DENGUE: EPIDEMIOLOGY PART 1. SCOTT B HALSTEAD, MD. Director, Research PEDIATRIC DENGUE VACCINE INITIATIVE. TRANSMISSION. Aedes aegypti breeds in clean water in and around houses. Daytime biting.
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SCOTT B HALSTEAD, MD
PEDIATRIC DENGUE VACCINE INITIATIVE
DEN 1 & 3 – mild illness
DEN 2 & 4 – no illness
DEN 1 & 3 – Disease/Infection ~1; g.i. hemorrhages may accompany peptic ulcer disease.
DEN 2 & 4 - mild - moderate
Simmons et al
Phil J Sci 44:1-252, 1931
Day 5 after
DISEASE SPECTRUMMILD SEVEREDF DHF+ Thrombocytopenia +++ ThrombocytopeniaHidden Vasc. Perm1? Overt Vasc. Perm.1. Wills BA et al J Infect Dis 190:810-818, 2004
Rural to urban migration
Growth of cities
Deterioration of cities
Health services poorly organized/ underfunded
Lack of vector control professionalsWHY IS DENGUE SUCH A BIG PROBLEM TODAY?
50-100 million infections/year
Countries with active dengue +
Observed in two immunological settings.
Primary infections in infants.
2. Secondary infections in children
Two infections can occur in twelve
KALAYANROOJ S et al AJTMH 2008 in press.
MAMMAN MP personal communication
GUZMAN MG personal communication
EFFECT OF AVERAGE FORCE OF INFECTION (R Provinceso) ON
AGE SPECIFIC SECONDARY INFECTION INCIDENCE
Ro = 30%
Ro = 20%
Ro = 10%
Watts DM et al Lancet 354:1431-4, 1999
dengue 1 antibodies do not prevent but
maydown regulatedengue 2 infections