Dengue virus infection: Epidemiology
- Stephen J Thomas, MD
Stephen J Thomas, MD
- Professor and Chief, Division of Infectious Diseases
- State University of New York, Upstate Medical University
- Alan L Rothman, MD
Alan L Rothman, MD
- University of Rhode Island
Records of dengue-like illness date back more than 200 years; the viral etiology of dengue virus was established in the 1940s [1,2]. Major changes in the epidemiology of dengue virus infections began after World War II, and geographic expansion of transmission has continued to date. Given estimates of 390 million infections worldwide each year and over 2.5 billion individuals at risk for infection , the dengue viruses remain 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 "Dengue virus infection: Pathogenesis" and "Dengue virus infection: Clinical manifestations and diagnosis" and "Dengue virus infection: Prevention and treatment".)
Dengue viruses are members of the family Flaviviridae, genus Flavivirus [4,5]. The dengue virus complex comprises at least four antigenically related but distinct viruses, designated dengue virus types 1 through 4. All dengue viruses are mosquito-borne human pathogens that exclusively cause acute infection.
Both epidemic and endemic transmission of dengue viruses are maintained through a human-mosquito-human cycle involving mosquitoes of the genus Aedes (Stegomyia) . 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 [6,7].
Susceptible humans become infected after an infected female Aedes mosquito takes a human blood meal. Viremia in humans begins toward the end of a four- to six-day incubation period and persists until around the time fever abates, which is typically three to seven days [8,9]. An uninfected Aedes mosquito may acquire the virus from an infected human if they feed during this time and the human viremia is of sufficient titer to support mosquito infection. The incubation period within the mosquito is 8 to 12 days; after this period, it is capable of transmitting the virus to humans. Once infected, mosquitoes carry the virus for their lifespan and remain infective.
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- TRANSMISSION CYCLE
- MOSQUITO VECTORS
- DISTRIBUTION OF AE. AEGYPTI MOSQUITOES
- Asia and Pacific
- - Southeast Asia
- - South Asia
- - Western Pacific islands
- - Australia
- Africa and Eastern Mediterranean
- - North America
- - Central America
- - Caribbean
- - South America
- PATTERNS OF TRANSMISSION
- Epidemic dengue
- Hyperendemic dengue
- FACTORS INFLUENCING TRANSMISSION
- OTHER ROUTES OF TRANSMISSION
- Nosocomial transmission
- Vertical transmission