11/19/2015

CDCEpidemiologyDengue

Epidemiology
Denguefever(DF)iscausedbyanyoffourcloselyrelatedviruses,orserotypes:dengue14.
Infectionwithoneserotypedoesnotprotectagainsttheothers,andsequentialinfectionsput
peopleatgreaterriskfordenguehemorraghicfever(DHF)anddengueshocksyndrome(DSS).

TransmissionoftheDengueVirus
DengueistransmittedbetweenpeoplebythemosquitoesAedesaegyptiandAedesalbopictus,
whicharefoundthroughouttheworld.Insectsthattransmitdiseasearevectors.Symptomsof
infectionusuallybegin47daysafterthemosquitobiteandtypicallylast310days.Inorderfor
transmissiontooccurthemosquitomustfeedonapersonduringa5dayperiodwhenlarge
amountsofvirusareinthebloodthisperiodusuallybeginsalittlebeforethepersonbecome
symptomatic.Somepeopleneverhavesignificantsymptomsbutcanstillinfectmosquitoes.After
enteringthemosquitointhebloodmeal,theviruswillrequireanadditional812daysincubation
beforeitcanthenbetransmittedtoanotherhuman.Themosquitoremainsinfectedforthe
remainderofitslife,whichmightbedaysorafewweeks.
Inrarecasesdenguecanbetransmittedinorgantransplantsorbloodtransfusionsfrominfected
donors,andthereisevidenceoftransmissionfromaninfectedpregnantmothertoherfetus
(/dengue/educationTraining/).Butinthevastmajorityofinfections,amosquitobiteisresponsible.
Inmanypartsofthetropicsandsubtropics,dengueisendemic,thatis,itoccurseveryyear,
usuallyduringaseasonwhenAedesmosquitopopulationsarehigh,oftenwhenrainfallisoptimal
forbreeding.Theseareasare,however,additionallyatperiodicriskforepidemicdengue,when
largenumbersofpeoplebecomeinfectedduringashortperiod.Dengueepidemicsrequirea
coincidenceoflargenumbersofvectormosquitoes,largenumbersofpeoplewithnoimmunityto
oneofthefourvirustypes(DENV1,DENV2,DENV3,DENV4),andtheopportunityforcontact
betweenthetwo.AlthoughAedesarecommoninthesouthernU.S.,dengueisendemicin
northernMexico,andtheU.S.populationhasnoimmunity,thelackofdenguetransmissionin
thecontinentalU.S.isprimarilybecausecontactbetweenpeopleandthevectorsistooinfrequent
tosustaintransmission.

TopofPage(#top)

DengueisanEmergingDisease
ThefourdenguevirusesoriginatedinmonkeysandindependentlyjumpedtohumansinAfricaor
SoutheastAsiabetween100and800yearsago.Dengueremainedarelativelyminor,
geographicallyrestricteddiseaseuntilthemiddleofthe20thcentury.Thedisruptionofthe
secondworldwarinparticularthecoincidentaltransportofAedesmosquitoesaroundtheworld
incargoarethoughttohaveplayedacrucialroleinthedisseminationoftheviruses.DHFwas
firstdocumentedonlyinthe1950sduringepidemicsinthePhilippinesandThailand.Itwasnot
until1981thatlargenumbersofDHFcasesbegantoappearintheCarribeanandLatinAmerica,
wherehighlyeffectiveAedescontrolprogramshadbeeninplaceuntiltheearly1970s.
http://www.cdc.gov/dengue/epidemiology/

1/4

11/19/2015

CDCEpidemiologyDengue

TopofPage(#top)

GlobalDengue
Todayabout2.5billionpeople,or40%oftheworlds
population,liveinareaswherethereisariskofdengue
transmissionseeWHO/ImpactofDengue
(http://www.who.int/csr/disease/dengue/impact/en/)
(http://www.cdc.gov/Other/disclaimer.html).Dengueisendemic

inatleast100countriesinAsia,thePacific,theAmericas,
Africa,andtheCaribbean.TheWorldHealthOrganization(WHO)estimatesthat50to100
millioninfectionsoccuryearly,including500,000DHFcasesand22,000deaths,mostlyamong
children.

