{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T08:09:28Z","timestamp":1784534968040,"version":"3.55.0"},"posted":{"date-parts":[[2026,7,16]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":54,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"funder":[{"name":"National Institutes of Health Fogarty International Center","award":["K01 TW012177"],"award-info":[{"award-number":["K01 TW012177"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,7,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Dengue is intensifying globally due to climate change, urbanization, and land use changes. In Nepal, dengue has expanded from lowland regions to higher altitudes, with record outbreaks in 2022 and 2023. However, reliance on passive surveillance and hospital-based studies may underestimate community-level infection burden.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    We conducted a population-based serologic cohort study in Kathmandu and Kavrepalanchok districts, Nepal, enrolling a geographically representative, age-stratified random sample of residents aged 0\u201325 years from pre-defined hospital catchment areas. Enrollment occurred in two phases: Phase I (February 2019 to April 2021) with follow-up visits at approximately 3, 6, and 12 months, and Phase II (February to June 2023) revisiting the original cohort. At each household visit, we collected capillary blood samples by finger-prick onto filter paper and tested the samples for IgG responses against dengue-derived recombinant antigen using InBios DENV Detect\n                    <jats:sup>TM<\/jats:sup>\n                    ELISA. Serostatus was classified using the manufacturer\u2019s recommended immune status ratio (ISR) cutoffs. We calculated seroprevalence at each time point and estimated seroincidence rates by identifying seroconversion events per 1,000 person-years. We assessed risk factors using multivariable regression models.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Between 2019 and 2023, we enrolled 840 participants and collected 2,082 blood samples. The overall seroincidence rate was 33.8 per 1,000 person-years (95% CI [24.9-45.0]), with the highest rates in urban Kathmandu ([105.7], 95% CI [75.1-144.4]). Seroincidence increased with age and over time from 46.1 in 2019 to 51.0 in 2023. Participants living with a dengue-positive individual in the same household (adjusted RR [4.65], 95% CI [2.72\u20138.0]) and households with water-filled flower basins (adjusted RR [2.53], 95% CI [1.28\u20135.74]) had significantly higher risk of seroconversion.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study reveals a significant and increasing burden of dengue infection in the Kathmandu Valley between 2019 and 2023. highlighting an urgent need for immediate public health interventions to mitigate dengue\u2019s rise in Nepal\u2019s higher-altitude regions.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.07.14.26357903","type":"posted-content","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T21:40:11Z","timestamp":1784238011000},"source":"Crossref","is-referenced-by-count":0,"title":["Rising dengue burden in high-altitude central Nepal: evidence from a population-based longitudinal serosurvey, 2019-2023"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2729-1241","authenticated-orcid":false,"given":"Aastha","family":"Shrestha","sequence":"first","affiliation":[{"name":"Center for Infectious Disease Research and Surveillance, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal"},{"name":"Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melina","family":"Thapa","sequence":"additional","affiliation":[{"name":"Center for Infectious Disease Research and Surveillance, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Nepal"},{"name":"Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, 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