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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Rush AB. An account of the bilious remitting fever, as it appeared in Philadelphia in the summer and autumn of the year 1780. In: Medical Inquiries and Observations, Richard & Hall, Philadelphia p.104.
- Ashburn PM, Craig CF, US Army Board for the Study of Tropical Diseases. Experimental investigations regarding the etiology of dengue fever. 1907. J Infect Dis 2004; 189:1747.
- Bhatt S, Gething PW, Brady OJ, et al. The global distribution and burden of dengue. Nature 2013; 496:504.
- Henchal EA, Putnak JR. The dengue viruses. Clin Microbiol Rev 1990; 3:376.
- Wilder-Smith A, Schwartz E. Dengue in travelers. N Engl J Med 2005; 353:924.
- Kuno G. Review of the factors modulating dengue transmission. Epidemiol Rev 1995; 17:321.
- Wang E, Ni H, Xu R, et al. Evolutionary relationships of endemic/epidemic and sylvatic dengue viruses. J Virol 2000; 74:3227.
- Gubler DJ. Epidemic dengue and dengue hemorrhagic fever: a global public health problem in the 21st century. In: Emerging Infections I, Scheld WM, Armstrong D, Hughes JM (Eds), ASM Press, Washington, DC 1998. p.1.
- Vaughn DW, Green S, Kalayanarooj S, et al. Dengue in the early febrile phase: viremia and antibody responses. J Infect Dis 1997; 176:322.
- Halstead SB. Selective primary health care: strategies for control of disease in the developing world. XI. Dengue. Rev Infect Dis 1984; 6:251.
- Harrington LC, Scott TW, Lerdthusnee K, et al. Dispersal of the dengue vector Aedes aegypti within and between rural communities. Am J Trop Med Hyg 2005; 72:209.
- Scott TW, Amerasinghe PH, Morrison AC, et al. Longitudinal studies of Aedes aegypti (Diptera: Culicidae) in Thailand and Puerto Rico: blood feeding frequency. J Med Entomol 2000; 37:89.
- Gratz NG. Critical review of the vector status of Aedes albopictus. Med Vet Entomol 2004; 18:215.
- Centers for Disease Control (CDC). Update: Aedes albopictus infestation--United States, Mexico. MMWR Morb Mortal Wkly Rep 1989; 38:440, 445.
- Caron M, Paupy C, Grard G, et al. Recent introduction and rapid dissemination of Chikungunya virus and Dengue virus serotype 2 associated with human and mosquito coinfections in Gabon, central Africa. Clin Infect Dis 2012; 55:e45.
- Savage HM, Fritz CL, Rutstein D, et al. Epidemic of dengue-4 virus in Yap State, Federated States of Micronesia, and implication of Aedes hensilli as an epidemic vector. Am J Trop Med Hyg 1998; 58:519.
- Pinheiro FP, Corber SJ. Global situation of dengue and dengue haemorrhagic fever, and its emergence in the Americas. World Health Stat Q 1997; 50:161.
- WHO Report on Global Surveillance of Epidemic-Prone Infectious Diseases. www.who.int/csr/resources/publications/dengue/CSR_ISR_2000_1/en (Accessed on October 08, 2014).
- DengueNet www.who.int/denguenet (Accessed on October 08, 2014).
- PanAmerican Health Organization. Dengue. http://new.paho.org/hq/index.php?option=com_content&task=view&id=264&Itemid=363&lang=en (Accessed on October 08, 2014).
- Undurraga EA, Halasa YA, Shepard DS. Use of expansion factors to estimate the burden of dengue in Southeast Asia: a systematic analysis. PLoS Negl Trop Dis 2013; 7:e2056.
- Qiu FX, Gubler DJ, Liu JC, Chen QQ. Dengue in China: a clinical review. Bull World Health Organ 1993; 71:349.
- Wartel TA, Prayitno A, Hadinegoro SR, et al. Three Decades of Dengue Surveillance in Five Highly Endemic South East Asian Countries. Asia Pac J Public Health 2017; 29:7.
- Kutsuna S, Kato Y, Moi ML, et al. Autochthonous dengue fever, Tokyo, Japan, 2014. Emerg Infect Dis 2015; 21:517.
- World Health Organization Regional Office of South-East Asia. Dengue fact sheet. http://www.searo.who.int/entity/vector_borne_tropical_diseases/data/data_factsheet/en/ (Accessed on October 09, 2014).
