Transmission dynamics of dengue in Malaysia

Dengue has become one of the most important vector borne diseases endangering human health. The burden of dengue will continue to increase if more effective methods of controlling dengue are not found. Therefore, understanding the transmission dynamics of dengue is important so that efficient and effective control programmes can be developed. I focused my research in Malaysia, particularly Selangor, one of the state with the highest reported dengue incidence. In this thesis, I showed two methods of estimating dengue transmission parameter. First was estimating the force of infection from age-stratified case notification data. Second, using a basic catalytic model, I estimated the force of infection and R0 from the seroprevalence data. Using both methods, my force of infection and R0 estimates for Selangor was comparable with other SE Asia countries. I used the parameters estimated from our data in a model of dengue transmission to assess the potential impact of dengue vaccination in Malaysia. I parameterised my model using the results from the phase 3 clinical trials of the leading vaccine candidate (CYD-TDV). My result shows that for a vaccine with the complex profile of efficacy shown by CYD-TDV, the impact of vaccination is critically hinge on the age of vaccination and the transmission intensity of dengue (R0 ) in the vaccinated population. Our results have shown that as R0 decreases, the optimal age of vaccination increase. My model also shows that vaccination can have a moderate impact on dengue disease incidence, but not sufficient to stop transmission except perhaps in very low transmission settings.Open Acces