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      Epidemiological Trends of Dengue Disease in Brazil (2000–2010): A Systematic Literature Search and Analysis

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          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.

          Author Summary

          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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          Most cited references44

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          Dengue, Urbanization and Globalization: The Unholy Trinity of the 21st Century

          Dengue is the most important arboviral disease of humans with over half of the world’s population living in areas of risk. The frequency and magnitude of epidemic dengue have increased dramatically in the past 40 years as the viruses and the mosquito vectors have both expanded geographically in the tropical regions of the world. There are many factors that have contributed to this emergence of epidemic dengue, but only three have been the principal drivers: 1) urbanization, 2) globalization and 3) lack of effective mosquito control. The dengue viruses have fully adapted to a human-Aedes aegypti-human transmission cycle, in the large urban centers of the tropics, where crowded human populations live in intimate association with equally large mosquito populations. This setting provides the ideal home for maintenance of the viruses and the periodic generation of epidemic strains. These cities all have modern airports through which 10s of millions of passengers pass each year, providing the ideal mechanism for transportation of viruses to new cities, regions and continents where there is little or no effective mosquito control. The result is epidemic dengue. This paper discusses this unholy trinity of drivers, along with disease burden, prevention and control and prospects for the future.
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            The epidemiology of dengue in the americas over the last three decades: a worrisome reality.

            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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              Seroprevalence and risk factors for dengue infection in socio-economically distinct areas of Recife, Brazil.

              Brazil currently accounts for the majority of dengue cases reported in the Americas, with co-circulation of DENV 1-3. Striking variation in the epidemiological pattern of infection within cities has been observed. Therefore, investigation of dengue transmission in small areas is important to formulate control strategies. A population-based household survey was performed in three diverse socio-economic and environmental areas of Recife, a large urban center of Brazil, between 2005 and 2006. Dengue serostatus and individual- and household-level risk factors for infection were collected in residents aged between 5 and 64 years. A total of 2833 individuals were examined, and their residences were geo-referenced. Anti-dengue IgG antibodies were measured using commercial ELISA. The dengue seroprevalence and the force of infection were estimated in each area. Individual and household variables associated with seropositivity were assessed by multilevel models for each area. A spatial analysis was conducted to identify risk gradients of dengue seropositivity using Generalized Additive Models (GAM). The dengue seroprevalence was 91.1%, 87.4% 74.3%, respectively, in the deprived, intermediate and high socio-economic areas, inversely related to their socio-economic status. In the deprived area, 59% of children had already been exposed to dengue virus by the age of 5 years and the estimated force of infection was three times higher than that in the privileged area. The risk of infection increased with age in the three areas. Not commuting away from the area was a risk factor for seropositivity in the deprived area (OR=2.26; 95% CI: 1.18-4.30). Number of persons per room was a risk factor for seropositivity in the intermediate (OR=3.00; 95% CI: 3.21-7.37) and privileged areas (OR=1.81; 95% CI: 1.07-3.04). Living in a house, as opposed to an apartment, was a risk factor for seropositivity in the privileged area (OR=3.62; 95% CI: 2.43-5.41). The main difference between the privileged and other areas could be attributed to the much larger proportion of apartment dwellers. Intensive vector control, surveillance and community education should be considered in deprived urban areas where a high proportion of children are infected by an early age. Copyright 2009. Published by Elsevier B.V.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS Negl Trop Dis
                PLoS Negl Trop Dis
                plos
                plosntds
                PLoS Neglected Tropical Diseases
                Public Library of Science (San Francisco, USA )
                1935-2727
                1935-2735
                December 2013
                19 December 2013
                23 December 2013
                : 7
                : 12
                : e2520
                Affiliations
                [1 ]Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil
                [2 ]Universidade Federal de Goiás, Goiânia, Brazil
                [3 ]Sanofi Pasteur, Global Epidemiology, Lyon, France
                [4 ]Sanofi Pasteur, São Paulo, Brazil
                [5 ]Communigen Ltd., The Magdalen Centre, Oxford Science Park, Oxford, United Kingdom
                University of South Florida, United States of America
                Author notes

                The authors have declared the following competing interests: MGT and JBS declare that they have no conflicts of interest. MGT is sponsored by CNPQ/Brazil. JBS is a consultant to the Ministry of Health, Brasília, Brazil. MGT and JBS received no payments in respect of their work on this review. LB is employed by Sanofi Pasteur and GLCF was employed by Sanofi Pasteur at the time of writing. GJ is employed as a medical writer by Communigen Ltd. All authors confirm that they had full access to all data and had final responsibility for the decision to submit for publication. This does not alter our adherence to all PLOS policies on sharing data and materials.

                Conceived and designed the experiments: JBS MGT LB GJ. Performed the experiments: JBS MGT LB GJ. Analyzed the data: JBS MGT LB GJ. Wrote the paper: JBS MGT LB GJ. Contributed to the conceptualization and drafting of the article and participated in the data analysis and interpretation, critical review of the article, and final approval of the version to be submitted for publication: JBS MGT LB GJ. Contributed to the conceptualization and drafting of the article, data analysis and interpretation, and final approval of the version to be submitted for publication: GLCF.

                Article
                PNTD-D-13-00598
                10.1371/journal.pntd.0002520
                3871634
                24386496
                30c4fb96-00d3-422b-b6c6-c58578f15612
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 24 April 2013
                : 18 September 2013
                Page count
                Pages: 13
                Funding
                Sanofi Pasteur sponsored this survey and analysis. The literature review group (including members of Sanofi Pasteur) was responsible for the conception of the literature analysis, development of the protocol, data collection, analysis and interpretation of data, provision of critical comments, writing the paper and approving the final version to be published. All authors were involved in the decision to submit this paper for publication in PLoS NTD.
                Categories
                Research Article

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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