- Nealon J, Taurel AF, Capeding MR, et al. Symptomatic Dengue Disease in Five Southeast Asian Countries: Epidemiological Evidence from a Dengue Vaccine Trial. PLoS Negl Trop Dis 2016; 10:e0004918.
- Garg S, Chakravarti A, Singh R, et al. Dengue serotype-specific seroprevalence among 5- to 10-year-old children in India: a community-based cross-sectional study. Int J Infect Dis 2017; 54:25.
- World Health Organization Western Pacific Region. Dengue in the Western Pacific Region. http://www.wpro.who.int/emerging_diseases/Dengue/en/ (Accessed on October 09, 2014).
- Dengue in the WHO Western Pacific Region. Wkly Epidemiol Rec 1998; 73:273.
- Mackenzie JS, Broom AK, Hall RA, et al. Arboviruses in the Australian region, 1990 to 1998. Commun Dis Intell 1998; 22:93.
- Knope KE, Muller M, Kurucz N, et al. Arboviral diseases and malaria in Australia, 2013-14: Annual report of the National Arbovirus and Malaria Advisory Committee. Commun Dis Intell Q Rep 2016; 40:E400.
- Eisenhut M, Schwarz TF, Hegenscheid B. Seroprevalence of dengue, chikungunya and Sindbis virus infections in German aid workers. Infection 1999; 27:82.
- Sharp TW, Wallace MR, Hayes CG, et al. Dengue fever in U.S. troops during Operation Restore Hope, Somalia, 1992-1993. Am J Trop Med Hyg 1995; 53:89.
- Humphrey JM, Cleton NB, Reusken CB, et al. Dengue in the Middle East and North Africa: A Systematic Review. PLoS Negl Trop Dis 2016; 10:e0005194.
- Schaffner F, Medlock JM, Van Bortel W. Public health significance of invasive mosquitoes in Europe. Clin Microbiol Infect 2013; 19:685.
- Tomasello D, Schlagenhauf P. Chikungunya and dengue autochthonous cases in Europe, 2007-2012. Travel Med Infect Dis 2013; 11:274.
- Centers for Disease Control and Prevention (CDC). Imported dengue--United States, 1997 and 1998. MMWR Morb Mortal Wkly Rep 2000; 49:248.
- Rigau-Pérez JG, Gubler DJ, Vorndam AV, Clark GG. Dengue surveillance--United States, 1986-1992. MMWR CDC Surveill Summ 1994; 43:7.
- Centers for Disease Control and Prevention (CDC). Travel-associated dengue infections--United States, 2001-2004. MMWR Morb Mortal Wkly Rep 2005; 54:556.
- Centers for Disease Control and Prevention (CDC). Notes from the field: School reporting of a dengue outbreak--St. Croix, U.S. Virgin Islands, 2012. MMWR Morb Mortal Wkly Rep 2013; 62:172.
- Centers for Disease Control and Prevention (CDC). Imported dengue--United States, 1996. MMWR Morb Mortal Wkly Rep 1998; 47:544.
- Centers for Disease Control and Prevention (CDC). Dengue hemorrhagic fever--U.S.-Mexico border, 2005. MMWR Morb Mortal Wkly Rep 2007; 56:785.
- Thomas DL, Santiago GA, Abeyta R, et al. Reemergence of Dengue in Southern Texas, 2013. Emerg Infect Dis 2016; 22:1002.
- Centers for Disease Control and Prevention (CDC). Locally acquired Dengue--Key West, Florida, 2009-2010. MMWR Morb Mortal Wkly Rep 2010; 59:577.
- Effler PV, Pang L, Kitsutani P, et al. Dengue fever, Hawaii, 2001-2002. Emerg Infect Dis 2005; 11:742.
- Centers for Infectious Disease Research and Policy. News Scan for Oct 30, 2015: Hawaii dengue cases; Plague case in Oregon teen. http://www.cidrap.umn.edu/news-perspective/2015/10/news-scan-oct-30-2015 (Accessed on November 04, 2015).
- Johnston D, Viray M, Ushiroda J, et al. Notes from the Field: Outbreak of Locally Acquired Cases of Dengue Fever--Hawaii, 2015. MMWR Morb Mortal Wkly Rep 2016; 65:34.
- Siqueira JB Jr, Martelli CM, Coelho GE, et al. Dengue and dengue hemorrhagic fever, Brazil, 1981-2002. Emerg Infect Dis 2005; 11:48.
- McBride WJ, Mullner H, LaBrooy JT, Wronski I. The 1993 dengue 2 epidemic in North Queensland: a serosurvey and comparison of hemagglutination inhibition with an ELISA. Am J Trop Med Hyg 1998; 59:457.
