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Ribeiro Prist P, Reverberi Tambosi L, Filipe Mucci L, Pinter A, Pereira de Souza R, Lara Muylaert R, Roger Rhodes J, Henrique Comin C, Fontoura Costa L, Lang D'Agostini T, Telles de Deus J, Pavão M, Port‐Carvalho M, Del Castillo Saad L, Mureb Sallum MA, Fernandes Spinola RM, Metzger JP. Roads and forest edges facilitate yellow fever virus dispersion. J Appl Ecol 2021. [DOI: 10.1111/1365-2664.14031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Paula Ribeiro Prist
- Department of Ecology Institute of Bioscience University of São Paulo São Paulo Brazil
| | - Leandro Reverberi Tambosi
- Department of Ecology Institute of Bioscience University of São Paulo São Paulo Brazil
- Center for Engineering, Modelling and Applied Social Sciences Federal University of ABC Santo André Brazil
| | | | | | | | - Renata Lara Muylaert
- Molecular Epidemiology and Public Health Laboratory Hopkirk Research InstituteMassey University Palmerston North New Zealand
| | - Jonathan Roger Rhodes
- School of Earth and Environmental Sciences The University of Queensland Brisbane QLD Australia
| | - César Henrique Comin
- Department of Computer Science Federal University of São Carlos São Carlos Brazil
| | | | - Tatiana Lang D'Agostini
- Center for Epidemiology Surveillance ‘Dr Alexandre Vranjac’ Coordination for Disease ControlPublic Health Branch São Paulo Brazil
| | | | - Mônica Pavão
- Geoprocessing and Spatial Analysis Core Environment Research Institute. Infrastructure and Environment Secretariat of São Paulo São Paulo Brazil
| | - Márcio Port‐Carvalho
- Conservation Biodiversity Nucleus, Environmental Research Institute, Infrastructure and Environment Secretariat of São Paulo São Paulo SP Brazil
- Post Graduated Program in Biodiversity of Conservations UnitsNational School of Tropical Botanical—Rio de Janeiro Botanical Garden Rio de Janeiro Brazil
| | - Leila Del Castillo Saad
- Center for Epidemiology Surveillance ‘Dr Alexandre Vranjac’ Coordination for Disease ControlPublic Health Branch São Paulo Brazil
| | | | - Roberta Maria Fernandes Spinola
- Center for Epidemiology Surveillance ‘Dr Alexandre Vranjac’ Coordination for Disease ControlPublic Health Branch São Paulo Brazil
| | - Jean Paul Metzger
- Department of Ecology Institute of Bioscience University of São Paulo São Paulo Brazil
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Bezerra JMT, Sousa SCD, Tauil PL, Carneiro M, Barbosa DS. Entry of dengue virus serotypes and their geographic distribution in Brazilian federative units: a systematic review. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210020. [PMID: 33825776 DOI: 10.1590/1980-549720210020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the entry of Dengue virus (DENV) serotypes in Brazil and its federative units. METHODS A systematic review of studies published between 1980 and 2018 in databases and in the gray literature was performed using descriptors related to the years of entry of the DENV serotypes. Additionally, experts and official sources of information (Brazilian Ministry of Health) were consulted. RESULTS From 100 publications selected for the systematic review, 26 addressed the entry of DENV serotypes in the North region of the country, 33 in the Northeast, 24 in the Southeast, 14 in the Central-West, and five in the South. DENV-1 and DENV-4 were introduced in the North region in 1981. DENV-2 was introduced in the Southeast in 1990. DENV-3 was introduced in the North in 1999. CONCLUSION The rapid expansion of dengue throughout the Brazilian territory was verified from the second half of the 1980s, with the gradual entry of the four serotypes, which resulted in the emergence of epidemics of arbovirus, which are currently verified in the country. Considering the epidemiology of the disease, more information should be disseminated and published in the wide-ranging scientific literature for a better understanding of the spread and circulation of DENV serotypes.
