Dengue Fever Fact Sheet - CDC Division of = Vector-Borne Infectious Diseases (DVBID)

From: Subject: Dengue Fever Fact Sheet - CDC Division of Vector-Borne Infectious Diseases (DVBID) Date: Thu, 31 Jan 2008 11:45:03 -0800 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0004_01C863FE.B7FEA0E0" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.3198 This is a multi-part message in MIME format. ------=_NextPart_000_0004_01C863FE.B7FEA0E0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.cdc.gov/NCIDOD/DVBID/DENGUE/ Dengue Fever Fact Sheet - CDC Division of = Vector-Borne Infectious Diseases (DVBID)

Dengue Contents
	Introduction
	Fact=20 Sheet
	Questions=20 & Answers
	Images
	Slides=
	Informatio= n=20 for Health Care = Providers

Chikungunya Fever Fact Sheet=20

Dengue=20 Fever Information for Travelers

Informaci=F3= n=20 sobre el dengue en espa=F1ol

Resources

Dengue Brochure 3D"About

(PDF 138KB/2 = pages)

Perspectives

Dengue = (DF) and=20 dengue hemorrhagic fever (DHF) are caused by one of four closely = related,=20 but antigenically distinct, virus serotypes (DEN-1, DEN-2, DEN-3, = and=20 DEN-4), of the genus Flavivirus. Infection with one of = these=20 serotypes provides immunity to only that serotype for life, so = persons=20 living in a dengue-endemic area can have more than one dengue = infection=20 during their lifetime. DF and DHF are primarily diseases of = tropical and=20 sub tropical areas, and the four different dengue serotypes are = maintained=20 in a cycle that involves humans and the Aedes mosquito. = However,=20 Aedes aegypti, a domestic, day-biting = mosquito that=20 prefers to feed on humans, is the most common Aedes = species.=20 Infections produce a spectrum of clinical illness ranging from a=20 nonspecific viral syndrome to severe and fatal hemorrhagic = disease.=20 Important risk factors for DHF include the strain of the infecting = virus,=20 as well as the age, and especially the prior dengue infection = history of=20 the patient.

History of=20 Dengue
Return to=20 top of page=20

The first = reported=20 epidemics of DF occurred in 1779-1780 in Asia, Africa, and North=20 America. The near simultaneous occurrence of outbreaks on = three=20 continents indicates that these viruses and their mosquito vector = have had=20 a worldwide distribution in the tropics for more than 200 years. = During=20 most of this time, DF was considered a mild, nonfatal disease of = visitors=20 to the tropics. Generally, there were long intervals (10-40 years) = between=20 major epidemics, mainly because the introduction of a new serotype = in a=20 susceptible population occurred only if viruses and their mosquito = vector=20 could survive the slow transport between population centers by = sailing=20 vessels.

A = pandemic of dengue=20 began in Southeast Asia after World War II and has spread around = the globe=20 since then. Epidemics caused by multiple serotypes = (hyperendemicity)=20 are more frequent, the geographic distribution of dengue viruses = and their=20 mosquito vectors has expanded, and DHF has emerged in the Pacific = region=20 and the Americas. In Southeast Asia, epidemic DHF first appeared = in the=20 1950s, but by 1975 it had become a frequent cause of = hospitalization and=20 death among children in many countries in that region.

Current = Trends
Return to top = of=20 page=20

In the = 1980s, DHF=20 began a second expansion into Asia when Sri Lanka, India, and the = Maldive=20 Islands had their first major DHF epidemics; Pakistan first = reported an=20 epidemic of dengue fever in 1994. The epidemics in Sri Lanka and = India=20 were associated with multiple dengue virus serotypes, but DEN-3 = was=20 predominant and was genetically distinct from DEN-3 viruses = previously=20 isolated from infected persons in those countries. After an = absence of 35=20 years, epidemic dengue fever reemerged in both Taiwan and the = People's=20 Republic of China in the 1980s. The People's Republic of China had = a=20 series of epidemics caused by all four serotypes, and its first = major=20 epidemic of DHF, caused by DEN-2, was reported on Hainan Island in = 1985.=20 Singapore also had a resurgence of dengue/DHF from 1990 to 1994 = after a=20 successful control program had prevented significant transmission = for over=20 20 years. In other countries of Asia where DHF is endemic, the = epidemics=20 have become progressively larger in the last 15 years.

In the = Pacific,=20 dengue viruses were reintroduced in the early 1970s after an = absence of=20 more than 25 years. Epidemic activity caused by all four serotypes = has=20 intensified in recent years with major epidemics of DHF on several = islands.

