8/13/2019 The Disease Pattern Associated With Dengue
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The disease pattern associated with dengue-like illness from
1780 to 1940 was
characterized by relatiely infre!uent but often large epidemics"
#oweer$ it is
likely that dengue iruses became endemic in many tropical urban
centers
during this time because during interepidemic periods$ when
there was no
apparent disease transmission$ nonimmune isitors inariably
contracted a
dengue-like illness within months of their arrial"
The ecologic disruption in the %outheast &sia and 'acific
theaters during and
following (orld (ar )) created ideal conditions for increased
transmission of
mos!uito-borne diseases$ and it was in this setting that a
global pandemic of
dengue began" (ith increased epidemic transmission$
hyperendemicity *the
cocirculation of multiple dengue irus serotypes+ deeloped in
%outheast &sian
cities and epidemic dengue hemorrhagic feer *,#+$ a newly
described disease$
emerged *.7$ 48$ /1$ /.+" The first known epidemic of ,#
occurred in anila$
'hilippines$ in 19. to 194$ but within 20 years the disease in
epidemic form
had spread throughout %outheast &sia3 by the mid-1970s$ ,#
had become a
leading cause of hospitalization and death among children in the
region *1+" )n
the 1970s$ dengue was reintroduced to the 'acific )slands and
epidemic actiity
increased there and in the &mericas" ,uring the 1980s and
1990s$ epidemic
dengue transmission intensified$ and there is now a global
resurgence of dengue
feer$ with epanding geographic distribution of both the mos!uito
ectors and
the iruses$ increased incidence of disease caused by an
increased fre!uency of
epidemic transmission$ and the emergence of ,# in many new
countries *./$
.9$ 41$ 4$ 48$ /1$ /.$ 110$111$ 124+"
)n &sia$ epidemic ,# has epanded geographically from
%outheast &sian
countries west to )ndia$ %ri 5anka$ the aldies$ and 'akistan and
east to 6hina
*42+" %eeral island countries of the %outh and 6entral 'acific
*iue$ 'alau$ ap$
6ook )slands$ Tahiti$ ew 6aledonia$ and anuatu+ hae eperienced
ma:or or
minor ,# epidemics *41+" ;pidemiologic changes in the
&mericas$ howeer$
hae been the most dramatic" )n the 190s$ 19/0s$ and most of the
1970s$
epidemic dengue was rare in the &merican region because the
principal
mos!uito ector$ &edes aegypti$ had been eradicated from most
of 6entral and%outh &merica *./-.8$ 110+" The eradication
program was discontinued in the
early 1970s$ and this species then began to reinade the
countries from which it
had been eradicated *.8$ 110+"