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Affiliation(s)
| | - Selma Costa de Sousa
- Department of Occupational Health Care, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.,Laboratory of Epidemiology of Infectious and Parasitic Diseases, Department of Parasitology, Biological Sciences Institute, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Pedro Luiz Tauil
- School of Medicine, Graduate Program in Tropical Medicine, Universidade de Brasília - Brasília (DF), Brazil
| | - Mariângela Carneiro
- Laboratory of Epidemiology of Infectious and Parasitic Diseases, Department of Parasitology, Biological Sciences Institute, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.,Graduate Program in Health Sciences, Infectious Disease and Tropical Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - David Soeiro Barbosa
- Laboratory of Epidemiology of Infectious and Parasitic Diseases, Department of Parasitology, Biological Sciences Institute, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
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Vicente CR, Herbinger KH, Cerutti Junior C, Malta Romano C, de Souza Areias Cabidelle A, Fröschl G. Determination of clusters and factors associated with dengue dispersion during the first epidemic related to Dengue virus serotype 4 in Vitória, Brazil. PLoS One 2017; 12:e0175432. [PMID: 28388694 PMCID: PMC5384768 DOI: 10.1371/journal.pone.0175432] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/24/2017] [Indexed: 11/19/2022] Open
Abstract
Dengue occurrence is partially influenced by the immune status of the population. Consequently, the introduction of a new Dengue virus serotype can trigger explosive epidemics in susceptible populations. The determination of clusters in this scenario can help to identify hotspots and understand the disease dispersion regardless of the influence of the population herd immunity. The present study evaluated the pattern and factors associated with dengue dispersion during the first epidemic related to Dengue virus serotype 4 in Vitória, Espírito Santo state, Brazil. Data on 18,861 dengue cases reported in Vitória from September 2012 to June 2013 were included in the study. The analysis of spatial variation in temporal trend was performed to detect clusters that were compared by their respective relative risk, house index, population density, and income in an ecological study. Overall, 11 clusters were detected. The time trend increase of dengue incidence in the overall study population was 636%. The five clusters that showed a lower time trend increase than the overall population presented a higher incidence in the beginning of the epidemic and, compared to the six clusters with higher time trend increase, they presented higher relative risk for their inhabitants to acquire dengue infection (P-value = 0.02) and a lower income (P-value <0.01). House index and population density did not differ between the clusters. Early increase of dengue incidence and higher relative risk for acquiring dengue infection were favored in low-income areas. Preventive actions and improvement of infrastructure in low-income areas should be prioritized in order to diminish the magnitude of dengue dispersion after the introduction of a new serotype.
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Affiliation(s)
- Creuza Rachel Vicente
- Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany
- * E-mail:
| | - Karl-Heinz Herbinger
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | | | - Camila Malta Romano
- Institute of Tropical Medicine, LIM-52 (LIMHC), University of São Paulo, São Paulo, Brazil
| | | | - Günter Fröschl
- Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
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Seroprevalence and seroconversion of dengue and implications for clinical diagnosis in amazonian children. Interdiscip Perspect Infect Dis 2014; 2014:703875. [PMID: 25548558 PMCID: PMC4273531 DOI: 10.1155/2014/703875] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 11/12/2014] [Accepted: 11/15/2014] [Indexed: 12/28/2022] Open
Abstract
This study aimed to evaluate the prevalence of serum IgG dengue in children in an Amazonian population, to assess the seroconversion rate in 12 months, and to estimate how many seropositive children had a prior clinical diagnosis of dengue. We conducted a population-based study between 2010 and 2011, with children aged 6 months to 12 years that were living in the urban area of a small town in the Brazilian Amazon. The prevalence of IgG antibodies against dengue antigens was determined by indirect ELISA technique, and seronegative children were reexamined after 12 months to determine seroconversion rates. Results showed seroprevalence of IgG antibodies against dengue type of 2.9%, with no significant association between age, race, and sex. In seropositive children, only 8.4% had received a clinical diagnosis of dengue, and the ratio of clinically diagnosed cases and subclinical cases was 1 : 11. The seroconversion rate between 2010 and 2011 was 1.4% (CI 3.8% to 35.1%). The seroprevalence of dengue in this pediatric population was low, and the vast majority of cases were not clinically detected, suggesting a difficulty in making the clinical diagnosis in children and a high frequency of asymptomatic infections.
