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ATN Blog - Dengue and its spread into the non-endemic area is a threat to public health

Datum:28 juni 2022
Angga Prawira Kautsar
Angga Prawira Kautsar

By Angga Prawira Kautsar1,2

1 Department of Pharmaceutical and Pharmacy Technology, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 40132, Indonesia

2 Unit of Global Health, Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, 9713 AV Groningen, The Netherlands

Dengue has been around for a few decades, escalating from outbreaks and epidemics to endemic in some countries.[1] There are already 300 million people infected worldwide.[2] The manifestation of four dengue virus serotypes (DENV1-DENV4) is fever with a characteristic pattern (dengue shock syndrome (DSS) and dengue hemorrhagic fever (DHF) resulting in death from systemic bleeding in infected humans.[3] In addition to the clinical impact, the economy has also been impacted and millions of USD lost have been lost.[4] The burden of disease and the economy must be eliminated by tackling the virus’ spread, where interventions take into account clinically and non-clinically.[5]

Dengue research has various objectives but still refers to the prior interventions, such as controlling the virus vector (Aedes aegypti),[6] government policies supporting vector control and a green environment,[7] and vaccine manufacturing.[8] Vaccines combined with other interventions are promising today because they have relatively better effectiveness than other interventions.[9] Besides research focusing on clinical outcomes, cost and budgets are elements of the economy that are considered to have massive losses by dengue. Therefore, research on dengue’s health economics evaluation (HEE) is necessary.

Dengue becomes an outbreak in endemic areas with distinctive characteristics, such as tropical climates.[10] People can access the site launched by the CDC to discover the various endemic area, including the level of risk and the local surveillance report.[11] The most dengue infected are in Asia, Africa, and the Middle East, followed by Latin America. However, dengue is discovered outside of those typical features at this time, for example, cases found in Greece, France, Croatia, and Portugal.[12] Most countries in Europe have a cold climate because of their proximity to the Arctic. Consequently, disease transmission in Europe derives from tourists infected with the virus after traveling to endemic areas.[13]

The spread of dengue across Europe could alarm the global population as its spread patterns are already prevalent and out of their characteristic geographies.10 While the CDC’s dengue health map shows Europe is a region at risk with no evidence, and surveillance reports show something different.11 The following research consideration could be factors of the virus’ spread related to temperature characteristics in a particular region.10 Also, the adaptability of viruses that live and develop on vectors other than Aedes aegypti in new areas can be studied in depth.

Global interventions by preventing the acceleration of the greenhouse effect resulting in climate change in regions are the utmost solutions.7 Restrictions on human mobility in this era of globalization are impossible to limit with regard the virus eradication. Providing education and preventing by giving a vaccine shot before leaving for endemic areas are probably the best way. These interventions are applied because medicine for dengue infection has not been found.[14]

This blog was made possible by the Aletta Talents Network. If you would like to contribute a blog for the ATN, please contact Tom at t.a.lowe

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[1] Messina, J. P., Brady, O. J., Scott, T. W., Zou, C., Pigott, D. M., Duda, K. A., Bhatt, S., Katzelnick, L., Howes, R. E., Battle, K. E., Simmons, C. P., & Hay, S. I. (2014). Global spread of dengue virus types: mapping the 70 year history. Trends in Microbiology, 22(3), 138–146.

[2] WHO. (2022). Dengue and severe dengue. WHO.

[3] P. Bhatt, S.P. Sabeena, M. Varma, G. Arunkumar, Current Understanding of the Pathogenesis of Dengue Virus Infection, Curr. Microbiol. 78 (2021) 17–32.

[4] D.S. Shepard, E.A. Undurraga, Y.A. Halasa, J.D. Stanaway, The global economic burden of dengue: a systematic analysis, Lancet Infect. Dis. 16 (2016) 935–941.

[5] A.A. Suwantika, A.P. Kautsar, W. Supadmi, N. Zakiyah, R. Abdulah, M. Ali, M.J. Postma, Cost-effectiveness of dengue vaccination in Indonesia: Considering integrated programs with wolbachia-infected mosquitos and health education, Int. J. Environ. Res. Public Health. 17 (2020) 1–15.

[6] A. Wilder-Smith, E.E. Ooi, O. Horstick, B. Wills, Dengue, Lancet. 393 (2019) 350–363.

[7] Sim S, Ng LC, Lindsay SW, Wilson AL. A greener vision for vector control: The example of the Singapore dengue control programme. PLoS Negl Trop Dis. 2020 Aug 27;14(8):e0008428. doi: 10.1371/journal.pntd.0008428. PMID: 32853197; PMCID: PMC7451545.

[8] Adams, L. E., Waterman, S., & Paz-Bailey, G. (2022). Vaccination for Dengue Prevention. JAMA - Journal of the American Medical Association, 327(9), 817–818.

[9] Wilder-Smith A, Ooi EE, Horstick O, Wills B. Dengue. Lancet. 2019 Jan 26;393(10169):350-363. doi: 10.1016/S0140-6736(18)32560-1. PMID: 30696575.

[10] Hosseini S, Oliva-Ramírez J, Vázquez-Villegas P, Rodriguez-Garcia A, Muñoz-Soto RB, Aghamohammadi N, Martinez-Chapa SO. Dengue Fever: A Worldwide Threat An Overview of the Infection Process, Environmental Factors for a Global Outbreak, Diagnostic Platforms and Vaccine Developments. Curr Top Med Chem. 2018;18(18):1531-1549. doi: 10.2174/1568026618666181105130000. PMID: 30394209.

[11] CDC. (2022). Dengue Around the World | Dengue | CDC. CDC.


[12] Ahmed, A. M., Mohammed, A. T., Vu, T. T., Khattab, M., Doheim, M. F., Ashraf Mohamed, A., Abdelhamed, M. M., Shamandy, B. E., Dawod, M. T., Alesaei, W. A., Kassem, M. A., Mattar, O. M., Smith, C., Hirayama, K., & Huy, N. T. (2020). Prevalence and burden of dengue infection in Europe: A systematic review and meta-analysis. Reviews in Medical Virology, 30(2).

[13] Yang, X., Quam, M. B. M., Zhang, T., & Sang, S. (2021). Global burden for dengue and the evolving pattern in the past 30 years. Journal of Travel Medicine, 28(8).

[14] Huang, C. H., Tsai, Y. te, Wang, S. F., Wang, W. H., & Chen, Y. H. (2021). Dengue vaccine: an update. Expert Review of Anti-Infective Therapy, 19(12), 1495–1502.