Despite = poor=20 surveillance for dengue in Africa, epidemic dengue fever caused by = all=20 four serotypes has increased dramatically since 1980. Most = activity has=20 occurred in East Africa, and major epidemics were reported for the = first=20 time in the Seychelles (1977), Kenya (1982, DEN-2), Mozambique = (1985,=20 DEN-3), Djibouti (1991-92, DEN-2), Somalia (1982, 1993, DEN-2), = and Saudi=20 Arabia (1994, DEN-2). Epidemic DHF has not been reported in Africa = or the=20 Middle East, but sporadic cases clinically compatible with DHF = have been=20 reported from Mozambique, Djibouti, and Saudi Arabia.

The = emergence of=20 dengue/DHF as a major public health problem has been most dramatic = in the=20 American region. In an effort to prevent urban yellow fever, which = is also=20 transmitted by Ae. aegypti, the Pan American Health = Organization=20 started a campaign that eradicated Ae. aegypti from most = Central=20 and South American countries in the 1950s and 1960s. As a result, = epidemic=20 dengue occurred only sporadically in some Caribbean islands during = this=20 period. The Ae. aegypti eradication program, which was = officially=20 discontinued in the United States in 1970, gradually weakened = elsewhere,=20 and the mosquito began to reinfest countries from which it had = been=20 eradicated. As a result, the geographic distribution of Ae. = aegypti=20 in 2002 was much wider than that before the eradication program = (Figure=20 1).

Figure 1. Distribution of Aedes aegypti = (red shaded=20 areas) in the Americas in 1970, at the end of the mosquito = eradication=20 program, and in 2002.

In 1970, = only DEN-2=20 virus was present in the Americas, although DEN-3 may have had a = focal=20 distribution in Colombia and Puerto Rico. In 1977, DEN-1 was = introduced=20 and caused major epidemics throughout the region over a 16-year = period.=20 DEN-4 was introduced in 1981 and caused similar widespread = epidemics. Also=20 in 1981, a new strain of DEN-2 from Southeast Asia caused the = first major=20 DHF epidemic in the Americas (Cuba). This strain has spread = rapidly=20 throughout the region and has caused outbreaks of DHF in = Venezuela,=20 Colombia, Brazil, French Guiana, Suriname, and Puerto Rico. By = 2003, 24=20 countries in the American region had reported confirmed DHF cases = (Figure=20 2), and DHF is now endemic in many of these countries.

Figure 2. American countries with = laboratory-confirmed=20 dengue hemorrhagic fever (red shaded areas), prior to 1981 and = from 1981=20 to 2003.

DEN-3 = virus=20 reappeared in the Americas after an absence of 16 years. This = serotype was=20 first detected in association with a 1994 dengue/DHF epidemic in=20 Nicaragua. Almost simultaneously, DEN-3 was confirmed in Panama = and, in=20 early 1995, in Costa Rica.

Viral = envelope gene=20 sequence data from the DEN-3 strains isolated from Panama and = Nicaragua=20 have shown that this new American DEN-3 virus strain was likely a = recent=20 introduction from Asia since it is genetically distinct from the = DEN-3=20 strain found previously in the Americas, but is identical to the = DEN-3=20 virus serotype that caused major DHF epidemics in Sri Lanka and = India in=20 the 1980s. As suggested by the finding of a new DEN-3 strain, and = the=20 susceptibility of the population in the American tropics to it = DEN-3=20 spread rapidly throughout the region causing major epidemics of = dengue/DHF=20 in Central America in 1995.

Figure 3. Presence of DEN-3 in the Americas from = 1994 to=20 2003

In 2005, = dengue is=20 the most important mosquito-borne viral disease affecting humans; = its=20 global distribution is comparable to that of malaria, and an = estimated 2.5=20 billion people live in areas at risk for epidemic transmission = (Figure 4).=20 Each year, tens of millions of cases of DF occur and, depending on = the=20 year, up to hundreds of thousands of cases of DHF. The = case-fatality rate=20 of DHF in most countries is about 5%, but this can be reduced to = less than=20 1% with proper treatment. Most fatal cases are among = children and=20 young adults.

Figure 4. World distribution of dengue viruses and = their=20 mosquito vector, Aedes aegypti, in 2005.

