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The global distribution and burden of dengue
Open accessAbstract
Dengue is a systemic viral infection transmitted between humans by Aedes mosquitoes. For some patients, dengue is a life-threatening illness. There are currently no licensed vaccines or specific therapeutics, and substantial vector control efforts have not stopped its rapid emergence and global spread. The contemporary worldwide distribution of the risk of dengue virus infection and its public health burden are poorly known. Here we undertake an exhaustive assembly of known records of dengue occurrence worldwide, and use a formal modelling framework to map the global distribution of dengue risk. We then pair the resulting risk map with detailed longitudinal information from dengue cohort studies and population surfaces to infer the public health burden of dengue in 2010. We predict dengue to be ubiquitous throughout the tropics, with local spatial variations in risk influenced strongly by rainfall, temperature and the degree of urbanization. Using cartographic approaches, we estimate there to be 390 million (95% credible interval 284-528) dengue infections per year, of which 96 million (67-136) manifest apparently (any level of disease severity). This infection total is more than three times the dengue burden estimate of the World Health Organization. Stratification of our estimates by country allows comparison with national dengue reporting, after taking into account the probability of an apparent infection being formally reported. The most notable differences are discussed. These new risk maps and infection estimates provide novel insights into the global, regional and national public health burden imposed by dengue. We anticipate that they will provide a starting point for a wider discussion about the global impact of this disease and will help to guide improvements in disease control strategies using vaccine, drug and vector control methods, and in their economic evaluation.
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“An estimated 70% of dengue virus infections are thought to occur in Asia. (2)”
From Epidemiology of dengue reported in the World Health Organization Western Pacific Region, 2013–2019 (2023) · cites this paper as [2]
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“As a result of differences in case definitions and other factors, there is likely to be underreporting and, thus, an underestimation of the true regional burden in terms of the number of cases, CFRs and incidence. (1, 2)”
From Epidemiology of dengue reported in the World Health Organization Western Pacific Region, 2013–2019 (2023) · cites this paper as [2]
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“Sharing information and data about dengue helps countries and areas better understand transmission patterns and supports the implementation of dengue prevention and control measures. (2)”
From Epidemiology of dengue reported in the World Health Organization Western Pacific Region, 2013–2019 (2023) · cites this paper as [2]
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Ulrich, J. N., Beier, J. C., Devine, G. J., & Hugo, L. E. (2016) · PLoS neglected tropical diseases · doi:10.1371/journal.pntd.0004873 · Cited by 118
Dengue and Dengue Hemorrhagic Fever
Saeed, M. A., & Attia, T. H. (2015) · Afro-Egyptian Journal of Infectious and Endemic Diseases · doi:10.21608/aeji.2015.17830 · Cited by 118
Recent advances in understanding dengue
Halstead, S. B. (2019) · F1000Research · doi:10.12688/f1000research.19197.1 · Cited by 118
Liang, R., Lu, Y., Qu, X., Su, Q., Li, C., Xia, S., Liu, Y., Zhang, Q., Cao, X., Chen, Q., et al. (2019) · Transboundary and Emerging Diseases · doi:10.1111/tbed.13424 · Cited by 118
Dengue and Zika Viruses: Epidemiological History, Potential Therapies, and Promising Vaccines
Silva, N. M., Santos, N. C., & Martins, I. C. (2020) · Tropical Medicine and Infectious Disease · doi:10.3390/tropicalmed5040150 · Cited by 116
A Review: Aedes-Borne Arboviral Infections, Controls and Wolbachia-Based Strategies
Ogunlade, S. T., Meehan, M. T., Adekunle, A. I., Rojas, D. P., Adegboye, O. A., & McBryde, E. S. (2021) · Vaccines · doi:10.3390/vaccines9010032 · Cited by 119
“Modelling studies recently estimated that approximately 390 million dengue infections occur per year, with 96 million of these exhibiting clinical symptoms [16,17], and that the global population at risk of dengue is 3.”
Zhang, Y., Sun, Y.-Q., Chen, J., Teng, A.-Y., Wang, T., Li, H., Hay, S. I., Fang, L., Yang, Y., & Liu, W. Y. (2022) · The Lancet Digital Health · doi:10.1016/s2589-7500(22)00212-6 · Cited by 118
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“There are an estimated 390 million infections per year, of which 96 million are clinically apparent [3].”
