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Background: Obesity and diabetes are known risk factors for severe dengue. Therefore, we sought to investigate the association of obesity with increased risk of hospitalization, as there is limited information. Methods and findings: Children aged 10 to 18 years (n = 4782), were recruited from 9 districts in Sri Lanka using a stratified multi-stage cluster sampling method. Details of previous admissions to hospital due to dengue and anthropometric measurements were recorded and seropositivity rates for dengue were assessed. The body mass index (BMI) centile in children aged 10 to 18, was derived by plotting the values on the WHO BMI-for-age growth charts, to acquire the percentile ranking. Results: Although the dengue seropositivity rates were similar in children of the different BMI centiles, 12/66 (18.2%) seropositive children with a BMI centile >97th, had been hospitalized for dengue, compared to 103/1086 (9.48%) of children with a BMI centile of <97th. The logistic regression model suggested that BMI centiles 50th to 85th (OR = 1.06, 95% CI, 1.00 to 1.11, p = 0.048) and BMI centile of >97th (OR 2.33, 95% CI, 1.47 to 3.67, p = 0.0003) was significantly associated with hospitalization when compared to children in other BMI categories. Conclusions: Obesity appears to be associated with an increased risk of hospitalization in dengue, which should be further investigated in longitudinal prospective studies. With the increase in obesity in many countries, it would be important to create awareness regarding obesity and risk of severe disease and hospitalization in dengue. Author summary: Although obesity and diabetes are known risk factors for severe dengue, there is limited information on whether they are risk factors for increased hospitalization due to dengue. To investigate this, we studied the association of obesity with hospitalization rates for dengue, in children aged 10 to 18 years (n = 4782), who were recruited from 9 districts in Sri Lanka using a stratified multi-stage cluster sampling method. Details of previous admissions to hospital due to dengue and anthropometric measurements were recorded and seropositivity rates for dengue were assessed. The body mass index centile (BMI) in children aged 10 to 18, was derived by plotting the values on the WHO BMI-for-age growth charts, to acquire the percentile ranking. We found that BMI centiles 50th to 85th and BMI centile of >97th were significantly associated with hospitalization rates when compared to children in other BMI categories, which should be further investigated in longitudinal prospective studies. [ABSTRACT FROM AUTHOR]

We sought to understand the differences in age‐stratified seroprevalence rates in different regions in Sri Lanka to plan dengue vaccination programs, especially as the WHO has given guidance to vaccinate in high transmission settings. Age stratified seroprevalence rates were assessed in children, aged 10−20 years, in nine districts representing the nine provinces in Sri Lanka, from September 2022 to March 2023. A stratified multistage cluster was used to select 146 schools representing each district. Of the 5207 children recruited, the overall dengue seroprevalence rates in children was 24.8%, with the highest rates reported from Trincomalee (54.3%) and the lowest rates from Badulla (14.2%), which is a high‐altitude estate area. While the age‐stratified seroprevalence rates increased in some districts such as Trincomalee, Jaffna, Gampaha, and Ratnapura, which reported the highest seropositivity rates, there was no such increase with age in the other districts. There was a weak correlation between the dengue antibody positivity rates and age in most districts which had seroprevalence rates of >25%, while there was no increase in antibody titers with age in the other districts. The seroprevalence rates was significantly higher in urban areas (35.8%) compared to rural (23.2%) and estate areas (9.4%), although there was no association with seropositivity rates with population density (Spearman's r = −0.01, p = 0.98), in each district. The seroprevalence rates in many districts were very different to those reported from Colombo, with many districts reporting low transmission rates. These data would be important to consider when rolling out dengue vaccines in Sri Lanka. [ABSTRACT FROM AUTHOR]