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Epidemiological trends of dengue disease in Brazil (2000-2010): a systematic literature search and analysis. PLoS Negl Trop Dis 2013; 7:e2520. [PMID: 24386496 PMCID: PMC3871634 DOI: 10.1371/journal.pntd.0002520] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/18/2013] [Indexed: 11/19/2022] Open
Abstract
A literature survey and analysis was conducted to describe the epidemiology of dengue disease in Brazil reported between 2000 and 2010. The protocol was registered on PROSPERO (CRD42011001826: http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42011001826). Between 31 July and 4 August 2011, the published literature was searched for epidemiological studies of dengue disease, using specific search strategies for each electronic database. A total of 714 relevant citations were identified, 51 of which fulfilled the inclusion criteria. The epidemiology of dengue disease in Brazil, in this period, was characterized by increases in the geographical spread and incidence of reported cases. The overall increase in dengue disease was accompanied by a rise in the proportion of severe cases. The epidemiological pattern of dengue disease in Brazil is complex and the changes observed during this review period are likely to have been influenced by multiple factors. Several gaps in epidemiological knowledge regarding dengue disease in Brazil were identified that provide avenues for future research, in particular, studies of regional differences, genotype evolution, and age-stratified seroprevalence. Systematic Review Registration PROSPERO registration number: CRD42011001826. Dengue disease is the most prevalent arthropod-borne viral disease in humans and is a global and national public health concern in Brazil. We conducted this review to consolidate and describe the existing evidence on the epidemiology of dengue disease in Brazil, between 2000 and 2011, to gauge the recent national and regional impact of dengue disease and provide a basis for setting research priorities and prevention efforts. We used well-defined methods to search and identify relevant research, according to predetermined inclusion criteria. Despite control measures, the increased territorial distribution of the mosquito vector and the co-circulation of multiple dengue virus serotypes have resulted in increases in the incidence and distribution of dengue disease. The number of disease-related hospitalizations and deaths has also increased. Efforts to control the increasing disease incidence have been unsuccessful. This review of dengue disease epidemiology will help enhance knowledge and future disease management. Despite the high volume of research retrieved, we have identified several avenues for future research, in particular studies of regional differences, genotype evolution and age-stratified seroprevalence that will improve our knowledge of dengue disease, contribute to a more accurate estimate of global disease incidence, and also inform evidence-based policies for dengue disease prevention.
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Brathwaite Dick O, San Martín JL, Montoya RH, del Diego J, Zambrano B, Dayan GH. The history of dengue outbreaks in the Americas. Am J Trop Med Hyg 2012; 87:584-93. [PMID: 23042846 PMCID: PMC3516305 DOI: 10.4269/ajtmh.2012.11-0770] [Citation(s) in RCA: 266] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 07/13/2012] [Indexed: 11/07/2022] Open
Abstract
Dengue is a viral disease usually transmitted by Aedes aegypti mosquitoes. Dengue outbreaks in the Americas reported in medical literature and to the Pan American Health Organization are described. The outbreak history from 1600 to 2010 was categorized into four phases: Introduction of dengue in the Americas (1600-1946); Continental plan for the eradication of the Ae. aegypti (1947-1970) marked by a successful eradication of the mosquito in 18 continental countries by 1962; Ae. aegypti reinfestation (1971-1999) caused by the failure of the mosquito eradication program; Increased dispersion of Ae. aegypti and dengue virus circulation (2000-2010) characterized by a marked increase in the number of outbreaks. During 2010 > 1.7 million dengue cases were reported, with 50,235 severe cases and 1,185 deaths. A dramatic increase in the number of outbreaks has been reported in recent years. Urgent global action is needed to avoid further disease spread.