- Gubler DJ. Dengue and dengue hemorrhagic fever: its history and resurgence as a global public health problem. In: Dengue and Dengue Hemorrhagic Fever, Gubler DJ, Kuno G (Eds), CAB International, Wallingford 1997. p.1.
- Kouri GP, Guzmán MG, Bravo JR, Triana C. Dengue haemorrhagic fever/dengue shock syndrome: lessons from the Cuban epidemic, 1981. Bull World Health Organ 1989; 67:375.
- Endy TP, Nisalak A, Chunsuttiwat S, et al. Spatial and temporal circulation of dengue virus serotypes: a prospective study of primary school children in Kamphaeng Phet, Thailand. Am J Epidemiol 2002; 156:52.
- Cummings DA, Irizarry RA, Huang NE, et al. Travelling waves in the occurrence of dengue haemorrhagic fever in Thailand. Nature 2004; 427:344.
- Burke DS, Nisalak A, Johnson DE, Scott RM. A prospective study of dengue infections in Bangkok. Am J Trop Med Hyg 1988; 38:172.
- Porter KR, Beckett CG, Kosasih H, et al. Epidemiology of dengue and dengue hemorrhagic fever in a cohort of adults living in Bandung, West Java, Indonesia. Am J Trop Med Hyg 2005; 72:60.
- Endy TP, Chunsuttiwat S, Nisalak A, et al. Epidemiology of inapparent and symptomatic acute dengue virus infection: a prospective study of primary school children in Kamphaeng Phet, Thailand. Am J Epidemiol 2002; 156:40.
- Hales S, Weinstein P, Woodward A. Dengue fever epidemics in the South Pacific: driven by El Niño Southern Oscillation? Lancet 1996; 348:1664.
- Dengue. Wkly Epidemiol Rec 1998; 73:185.
- Jetten TH, Focks DA. Potential changes in the distribution of dengue transmission under climate warming. Am J Trop Med Hyg 1997; 57:285.
- Hales S, de Wet N, Maindonald J, Woodward A. Potential effect of population and climate changes on global distribution of dengue fever: an empirical model. Lancet 2002; 360:830.
- Nguyet MN, Duong TH, Trung VT, et al. Host and viral features of human dengue cases shape the population of infected and infectious Aedes aegypti mosquitoes. Proc Natl Acad Sci U S A 2013; 110:9072.
- Bhamarapravati N, Yoksan S, Chayaniyayothin T, et al. Immunization with a live attenuated dengue-2-virus candidate vaccine (16681-PDK 53): clinical, immunological and biological responses in adult volunteers. Bull World Health Organ 1987; 65:189.
- Schoepp RJ, Beaty BJ, Eckels KH. Infection of Aedes albopictus and Aedes aegypti mosquitoes with dengue parent and progeny candidate vaccine viruses: a possible marker of human attenuation. Am J Trop Med Hyg 1991; 45:202.
- Gubler DJ, Suharyono W, Lubis I, et al. Epidemic dengue 3 in central Java, associated with low viremia in man. Am J Trop Med Hyg 1981; 30:1094.
- Chen LH, Wilson ME. Transmission of dengue virus without a mosquito vector: nosocomial mucocutaneous transmission and other routes of transmission. Clin Infect Dis 2004; 39:e56.
- Stramer SL, Linnen JM, Carrick JM, et al. Dengue viremia in blood donors identified by RNA and detection of dengue transfusion transmission during the 2007 dengue outbreak in Puerto Rico. Transfusion 2012; 52:1657.
- Sabino EC, Loureiro P, Lopes ME, et al. Transfusion-Transmitted Dengue and Associated Clinical Symptoms During the 2012 Epidemic in Brazil. J Infect Dis 2016; 213:694.
- Sirinavin S, Nuntnarumit P, Supapannachart S, et al. Vertical dengue infection: case reports and review. Pediatr Infect Dis J 2004; 23:1042.
- Carroll ID, Toovey S, Van Gompel A. Dengue fever and pregnancy - a review and comment. Travel Med Infect Dis 2007; 5:183.
- Tan PC, Rajasingam G, Devi S, Omar SZ. Dengue infection in pregnancy: prevalence, vertical transmission, and pregnancy outcome. Obstet Gynecol 2008; 111:1111.
- Barthel A, Gourinat AC, Cazorla C, et al. Breast milk as a possible route of vertical transmission of dengue virus? Clin Infect Dis 2013; 57:415.
- 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