Dynamics and determinants of the force of infection of dengue virus from 1994 to 2015 in Managua, Nicaragua

Significance A recently licensed dengue vaccine requires pre-vaccination screening for dengue virus (DENV)-specific antibodies and was initially recommended for use only in areas with high DENV transmission. However, DENV transmission intensity is not static. We show that the age at which children acquired DENV-specific immunity more than doubled during the observational period (2004–2015) of a pediatric cohort study in Managua, Nicaragua. A high force of infection of DENV in the 1990s could be explained by the introduction of a novel DENV serotype, while a gradual decline in force of infection could be explained by a long-term population demographic transition. Such dynamics make DENV transmission intensity a problematic metric for designing, implementing, and evaluating interventions and for selecting target age groups/sites.