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Affiliation(s)
- Olivia Brathwaite Dick
- Viral Diseases Program, Pan American Health Organization (PAHO), Washington, DC; Dengue Regional Program, Pan American Health Organization (PAHO), San José, Costa Rica; Sanofi Pasteur, Research and Development, Clinical Department, Swiftwater, Pennsylvania
| | | | | | | | | | - Gustavo H. Dayan
- Viral Diseases Program, Pan American Health Organization (PAHO), Washington, DC; Dengue Regional Program, Pan American Health Organization (PAHO), San José, Costa Rica; Sanofi Pasteur, Research and Development, Clinical Department, Swiftwater, Pennsylvania
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Teixeira MG, Morato V, Barreto FR, Mendes CMC, Barreto ML, Costa MDCN. Risk factors for the incidence of dengue virus infection in preschool children. Trop Med Int Health 2012; 17:1391-5. [DOI: 10.1111/j.1365-3156.2012.03086.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Complex dynamic of dengue virus serotypes 2 and 3 in Cambodia following series of climate disasters. INFECTION GENETICS AND EVOLUTION 2012; 15:77-86. [PMID: 22677620 DOI: 10.1016/j.meegid.2012.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 05/13/2012] [Accepted: 05/16/2012] [Indexed: 11/23/2022]
Abstract
The Dengue National Control Program was established in Cambodia in 2000 and has reported between 10,000 and 40,000 dengue cases per year with a case fatality rate ranging from 0.7 to 1.7. In this study 39 DENV-2 and 57 DENV-3 viruses isolated from patients between 2000 and 2008 were fully sequenced. Five DENV2 and four DENV3 distinct lineages with different dynamics were identified. Each lineage was characterized by the presence of specific mutations with no evidence of recombination. In both DENV-2 and DENV-3 the lineages present prior to 2003 were replaced after that date by unrelated lineages. After 2003, DENV-2 lineages D2-3 and D2-4 cocirculated until 2007 when they were almost completely replaced by a lineage D2-5 which emerged from D2-3 Conversely, all DENV-3 lineages remained, diversified and cocirculated with novel lineages emerging. Years 2006 and 2007 were marked by a high prevalence of DENV-3 and 2007 with a large dengue outbreak and a high proportion of patients with severe disease. Selective sweeps in DENV-1 and DENV-2 were linked to immunological escape to a predominately DENV-3-driven immunological response. The complex dynamic of dengue in Cambodia in the last ten years has been associated with a combination of stochastic climatic events, cocirculation, coevolution, adaptation to different vector populations, and with the human population immunological landscape.
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Melo PRS, Domingo C, Santos SC, Cerqueira BA, Andrade LJ, Nunes JB, Ciuffo IA, Tenório A, Blanton RE, Reis MG. Molecular surveillance of dengue virus in Bahia State, Brazil. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ajmb.2012.21005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Duong V, Simmons C, Gavotte L, Viari A, Ong S, Chantha N, Lennon NJ, Birren BW, Vong S, Farrar JJ, Henn MR, Deubel V, Frutos R, Buchy P. Genetic diversity and lineage dynamic of dengue virus serotype 1 (DENV-1) in Cambodia. INFECTION GENETICS AND EVOLUTION 2011; 15:59-68. [PMID: 21757030 DOI: 10.1016/j.meegid.2011.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 06/12/2011] [Accepted: 06/27/2011] [Indexed: 11/28/2022]
Abstract
In Cambodia, dengue virus (DENV) was first isolated in 1963 and has become endemic with peak epidemic during raining season. Since 2000, the Dengue National Control Program has reported from 10,000 to 40,000 cases per year with fatality rates ranging from 0.7 to 1.7. All four dengue serotypes are found circulating in Cambodia with alternative predominance of serotypes DENV-2 and DENV-3. The DENV-1 represents from 5% to 20% of all circulating viruses, depending upon the year. In this work, 79 clinical strains of DENV-1 were isolated between 2000 and 2009 and their genome fully sequenced. Four distinct lineages with different dynamics were identified. The main evolutionary drive was negative selective pressure but each lineage was characterized by the presence of specific mutations acquired through evolution. Coexistence, extinction and replacement of lineages occurred over the 10-year period. Lineages 1, 2 and 3 were all detected since 2000-2002 and disappeared in 2003, 2004-2005 and 2007, respectively. Lineages 1 and 2 displayed different dynamics. Lineage 1 was very diverse whereas lineage 2 was very homogeneous. Lineage 4 which derived from lineage 3 in 2003 remained the only one at the end of the sampling period in 2008-2009 owing to a selective sweep. The lineages dynamic of DENV-1 viruses and consequences for molecular epidemiology are discussed.
