstanding patient care and participation in this study, and the staff members at the Department of Virology, Armed Forces Research Institute of Medical Sciences, over the past 27 years who have carefully performed diagnostic testing, data entry, and specimen archival. We also thank Dr. Daniel Libraty for his critical reading of this manuscript and Dr. Scott Halstead for sharing his thoughts and vast knowledge base, and giving his comments and suggestions on improving the manuscript.
Financial support: This work was funded by the U.S. Army Medical Research and Materiel Command, Fort Detrick, MD.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the official views of the United States Army or the Department of Defense.
Reprint requests: Timothy P. Endy, Division of Virology, U.S. Army Medical Research Institute for Infectious Diseases, 1425 Porter St., Fort Detrick, MD 21702-5011
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