TIM-1 Ubiquitination Mediates Dengue Virus Entry
Dejarnac, O., Hafirassou, M. L., Chazal, M., Versapuech, M., Burlaud‐Gaillard, J., Perera-Lecoin, M., Umaña-Diaz, C., Bonnet‐Madin, L., Carnec, X., Tinévez, J.-Y., et al. (2018) · Cell Reports · doi:10.1016/j.celrep.2018.04.013 · Cited by 117
Small-Molecule Agonists of Ae. aegypti Neuropeptide Y Receptor Block Mosquito Biting
Duvall, L. B., Ramos-Espiritu, L. S., Barsoum, K. E., Glickman, J. F., & Vosshall, L. B. (2019) · Cell · doi:10.1016/j.cell.2018.12.004 · Cited by 125
“This cycling behavior makes mosquitoes particularly effective disease vectors: when they bite infected humans, disease-causing viral pathogens are passed to the mosquito, and each subsequent bite puts the next humanhost at risk for infection with dengue, Zika, yellow fever, and chikungunya viruses (Bhatt et al., 2013).”
Climate change may enable Aedes aegypti infestation in major European cities by 2100
Liu-Helmersson, J., Rocklöv, J., Sewe, M. O., & Brännström, Å. (2019) · Environmental Research · doi:10.1016/j.envres.2019.02.026 · Cited by 117
“This forces the model to omit climate association at the wider geographical scale [1].”
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“It is estimated that all four serotypes of DENV combined are responsible for ~390 million infections annually, leading to ~20,000 deaths [1].”
Trujillo, A. I., Quintero-Gil, C., Díaz-Castillo, F., Quiñones, W., Robledo, S. M., & Martínez‐Gutierrez, M. (2019) · BMC Complementary and Alternative Medicine · doi:10.1186/s12906-019-2695-1 · Cited by 117
The 2012 dengue outbreak in Madeira: exploring the origins
Wilder‐Smith, A., Quam, M., Sessions, O. M., Rocklöv, J., Liu-Helmersson, J., Franco, L., & Khan, K. (2014) · Eurosurveillance · doi:10.2807/1560-7917.es2014.19.8.20718 · Cited by 116
Mouse Models to Study Dengue Virus Immunology and Pathogenesis
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Clinical and differential diagnosis: Dengue, chikungunya and Zika
Beltrán-Silva, S. L., Chacón-Hernández, S. S., Moreno-Palacios, E., & Molina, J. A. P. (2016) · Revista Médica Del Hospital General De México · doi:10.1016/j.hgmx.2016.09.011 · Cited by 116
Improved prediction accuracy for disease risk mapping using Gaussian process stacked generalization
Bhatt, S., Cameron, E., Flaxman, S. R., Weiss, D. J., Smith, D. L., & Gething, P. W. (2017) · Journal of The Royal Society Interface · doi:10.1098/rsif.2017.0520 · Cited by 110
“Maps of diseases and socio- 362 economic indicators are increasingly being used to inform policy [4, 55], creating demand for 363 methods to produce accurate estimates at high spatial resolutions.”
Self-citationHumoral cross-reactivity between Zika and dengue viruses: implications for protection and pathology
Priyamvada, L., Hudson, W. H., Ahmed, R., & Wrammert, J. (2017) · Emerging Microbes & Infections · doi:10.1038/emi.2017.42 · Cited by 114
“All fi gures were created using PyMol (Schrödinger LLC). endemic areas 28,29,66 suggesting that prior DENV exposure may not protect against future ZIKV infections.”
Mosquito-Borne Diseases: Advances in Modelling Climate-Change Impacts
Tjaden, N. B., Caminade, C., Beierkuhnlein, C., & Thomas, S. M. (2017) · Trends in Parasitology · doi:10.1016/j.pt.2017.11.006 · Cited by 126
Forecasting dengue epidemics using a hybrid methodology
Chakraborty, T., Chattopadhyay, S., & Ghosh, I. (2019) · Physica A Statistical Mechanics and its Applications · doi:10.1016/j.physa.2019.121266 · Cited by 116
Uncovering the Burden of Dengue in Africa: Considerations on Magnitude, Misdiagnosis, and Ancestry
Gainor, E., Harris, E., & LaBeaud, A. D. (2022) · Viruses · doi:10.3390/v14020233 · Cited by 116
“Modeling further suggests that the burden of dengue in Africa and the Americas is roughly equivalent, despite the Americas historically receiving significantly more attention when it comes to dengue burden compared to Africa [5].”
Basavannacharya, C., & Vasudevan, S. G. (2014) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2014.09.113 · Cited by 115
Revisiting Dengue Virus–Host Cell Interaction
Acosta, E. G., Kumar, A., & Bartenschlager, R. F. W. (2014) · Advances in virus research · doi:10.1016/b978-0-12-800098-4.00001-5 · Cited by 122
A Dengue Virus Serotype 1 mRNA-LNP Vaccine Elicits Protective Immune Responses
Wollner, C. J., Richner, M., Hassert, M., Pinto, A. K., Brien, J. D., & Richner, J. M. (2021) · Journal of Virology · doi:10.1128/jvi.02482-20 · Cited by 120
“arthropod vector Aedes aegypti and, to a much lesser extent, Aedes albopictus (2, 3).”
