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Epidemiology of dengue virus infections

Author
Alan L Rothman, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

The viral etiology of dengue was established in the 1940s, and records of dengue-like illness date back more than 200 years [1]. Major changes in the epidemiology of dengue virus infections began after World War II and have continued to date. Given estimates of 390 million infections worldwide each year and over 2.5 billion individuals at risk for infection [2], the dengue viruses are arguably the most important arthropod-borne viruses from a medical and public health perspective.

The cardinal features of the dengue virus transmission cycle, the characteristics of the mosquito vectors, and the factors that contribute to dengue virus transmission in the major affected regions will be reviewed here. The pathogenesis, clinical manifestations, diagnosis, treatment, and prevention of dengue virus infection are discussed separately. (See "Pathogenesis of dengue virus infection" and "Clinical manifestations and diagnosis of dengue virus infection" and "Prevention and treatment of dengue virus infection".)

CLASSIFICATION

Dengue viruses are members of the family Flaviviridae, genus Flavivirus [3,4]. The dengue virus complex comprises at least four antigenically related but distinct viruses, designated dengue virus serotypes 1 through 4. All dengue viruses are mosquito-borne human pathogens that exclusively cause acute infection.

TRANSMISSION CYCLE

Both epidemic and endemic transmission of dengue viruses are maintained through a human-mosquito-human cycle involving mosquitoes of the genus Aedes (Stegomyia) [5]. Transmission of dengue viruses between mosquitoes and nonhuman primates has been demonstrated in Asia and Africa, but there is no evidence that such transmission is an important reservoir for transmission to humans [5,6].

Susceptible humans become infected after being bitten by an infected female Aedes mosquito. Viremia in humans begins toward the end of a four- to six-day incubation period and persists until fever abates, which is typically three to seven days [7,8]. An uninfected Aedes mosquito may acquire the virus after feeding during this viremic period. The mosquito has an incubation period of 8 to 12 days before it is capable of transmitting the virus to susceptible individuals. Once infected, mosquitoes carry the virus for their lifespan and remain infective for humans.

                      

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