Epidemic dengue transmission in southern Sumatra, Indonesia

Andrew Lee Corwin*, Ria Purwita Larasati, Michael J. Bangs, Suharyono Wuryadi, Sumarjati Arjoso, Nono Sukri, Erlin Listyaningsih, Sri Hartati, Rozali Namursa, Zarkasih Anwar, Surya Chandra, Benny Loho, Holani Ahmad, James R. Campbell, Kevin R. Porter

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

96 Scopus citations


An outbreak of dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) in the city of Palembang, south Sumatra, Indonesia was investigated to (i) validate epidemic occurrence, (ii) confirm dengue virus aetiology and associated serotype (s), (iii) provide a demonstrable measure of community impact, and (iv) identify causative relationship (if any) with climatic El Niño Southern Oscillation (ENSO) influences. Trend analysis based on a 6-year retrospective review of hospital records demonstrates a 3-fold increase in clinical cases for the outbreak period (January-April 1998), relative to historical records. In the 2 hospitals surveyed, the monthly mean number of outbreak-related dengue cases over 4 months was 833 (range 650-995 cases/month); the mean monthly value for the previous 72 months was 107 (range 14-779 cases/month). An apparent trend in epidemic transmission was observed, evolving from a 5-year cyclic phenomenon to an annual occurrence, often indistinguishable from one year to the next. The proportional distribution of clinical outbreak cases into DF, DHF and DSS diagnostic categories was 24%, 66%, and 10%, respectively. The population aged 10-19 years accounted for the largest (35%) proportion of hospitalized DHF cases, followed by children aged 5-9 years (25%) and children aged 4 years (16%). Serum samples obtained during acute illness from 221 hospitalized patients were examined using serology, RT-PCR, and virus isolation in cell culture: 59% of samples had laboratory evidence of a dengue infection. All 4 dengue virus serotypes (DEN 1-4) were identified in epidemic circulation, with DEN 3 predominating (43%). DEN 1 was the principal serotype associated with less severe dengue illness, suggesting that virulence may be, in part, a function of infecting serotype. The climatic influence of ENSO on rainfall and temperature in the months leading up to and during the outbreak was dramatic, and is likely to contribute to favourable outbreak conditions.

Original languageEnglish
Pages (from-to)257-265
Number of pages9
JournalTransactions of the Royal Society of Tropical Medicine and Hygiene
Issue number3
StatePublished - 2001
Externally publishedYes


  • Age-groups
  • Climate
  • Dengue fever
  • Dengue haemorrhagic fever
  • Dengue shock syndrome
  • Epidemic
  • Indonesia
  • Serotypes
  • Time trends


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