There is = a small risk=20 for dengue outbreaks in the continental United States. Two = competent=20 mosquito vectors, Ae. aegypti and Aedes albopictus, = are=20 present and, under certain circumstances, each could transmit = dengue=20 viruses. This type of transmission has been detected six times in = the last=20 25 years in south Texas (1980 -2004) and has been associated with = dengue=20 epidemics in northern Mexico by Aedes aegypti and in = Hawaii=20 (2001-02) due to Ae. albopictus. Moreover, numerous = viruses=20 are introduced annually by travelers returning from tropical areas = where=20 dengue viruses are endemic. From 1977 to = 2004, a total=20 of 3,806 suspected cases of imported dengue were reported in the = United=20 States. Although some specimens collected were not adequate for = laboratory=20 diagnosis, 864 (23%) cases were confirmed as dengue. Many = more=20 cases probably go unreported each year because surveillance in the = United=20 States is passive and relies on physicians to recognize the = disease,=20 inquire about the patient's travel history, obtain proper = diagnostic=20 samples, and report the case. These data suggest that states in = southern=20 and southeastern United States, where Ae. aegypti is found, = are at=20 risk for dengue transmission and sporadic outbreaks.

Although=20 travel-associated dengue and limited outbreaks do occur in the = continental=20 United States, most dengue cases in US citizens occur as endemic=20 transmission among residents in some of the US territories. CDC = conducts=20 laboratory-based passive surveillance in Puerto Rico in = collaboration with=20 the Puerto Rico Department of Health. The weekly surveillance = report=20 from = this=20 collaboration can be found at: Dengue Surveillance Report

The reasons for the dramatic global emergence of DF/DHF = as a major=20 public health problem are complex and not well understood. = However,=20 several important factors can be identified.

First, major = global=20 demographic changes have occurred, the most important of which = have been=20 uncontrolled urbanization and concurrent population growth. = These=20 demographic changes have resulted in substandard housing and = inadequate=20 water, sewer, and waste management systems, all of which = increase Ae.=20 aegypti population densities and facilitate transmission of = Ae.=20 aegypti-borne disease.
In most = countries the public=20 health infrastructure has deteriorated. Limited financial and = human=20 resources and competing priorities have resulted in a "crisis = mentality"=20 with emphasis on implementing so-called emergency control = methods in=20 response to epidemics rather than on developing programs to = prevent=20 epidemic transmission. This approach has been particularly = detrimental=20 to dengue control because, in most countries, surveillance is = (just as=20 in the U.S.) passive; the system to detect increased = transmission=20 normally relies on reports by local physicians who often do not = consider=20 dengue in their differential diagnoses. As a result, an epidemic = has=20 often reached or passed its peak before it is recognized. =
Increased travel = by airplane=20 provides the ideal mechanism for infected human transport of = dengue=20 viruses between population centers of the tropics, resulting in = a=20 frequent exchange of dengue viruses and other pathogens.=20
Lastly, = effective = mosquito control=20 is virtually nonexistent in most dengue-endemic countries. = Considerable=20 emphasis in the past has been placed on ultra-low-volume = insecticide=20 space sprays for adult mosquito control, a relatively = ineffective=20 approach for controlling Ae. aegypti.

Future=20 Outlook
Return to=20 top of page=20

No dengue = vaccine is=20 available. Recently, however, attenuated candidate vaccine viruses = have=20 been developed. Efficacy trials in human volunteers have yet = to be=20 initiated. Research is also being conducted to develop=20 second-generation recombinant vaccine viruses. Therefore, an = effective=20 dengue vaccine for public use will not be available for 5 to 10=20 years.

Prospects = for=20 reversing the recent trend of increased epidemic activity and = geographic=20 expansion of dengue are not promising. New dengue virus strains = and=20 serotypes will likely continue to be introduced into many areas = where the=20 population densities of Ae. aegypti are at high levels. = With no new=20 mosquito control technology available, in recent years public = health=20 authorities have emphasized disease prevention and mosquito = control=20 through community efforts to reduce larval breeding sources. = Although this=20 approach will probably be effective in the long run, it is = unlikely to=20 impact disease transmission in the near future. We must, = therefore,=20 develop improved, proactive, laboratory-based surveillance systems = that=20 can provide early warning of an impending dengue epidemic. At the = very=20 least, surveillance results can alert the public to take action = and=20 physicians to diagnose and properly treat DF/DHF cases.

Glossary of terms

3D"Return Return to=20 top of page

Endemic -=20 means a disease occurs continuously and with predictable = regularity in a=20 specific area or population .

Epidemic=20 - a widespread outbreak of an infectious disease where many people = are=20 infected at the same time.

