Epidemiology and challenges in dengue control

Abstract

Dengue is nowadays considered a growing public health problem worldwide. Several
outbreaks of dengue have occurred in Brazil in the last two decades, and the country
is now considered an endemic area where risk areas for sylvatic yellow fever also
coexist. The current manuscript reviews the main epidemiological features of dengue
in the world focusing in the peculiarities of the infection/disease progression in Brazil
and, specifically, in Central-West Brazil. Some issues related to the challenge of control
in the Central-West region and the opportunities for research are also discussed. In
Brazil, the re-introduction of the vector (Aedes aegypti) dates 1976-77. The city of
Rio de Janeiro (Southeast Brazil) was considered the starting point of viral dispersion
to coastal and inland areas, since the first epidemic (DENV-1) in 1986. Brazil reports
approximately 70% of the dengue cases in the Americas with the co-circulation of
3 dengue subtypes (DENV-1; DENV-2 and DENV-3). The disease affects mainly
the adult population and the surveillance system has detected an increasing trend
to hospitalization, disease severity and incidence in children and adolescents.
Approximately 500,000 of dengue cases and 158 deaths were reported in 2007
compared to approximately 300,000 and 77 deaths in the previous year in Brazil. The
first epidemic in Goiás State (Central-West Brazil) was reported in 1994. Nowadays
the three serotypes co-circulate with high incidence rates and a large outbreak was
reported in the city of Campo Grande (Mato Grosso do Sul State) (45,843 registered
cases). The recent increase in cases related to sylvatic yellow fever, mainly in Goiás
State, represents a public health warning related to vector surveillance and control.