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Farnesi, L. C., Vargas, H. C. M., Valle, D., & Rezende, G. L. (2017) · PLoS neglected tropical diseases · doi:10.1371/journal.pntd.0006063 · Cited by 114
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“Concurrently, DENV has continued to expand in the Western Hemisphere [5] and to cause a substantial global disease burden [6], CHIKV and ZIKV have emerged as significant threats in the Americas and elsewhere [7, 8], and recent outbreaks of YFV in central Africa and Brazil have increased concerns about its epidemic pot…”
Economic and Disease Burden of Dengue in Mexico
Undurraga, E. A., Betancourt-Cravioto, M., Ramos‐Castañeda, J., Martínez-Vega, R. A., Méndez-Galván, J. F., Gubler, D. J., Guzmán, M. G., Halstead, S. B., Harris, E., Kuri-Morales, P. A., et al. (2015) · PLoS neglected tropical diseases · doi:10.1371/journal.pntd.0003547 · Cited by 114
Prevention and control of dengue—the light at the end of the tunnel
Pang, T., Mak, T. K., & Gubler, D. J. (2017) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(16)30471-6 · Cited by 114
Iminosugar antivirals: the therapeutic sweet spot
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“The 4 serotypes of dengue viruses (DENV-1 to DENV-4) are primarily transmitted to humans by the Aedes aegypti mosquito and lead to approximately 390 million dengue infections every year, 96 million of which manifest clinically [1], with 500 000 cases requiring hospitalization [2].”
Vertical transmission of arboviruses in mosquitoes: A historical perspective
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Challenges of infectious diseases in the USA
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The Risk of Dengue Virus Transmission in Dar es Salaam, Tanzania during an Epidemic Period of 2014
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“Of these, 96 million cases manifests clinically [1] with about half a million cases of dengue haemorrhagic fever requiring hospitalization [2].”
Dengue in the Middle East and North Africa: A Systematic Review
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Metadata
- Authors
- Bhatt, S., Gething, P. W., Brady, O. J., Messina, J. P., Farlow, A. W., Moyes, C. L., Drake, J. M., Brownstein, J. S., Hoen, A. G., Sankoh, O., Myers, M. F., George, D. B., Jaenisch, T., Wint, G. R. W., Simmons, C. P., Scott, T. W., Farrar, J. J., & Hay, S. I.
- Affiliations
- University of Oxford (GB)
- University of Georgia (US)
- Boston Children's Hospital (US)
- Dartmouth College (US)
- University of the Witwatersrand (ZA)
- National Institutes of Health (US)
- University Hospital Heidelberg (DE)
- Churchill Hospital (GB)
- National University of Singapore (SG)
- Corresponding author
- Hay, Simon I.
- ORCID
- Venue
- Nature
- Published
- 2013-04
- Volume
- 496
- Issue
- 7446
- Pages
- 504-507
- ISSN
- 0028-0836 (ISSN-L)
- 1476-4687
- PMC
- PMC3651993
- OpenAlex
- W2131222241
- Cited by
- 10,037
- References
- 52
- Citations by year
- 2026: 615 · 2025: 704 · 2024: 830 · 2023: 846 · 2022: 816 · 2021: 943 · 2020: 946 · 2019: 922 · 2018: 777 · 2017: 724 · 2016: 744 · 2015: 551 · 2014: 467 · 2013: 141
- FWCI
- 650.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- U.S. Department of Homeland Security
- Wellcome Trust (089276, 095066, 084368, 097318)
- European Commission (261504)
- National Institutes of Health (5r01ai069341-05)
- Biotechnology and Biological Sciences Research Council (1090403)
- National Institute of General Medical Sciences (R01GM083224)
- National Institute of Allergy and Infectious Diseases (R01-AI069341, R01AI091980)
- Fogarty International Center
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mosquito-borne diseases and control
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Dengue and Mosquito Control Research
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Climate Change and Health Impacts
- Keywords
- dengue, global burden of disease, dengue incidence, dengue risk mapping, Aedes, mosquito-borne viral disease, temperature and precipitation effects, urbanization, dengue prevention, dengue control, tropical and subtropical regions, dengue vaccine
- MeSH terms
- Dengue, Dengue Virus, Humans, Public Health, Quality Control, Rain, Risk Factors, Temperature, Tropical Climate, Urbanization, Global Health, World Health Organization, Cohort Studies, Incidence, Databases, Factual
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