ArticlePLoS pathogens2018
Contributions from the silent majority dominate dengue virus transmission.
Article in PLoS pathogens, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 99 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
99 citing papers in PubMed, 3 syntheses or guidelines pooled it, 176 citations in OpenAlex.
- Mechanistic models for West Nile virus transmission: a systematic review of features, aims and parametrization.Proceedings. Biological sciences · 2024Pooled it
- Mathematical models for dengue fever epidemiology: A 10-year systematic review.Physics of life reviews · 2022Pooled it
- The worldwide seroprevalence of DENV, CHIKV and ZIKV infection: A systematic review and meta-analysis.PLoS neglected tropical diseases · 2021Pooled it
- Trial
- Community perspectives on treating asymptomatic infections for malaria elimination in The Gambia.Malaria journal · 2019Trial
- Genetic divergence in Aedes aegypti mosquitoes potentially associated with enhanced capacity for arbovirus transmission.BMC biology · 2026Article
- Longitudinal analysis of viral and host RNA in blood and saliva during controlled human dengue virus 3 infections.Journal of virology · 2026Article
- Dengue and chikungunya virus transmission in Kinshasa, Democratic Republic of the Congo.medRxiv : the preprint server for health sciences · 2026Article
- Long-term antibody dynamics challenge the paradigm of lifelong homotypic immunity to dengue virus.Proceedings of the National Academy of Sciences of the United States of America · 2026Article
- Presence of Dengue Virus NS1 antigen and IgM and IgG antibodies in asymptomatic individuals in Ecuadorian Amazonia - a descriptive repeated cross-sectional community-based survey.New microbes and new infections · 2026Article
- Silent reservoir species are shaping the emergence of Usutu virus.Nature ecology & evolution · 2026Article
- Unreported Rift Valley fever virus circulation during 2023-2024 El Niño event detected by slaughterhouse-based surveillance in southern Kenya.Scientific reports · 2026Article
- Entomo-Molecular and Epidemiological Survey of Arboviruses inResearch and reports in tropical medicine · 2026Article
- Monitoring Dengue Virus inViruses · 2025Article
- Methodological Approach for Dengue Viral Load Quantification in Wastewater: Protocol for a Systematic Review and Meta-Analysis.JMIR research protocols · 2025Article
- Inside-out: modelling the link between Zika virus viral dynamics within hosts and transmission to vectors across host species and virus strains.Journal of the Royal Society, Interface · 2025Article
- Multivariate resilience indicators to anticipate vector-borne disease outbreaks: A West Nile virus case-study.PLoS computational biology · 2025Article
- Afucosylation of anti-dengue IgG is associated with enhanced susceptibility to dengue virus infection postvaccination.Science translational medicine · 2025Article
- An explainable covariate compartmental model for predicting the spatio-temporal patterns of dengue in Sri Lanka.PLoS computational biology · 2025Article
- Dengue Infections Among Household Contacts of Symptomatic Index Cases: Implications for Community-Based Intervention Studies.Viruses · 2025Article
39 more citing papers are in PubMed but not listed here.
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Authors and funding
13 authors at 8 institutions in 3 countries.
Funding
Abstract
Despite estimates that, each year, as many as 300 million dengue virus (DENV) infections result in either no perceptible symptoms (asymptomatic) or symptoms that are sufficiently mild to go undetected by surveillance systems (inapparent), it has been assumed that these infections contribute little to onward transmission. However, recent blood-feeding experiments with Aedes aegypti mosquitoes showed that people with asymptomatic and pre-symptomatic DENV infections are capable of infecting mosquitoes. To place those findings into context, we used models of within-host viral dynamics and human demographic projections to (1) quantify the net infectiousness of individuals across the spectrum of DENV infection severity and (2) estimate the fraction of transmission attributable to people with different severities of disease. Our results indicate that net infectiousness of people with asymptomatic infections is 80% (median) that of people with apparent or inapparent symptomatic infections (95% credible interval (CI): 0-146%). Due to their numerical prominence in the infectious reservoir, clinically inapparent infections in total could account for 84% (CI: 82-86%) of DENV transmission. Of infections that ultimately result in any level of symptoms, we estimate that 24% (95% CI: 0-79%) of onward transmission results from mosquitoes biting individuals during the pre-symptomatic phase of their infection. Only 1% (95% CI: 0.8-1.1%) of DENV transmission is attributable to people with clinically detected infections after they have developed symptoms. These findings emphasize the need to (1) reorient current practices for outbreak response to adoption of pre-emptive strategies that account for contributions of undetected infections and (2) apply methodologies that account for undetected infections in surveillance programs, when assessing intervention impact, and when modeling mosquito-borne virus transmission.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.