TopofPage(#top)

DengueintheUnitedStates
Nearlyalldenguecasesreportedinthe48continentalstateswereacquiredelsewherebytravelers
orimmigrants.(TravelAssociatedDengueInfectionsUnitedStates,20012004
(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5422a2.htm),ImportedDengueUnitedStates,
1999and2000(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5113a5.htm))Becausecontact
betweenAedesandpeopleisinfrequentinthecontinentalU.S.,theseimportedcasesrarelyresult
insecondarytransmission.ThelastreportedcontinentaldengueoutbreakwasinsouthTexasin
2005.(DengueHemorrhagicFeverU.S.MexicoBorder,2005
(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5631a1.htm))Asmalldengueoutbreakoccurred
inHawaiiin2001.
MostdenguecasesinU.S.citizensoccurinthoseinhabitantsofPuertoRico,theU.S.Virgin
Islands,SamoaandGuam,whichareendemicforthevirus.DengueandDHFhavebeena
particularchallengeinPuertoRico(/dengue/about/inPuerto.html),whereoutbreakshavebeen
reportedsince1915andlargeislandwideepidemicshavebeendocumentedsincethelate1960s.
Themostrecentislandwideepidemicoccurredin2007,whenmorethan10,000caseswere
diagnosed.InPuertoRico,andmostoftheCaribbeanBasin,theprincipledenguevectorAe.
aegyptiisabundantyearround.DenguetransmissioninthePuertoRicofollowsaseasonal
pattern.LowtransmissionseasonbeginsinMarchandlastsuntilJune,andhightransmission
beginsinAugustuntilNovember.
http://www.cdc.gov/dengue/epidemiology/

2/4

11/19/2015

CDCEpidemiologyDengue

TopofPage(#top)

DengueSurveillanceintheU.S.
DFandDHFcaseshavelongbeenreportablebylawtopublichealthauthoritiesin26states.
Beginningin2009,allnationallydiagnoseddengueinfectionswillbereportabletotheCDC.
StatisticsoncaseshavebeencompiledinPuertoRicosince1915and,since1969,CDCsDengue
Branch,locatedatSanJuan,hasoperatedtheislandwidepassivedenguesurveillancesystem
(PDSS)inpartnershipwiththePuertoRicoDepartmentofHealth.PDSSwasinstrumentalin
confirmingtheendemicpresenceofdenguetransmissioninPuertoRico,identifyingthefirstcase
ofDHFintheAmericas,anddetectingthefirstclusterofcasesofDHFandthefirstlaboratory
confirmed,denguerelateddeathinPuertoRico.Instructionsandformsforreportingsuspected
orconfirmedcasesofdenguearelinkedbelow.

TopofPage(#top)

Toolsandlinks
1. WHOguidelinesfortheclinicalmanagementofdengueinfection

(http://www.who.int/csr/resources/publications/dengue/Denguepublication/en/)
(http://www.cdc.gov/Other/disclaimer.html)

2. WHOguidelinesfortreatmentofdenguefever/denguehemorrhagicfeverinsmallhospitals
[PDF33pages](http://www.searo.who.int/LinkFiles/Dengue_Guidelinedengue.pdf)
(http://www.cdc.gov/Other/disclaimer.html)

3. Denguecasedefinition(/dengue/clinicalLab/caseDef.html)

Clinicalmanagementtoolsforhealthcareproviders
1. DengueCaseManagementGuide

[PDF8pages](/dengue/resources/DENGUEclinician

guide_508.pdf)

2. Informationforhealthcareproviders

[PDF4pages](/Dengue/resources/Dengue&DHF

InformationforHealthCarePractitioners_2009.pdf)

Requestingdenguelaboratorytestingandcasereporting
1. Instructionsforcollecting,preparingandmailingspecimensfordenguetestingattheCDC
DengueLaboratory [PDF4pages](/Dengue/resources/TestpolEng_2.pdf)
2. DengueCaseInvestigationForm(English) [PDF4pages]
(/dengue/resources/dengueCaseReports/DCIF_English.pdf)

TopofPage(#top)
Pagelastreviewed:July28,2010
Pagelastupdated:June9,2014
Contentsource:CentersforDiseaseControlandPrevention
NationalCenterforEmergingandZoonoticInfectiousDiseases(NCEZID)
DivisionofVectorBorneDiseases(DVBD)

http://www.cdc.gov/dengue/epidemiology/

3/4

11/19/2015

CDCEpidemiologyDengue

CentersforDiseaseControlandPrevention1600CliftonRoadAtlanta,GA30329
4027,USA
800CDCINFO(8002324636)TTY:(888)2326348ContactCDCINFO

http://www.cdc.gov/dengue/epidemiology/

4/4