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      The global distribution and burden of dengue

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          Abstract

          Dengue is a systemic viral infection transmitted between humans by Aedes mosquitoes 1 . For some patients dengue is a life-threatening illness 2 . There are currently no licensed vaccines or specific therapeutics, and substantial vector control efforts have not stopped its rapid emergence and global spread 3 . The contemporary worldwide distribution of the risk of dengue virus infection 4 and its public health burden are poorly known 2, 5 . Here we undertake an exhaustive assembly of known records of dengue occurrence worldwide, and use a formal modelling framework to map the global distribution of dengue risk. We then pair the resulting risk map with detailed longitudinal information from dengue cohort studies and population surfaces to infer the public health burden of dengue in 2010. We predict dengue to be ubiquitous throughout the tropics, with local spatial variations in risk influenced strongly by rainfall, temperature and the degree of urbanisation. Using cartographic approaches, we estimate there to be 390 million (95 percent credible interval 284-528) dengue infections per year, of which 96 million (67-136) manifest apparently (any level of clinical or sub-clinical severity). This infection total is more than three times the dengue burden estimate of the World Health Organization 2 . Stratification of our estimates by country allows comparison with national dengue reporting, after taking into account the probability of an apparent infection being formally reported. The most notable differences are discussed. These new risk maps and infection estimates provide novel insights into the global, regional and national public health burden imposed by dengue. We anticipate that they will provide a starting point for a wider discussion about the global impact of this disease and will help guide improvements in disease control strategies using vaccine, drug and vector control methods and in their economic evaluation. [285]

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          Most cited references 52

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          Selecting pseudo-absences for species distribution models: how, where and how many?

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            A new world malaria map: Plasmodium falciparum endemicity in 2010

            Background Transmission intensity affects almost all aspects of malaria epidemiology and the impact of malaria on human populations. Maps of transmission intensity are necessary to identify populations at different levels of risk and to evaluate objectively options for disease control. To remain relevant operationally, such maps must be updated frequently. Following the first global effort to map Plasmodium falciparum malaria endemicity in 2007, this paper describes the generation of a new world map for the year 2010. This analysis is extended to provide the first global estimates of two other metrics of transmission intensity for P. falciparum that underpin contemporary questions in malaria control: the entomological inoculation rate (PfEIR) and the basic reproductive number (PfR). Methods Annual parasite incidence data for 13,449 administrative units in 43 endemic countries were sourced to define the spatial limits of P. falciparum transmission in 2010 and 22,212 P. falciparum parasite rate (PfPR) surveys were used in a model-based geostatistical (MBG) prediction to create a continuous contemporary surface of malaria endemicity within these limits. A suite of transmission models were developed that link PfPR to PfEIR and PfR and these were fitted to field data. These models were combined with the PfPR map to create new global predictions of PfEIR and PfR. All output maps included measured uncertainty. Results An estimated 1.13 and 1.44 billion people worldwide were at risk of unstable and stable P. falciparum malaria, respectively. The majority of the endemic world was predicted with a median PfEIR of less than one and a median PfR c of less than two. Values of either metric exceeding 10 were almost exclusive to Africa. The uncertainty described in both PfEIR and PfR was substantial in regions of intense transmission. Conclusions The year 2010 has a particular significance as an evaluation milestone for malaria global health policy. The maps presented here contribute to a rational basis for control and elimination decisions and can serve as a baseline assessment as the global health community looks ahead to the next series of milestones targeted at 2015.
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              Potential effect of population and climate changes on global distribution of dengue fever: an empirical model.

              Existing theoretical models of the potential effects of climate change on vector-borne diseases do not account for social factors such as population increase, or interactions between climate variables. Our aim was to investigate the potential effects of global climate change on human health, and in particular, on the transmission of vector-borne diseases. We modelled the reported global distribution of dengue fever on the basis of vapour pressure, which is a measure of humidity. We assessed changes in the geographical limits of dengue fever transmission, and in the number of people at risk of dengue by incorporating future climate change and human population projections into our model. We showed that the current geographical limits of dengue fever transmission can be modelled with 89% accuracy on the basis of long-term average vapour pressure. In 1990, almost 30% of the world population, 1.5 billion people, lived in regions where the estimated risk of dengue transmission was greater than 50%. With population and climate change projections for 2085, we estimate that about 5-6 billion people (50-60% of the projected global population) would be at risk of dengue transmission, compared with 3.5 billion people, or 35% of the population, if climate change did not happen. We conclude that climate change is likely to increase the area of land with a climate suitable for dengue fever transmission, and that if no other contributing factors were to change, a large proportion of the human population would then be put at risk.
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                Author and article information

                Journal
                0410462
                6011
                Nature
                Nature
                Nature
                0028-0836
                1476-4687
                25 March 2013
                07 April 2013
                25 April 2013
                25 October 2013
                : 496
                : 7446
                : 504-507
                Affiliations
                [1 ]Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, United Kingdom.
                [2 ]Oxitec Limited, Milton Park, Abingdon OX14 4RX, United Kingdom.
                [3 ]Odum School of Ecology, University of Georgia, Athens, Georgia 30602, United States of America.
                [4 ]Department of Pediatrics, Harvard Medical School and Children’s Hospital Informatics Program, Boston Children’s Hospital, Boston, Massachusetts 02115, United States of America.
                [5 ]Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire 03755, United States of America.
                [6 ]INDEPTH Network Secretariat, East Legon, P.O. Box KD 213, Accra, Ghana.
                [7 ]School of Public Health, University of the Witwatersrand, Braamfontein 2000, Johannesburg, South Africa.
                [8 ]Institute of Public Health, Heidelberg University, Heidelberg, Germany.
                [9 ]Fogarty International Center, National Institutes of Health, Bethesda, Maryland 20892, United States of America.
                [10 ]Section Clinical Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, INF 324, D 69120 Heidelberg, Germany.
                [11 ]Environmental Research Group Oxford (ERGO), Tinbergen Building, Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, United Kingdom.
                [12 ]Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
                [13 ]Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, United Kingdom.
                [14 ]Department of Entomology, University of California Davis, Davis, California 95616, United States of America.
                [15 ]Department of Medicine, National University of Singapore, Singapore.
                Author notes
                Correspondence and requests for materials should be addressed to SIH ( simon.hay@ 123456zoo.ox.ac.uk ).
                Article
                NIHMS453763
                10.1038/nature12060
                3651993
                23563266

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                Funding
                Funded by: National Institute of General Medical Sciences : NIGMS
                Award ID: R01 GM083224 || GM
                Funded by: National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID
                Award ID: R01 AI069341 || AI
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