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Affiliation(s)
- Veasna Duong
- Institut Pasteur in Cambodia, Réseau International des Instituts Pasteur, 5 Monivong Boulevard, PO Box 983, Phnom Penh, Cambodia
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San Martín JL, Brathwaite O, Zambrano B, Solórzano JO, Bouckenooghe A, Dayan GH, Guzmán MG. The epidemiology of dengue in the americas over the last three decades: a worrisome reality. Am J Trop Med Hyg 2010; 82:128-35. [PMID: 20065008 DOI: 10.4269/ajtmh.2010.09-0346] [Citation(s) in RCA: 317] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We have reported the epidemic patterns of dengue disease in the Region of the Americas from 1980 through 2007. Dengue cases reported to the Pan American Health Organization were analyzed from three periods: 1980-1989 (80s), 1990-1999 (90s), and 2000-2007 (2000-7). Age distribution data were examined from Brazil, Venezuela, Honduras, and Mexico. Cases increased over time: 1,033,417 (80s) to 2,725,405 (90s) to 4,759,007 (2000-7). The highest concentrations were reported in the Hispanic Caribbean (39.1%) in the 80s shifting to the Southern Cone in the 90s (55%) and 2000-7 (62.9%). From 1980 through 1987, 242 deaths were reported compared with 1,391 during 2000-7. The most frequently isolated serotypes were DENV-1 and DENV-2 (90s) and DENV-2 and DENV-3 (2000-7). The highest incidence was observed among adolescents and young adults; dengue hemorrhagic fever incidence was highest among infants in Venezuela. Increasing dengue morbidity/mortality was observed in the Americas in recent decades.
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Affiliation(s)
- José Luis San Martín
- Dengue Regional Program, Pan American Health Organization (PAHO), Panama, Republic of Panama.
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Honório NA, Codeço CT, Alves FC, Magalhães MAFM, Lourenço-De-Oliveira R. Temporal distribution of Aedes aegypti in different districts of Rio de Janeiro, Brazil, measured by two types of traps. JOURNAL OF MEDICAL ENTOMOLOGY 2009; 46:1001-14. [PMID: 19769029 DOI: 10.1603/033.046.0505] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Dengue dynamics in Rio de Janeiro, Brazil, as in many dengue-endemic regions of the world, is seasonal, with peaks during the wet-hot months. This temporal pattern is generally attributed to the dynamics of its mosquito vector Aedes aegypti (L.). The objectives of this study were to characterize the temporal pattern of Ae. aegypti population dynamics in three neighborhoods of Rio de Janeiro and its association with local meteorological variables; and to compare positivity and density indices obtained with ovitraps and MosquiTraps. The three neighborhoods are distinct in vegetation coverage, sanitation, water supply, and urbanization. Mosquito sampling was carried out weekly, from September 2006 to March 2008, a period during which large dengue epidemics occurred in the city. Our results show peaks of oviposition in early summer 2007 and late summer 2008, detected by both traps. The ovitrap provided a more sensitive index than MosquiTrap. The MosquiTrap detection threshold showed high variation among areas, corresponding to a mean egg density of approximately 25-52 eggs per ovitrap. Both temperature and rainfall were significantly related to Ae. aegypti indices at a short (1 wk) time lag. Our results suggest that mean weekly temperature above 22-24 degrees C is strongly associated with high Ae. aegypti abundance and consequently with an increased risk of dengue transmission. Understanding the effects of meteorological variables on Ae. aegypti population dynamics will help to target control measures at the times when vector populations are greatest, contributing to the development of climate-based control and surveillance measures for dengue fever in a hyperendemic area.
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Affiliation(s)
- N A Honório
- Laboratório de Transmissores de Hematozoários, Instituto Oswaldo Cruz-Fiocruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, CEP 21045-900, Brasil.
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Teixeira MG, Costa MDCN, Barreto F, Barreto ML. Dengue: twenty-five years since reemergence in Brazil. CAD SAUDE PUBLICA 2009; 25 Suppl 1:S7-18. [DOI: 10.1590/s0102-311x2009001300002] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 07/03/2008] [Indexed: 11/21/2022] Open
Abstract
This article revisits the epidemiology of dengue in Brazil, 25 years after its reemergence in the country, discussing the main determinants and implications for its control. The authors emphasize the clinical and epidemiological peculiarities of this viral disease in Brazil, which leads the world in both the number of cases reported and risk of occurrence of the disease. The article presents the changes occurring in the dengue epidemiological pattern in recent years, like the sudden age shift in the incidence of dengue hemorrhagic fever, and discusses possible associated factors. The article focuses specifically on the epidemic in Rio de Janeiro in 2008, this episode's impact on the international community, and the fear that the disease could spread to Europe. The authors conclude that the current situation emphasizes the need for the international scientific community to renew its efforts to generate knowledge allowing improvement and progress in the development of new tools and strategies for dengue prevention.
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