Public Health Responses to and Challenges for the Control of Dengue Transmission in High-Income Countries: Four Case Studies

Abstract

Dengue has a negative impact in low- and lower middle-income countries, but also affects upper middle- and high-income countries. Despite the efforts at controlling this disease, it is unclear why dengue remains an issue in affluent countries. A better understanding of dengue epidemiology and its burden, and those of chikungunya virus and Zika virus which share vectors with dengue, is required to prevent the emergence of these diseases in high-income countries in the future. The purpose of this review was to assess the relative burden of dengue in four high-income countries and to appraise the similarities and differences in dengue transmission. We searched PubMed, ISI Web of Science, and Google Scholar using specific keywords for articles published up to 05 May 2016. We found that outbreaks rarely occur where only Aedes albopictus is present. The main similarities between countries uncovered by our review are the proximity to dengue-endemic countries, the presence of a competent mosquito vector, a largely nonimmune population, and a lack of citizens’ engagement in control of mosquito breeding. We identified important epidemiological and environmental issues including the increase of local transmission despite control efforts, population growth, difficulty locating larval sites, and increased human mobility from neighboring endemic countries. Budget cuts in health and lack of practical vaccines contribute to an increased risk. To be successful, dengue-control programs for high-income countries must consider the epidemiology of dengue in other countries and use this information to minimize virus importation, improve the control of the cryptic larval habitat, and engage the community in reducing vector breeding. Finally, the presence of a communicable disease center is critical for managing and reducing future disease risks.

The cross-cutting contribution of the end of neglected tropical diseases to the sustainable development goals

“…In Europe, the Mediterranean basin is endemic for leishmaniasis [22]. Autochthonous outbreaks of dengue have also been reported in high-income countries of Portugal [23], France [24], Australia, USA, Singapore and Chinese Taipei [25] whilst recently a focus of urogenital schistosomiasis transmission (due to Schistosoma haematobium ) was found in Corsica, France [26]. …”

Patterns of Urban Housing Shape Dengue Distribution in Singapore at Neighborhood and Country Scales

“…The strategic plan of Urban Redevelopment Authority (URA) of Singapore focuses on affording public housing in high‐rise buildings as a solution for the growing population and scarcity of the land. Annual reports of the Ministry of Health (MOH) show a difference in dengue cases and incidence between three types of accommodations: HDB flats, compound houses, and condominiums (Viennet et al, ). However, further research is needed to investigate the impact of the urban planning and urban housing on magnitude and distribution of dengue in the country.…”

Mitigating the Risk of Transfusion-Transmitted Dengue in Australia

“…In this study we did not find evidence of DENV infection in the blood donors tested [6, 8]. The upper confidence interval of our blood donor viremia estimate of 1 in 1,667 suggests that the risk of collecting a viremic donation may be significant and supports the current precautionary strategy of restricting “at-risk” donors to donating plasma for fractionation only.…”

“…We previously estimated the risk of collecting a viremic donation during the 2008/2009 DENV outbreak to be 1 in 7,147 (95% CI: 1 in 2,218 to 1 in 50,021) [22], and modelling based on notification data obtained during a DENV outbreak in 2004 estimated the overall transmission risk to be 1 in 19,759 (95% CI: 1 in 3,404 to 75,486) with a peak of 1 in 5,968 (95% CI: 1 in 1,028 to 22,800) [26]. While this previous data suggests a low likelihood of finding a viremic sample in our study the absence of detectable evidence of DENV infection in donors, despite the higher number of reported cases during these outbreaks [6, 8], provides reassurance that our existing risk modelling does not substantially underestimate the risk of TT-DENV. While future studies using a larger sample size would refine the risk estimate, the small donor population in areas of Australia with DENV transmission means that such studies would not be practicable.…”

“…Collectively, this epidemic resulted in over 1,000 confirmed infections. Another sizeable DENV outbreak occurred in northeastern Australia in the summer of 2012/2013, resulting in 534 confirmed cases [8]. …”