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Interface."],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:p>Over 105 million dengue infections are estimated to occur annually. Understanding the disease dynamics of dengue is often difficult due to multiple strains circulating within a population. Interactions between dengue serotype dynamics may result in complex cross-immunity dynamics at the population level and create difficulties in terms of formulating intervention strategies for the disease. In this study, a nationally representative 16-year time series with over 43 000 serotyped dengue infections was used to infer the long-run effects of between and within strain interactions and their impacts on past outbreaks. We used a novel identification strategy incorporating sign-identified Bayesian vector autoregressions, using structural impulse responses, historical decompositions and counterfactual analysis to conduct inference on dengue dynamics post-estimation. We found that on the population level: (i) across-serotype interactions on the population level were highly persistent, with a one time increase in any other serotype associated with long run decreases in the serotype of interest (range: 0.5\u20132.5 years) and (ii) over 38.7% of dengue cases of any serotype were associated with across-serotype interactions. The findings in this paper will substantially impact public health policy interventions with respect to dengue.<\/jats:p>","DOI":"10.1098\/rsif.2021.0565","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T23:05:34Z","timestamp":1631660734000},"page":"20210565","update-policy":"https:\/\/doi.org\/10.1098\/crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["Hyperendemicity associated with increased dengue burden"],"prefix":"10.1098","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2245-0331","authenticated-orcid":true,"given":"Jue Tao","family":"Lim","sequence":"first","affiliation":[{"name":"Environmental Health Institute, National Environmental Agency, Singapore"},{"name":"Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borame Sue","family":"Dickens","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken Wei","family":"Tan","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel Ruihan","family":"Koo","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annabel","family":"Seah","sequence":"additional","affiliation":[{"name":"Environmental Health Institute, National Environmental Agency, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soon Hoe","family":"Ho","sequence":"additional","affiliation":[{"name":"Environmental Health Institute, National Environmental Agency, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Ong","sequence":"additional","affiliation":[{"name":"Environmental Health Institute, National Environmental Agency, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayanthi","family":"Rajarethinam","sequence":"additional","affiliation":[{"name":"Environmental Health Institute, National Environmental Agency, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy","family":"Soh","sequence":"additional","affiliation":[{"name":"Environmental Health Institute, National Environmental Agency, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex R.","family":"Cook","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee Ching","family":"Ng","sequence":"additional","affiliation":[{"name":"Environmental Health Institute, National Environmental Agency, Singapore"},{"name":"School of Biological Sciences, Nanyang Technological University, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"175","published-online":{"date-parts":[[2021,9,15]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aax4144"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1952.1.30"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-45816-6"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1098\/rsif.2013.0414"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32560-1"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.17-0819"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-016-1606-z"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0602960103"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3156.2003.01177.x"},{"key":"e_1_3_5_11_2","unstructured":"NEA. 2020 Dengue Cases. 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