Igm=20 - a = protein that=20 recognizes a particular epitope on an antigen and facilitates = clearance of=20 that antigen and is the primary antibody response to a viral = infection=20

Outbreak=20 - an epidemic limited to = localized increase=20 in the incidence of a disease, e.g., in a village, town, or closed = institution

Pandemic=20 - an epidemic occurring = worldwide, or over=20 a very wide area, crossing international boundaries, and usually = affecting=20 a large number of people.

Recombinant vaccine - using = the technique=20 of recombination to create an attenuated virus which elicits an = immune=20 response against the viral strain of interest in order to use as a = vaccine=20 in humans.

Seroytpe - a closely related set of viruses that can be = differiented by the=20 immune response they produce.

Viral=20 envelope gene sequence - the nucleic acid = composition=20 in the envelope gene

| CDC = Home | Search | Health Topics=20 A-Z |

This page last reviewed October 19, 2007

| Division of = Vector-Borne=20 Infectious Diseases |
| National Center for = Infectious=20 Diseases |
| Centers for=20 Disease Control and Prevention |
P.O. Box 2087
Fort = Collins, Colorado 80522

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'&ct=3D'+s_ape(ct):'')+(hp?'&hp=3D'+hp:'')+(s_vb?'&vb=3D'+s_vb:'')+(p?'&p= =3D' +s_ape(p):'')}if(s_gg('usePlugins'))s_wd.s_doPlugins();q+=3D(t?'&t=3D' +s_ape(t):'')+s_hav();if(s_lnk||s_eo){var o=3Ds_eo?s_eo:s_lnk;if(!o) return '';var = p=3Ds_wd.s_g_pageName,w=3D1,t=3Ds_ot(o),n=3Ds_oid(o),x=3Do.s_oidt, h,l,i,oc;if(s_eo&&o=3D=3Ds_eo){while(o&&!n&&t!=3D'BODY'){o=3Do.parentElem= ent? o.parentElement:o.parentNode;if(!o)return = '';t=3Ds_ot(o);n=3Ds_oid(o);x=3D o.s_oidt}oc=3Do.onclick?o.onclick.toString():'';if(oc.indexOf("s_gs(")>=3D= 0)return = ''}ta=3Do.target;h=3Do.href?o.href:'';i=3Dh.indexOf('?');h=3Ds_gg( 'linkLeaveQueryString')||i<0?h:h.substring(0,i);l=3Ds_gg('linkName')? s_gg('linkName'):s_ln(h);t=3Ds_gg('linkType')?s_gg('linkType' ).toLowerCase():s_lt(h);if(t&&(h||l))q+=3D'&pe=3Dlnk_'+(t=3D=3D'd'||t=3D=3D= 'e'? s_ape(t):'o')+(h?'&pev1=3D'+s_ape(h):'')+(l?'&pev2=3D'+s_ape(l):'');else trk=3D0;if(s_gg('trackInlineStats')){if(!p){p=3Ds_wd.location.href;w=3D0}= p=3D p?s_fl(p,255):'';t=3Ds_ot(o);i=3Do.sourceIndex;if(s_gg('objectID')){n=3D s_gg('objectID');x=3D1;i=3D1}if(p&&n&&t)qs=3D'&pid=3D'+s_ape(p)+(w?'&pidt= =3D'+w: '')+'&oid=3D'+s_ape(n)+(x?'&oidt=3D'+x:'')+'&ot=3D'+s_ape(t)+(i?'&oi=3D'+= i:'') }s_wd.s_linkName=3Ds_wd.s_linkType=3Ds_wd.s_objectID=3Ds_lnk=3Ds_eo=3D'';= if( !s_wd.s_disableLegacyVars)s_wd.linkName=3Ds_wd.linkType=3Ds_wd.objectID=3D= '' }if(!trk&&!qs)return '';var = code=3D'';if(un){if(trk&&s_vs(un,sed))code+=3D s_mr(un,sess,q+(qs?qs:s_rq(un)),ta);s_sq(un,trk?'':qs)}else if( s_wd.s_unl)for(var unn=3D0;unn

Perspectives

History of=20 DengueReturn to=20 top of page=20

Current = TrendsReturn to top = of=20 page=20

Future=20 OutlookReturn to=20 top of page=20

Glossary of terms

History of=20 Dengue
Return to=20 top of page=20

Current = Trends
Return to top = of=20 page=20

Future=20 Outlook
Return to=20 top of page=20