Epidemiology and burden of dengue fever in the United States: a systematic review

Abstract

Background Dengue is currently a global concern. The range of dengue vectors is expanding with climate change, yet US studies on dengue epidemiology and burden are limited. This systematic review sought to characterize the epidemiology and disease burden of dengue within the US. Methods Studies evaluating travel-related and endemic dengue in US states and territories were identified and qualitatively summarized. Commentaries and studies on ex-US cases were excluded. MEDLINE, Embase, Cochrane Library, Latin American and Caribbean Center of Health Sciences Information, Centre for Reviews and Dissemination, and Clinicaltrials.gov were searched through January 2022. Results 116 studies were included. In US states, dengue incidence was generally low with spikes occurring in recent years in 2013-2016 (0.17-0.31 cases/100,000) and peaking in 2019 (0.35 cases/100,000). Most cases (94%, n=7,895, 2010-2021) were travel related. Dengue was more common in Puerto Rico (cumulative average: 200 cases/100,000, 1980-2015); in 2010-2021, 99.9% of cases were locally acquired. There were <50 severe cases in US states (2010-2017); fatal cases were even rarer. Severe cases in Puerto Rico peaked in 1998 (n=173) and 2021 (n=76). Besides lower income, risk factors in US States included having birds in residence, suggesting unspecified environmental characteristics favorable to dengue vectors. Commonly reported symptoms included fever, headache, and rash; median disease duration was 3.5-11 days. Hospitalization rates increased following 2009 World Health Organization disease classification changes (pre-2009: 0%-54%; post-2009: 14%-75%); median length of stay was 2.7-8 days (Puerto Rico) and 2-3 days (US states). Hospitalization costs/case (2010 USD) were $14,350 (US states), $1,764-$5,497 (Puerto Rico), and $4,207 (US Virgin Islands). In Puerto Rico, average days missed were 0.2-5.3 (work) and 2.5 (school). Conclusions Though dengue risk is ongoing, treatments are limited, and the economic burden of dengue is high. There is an urgent need for additional preventive and therapeutic interventions.

Role of c-Abl in DENV-2 Infection and Actin Remodeling in Vero Cells

“…Its prevalence spans across tropical and subtropical regions and imposes a financial burden to public health. Climate change, urbanization, and the lack of an effective control of the vector [5] have affected the distribution pattern of the main vector, Aedes aegypti, which also has led to changes in dengue incidence [6] and increase in the frequency of epidemics [7][8][9][10]. The approaches to control dengue have focused on the eradication of the vector and the development of a vaccine.…”