Notes from the Field: Dengue Outbreak — Peru, 2023

Dengue is a mosquito-borne viral infection that has spread throughout the tropical world over the past 60 years and now affects over half the world’s population. The geographical range of dengue is expected to further expand due to ongoing global phenomena including climate change and urbanization. We applied statistical mapping techniques to the most extensive database of case locations to date to predict global environmental suitability for the virus as of 2015. We then made use of climate, population and socioeconomic projections for the years 2020, 2050 and 2080 to project future changes in virus suitability and human population at risk. This study is the first to consider the spread of Aedes mosquito vectors to project dengue suitability. Our projections provide a key missing piece of evidence for the changing global threat of vector-borne disease and will help decision-makers worldwide to better prepare for and respond to future changes in dengue risk.

Dengue is the disease caused by 1 of 4 distinct, but closely related dengue viruses (DENV-1-4) that are transmitted by Aedes spp. mosquito vectors. It is the most common arboviral disease worldwide, with the greatest burden in tropical and sub-tropical regions. In the absence of effective prevention and control measures, dengue is projected to increase in both disease burden and geographic range. Given its increasing importance as an etiology of fever in the returning traveler or the possibility of local transmission in regions in the United States with competent vectors, as well as the risk for large outbreaks in endemic US territories and associated states, clinicians should understand its clinical presentation and be familiar with appropriate testing, triage, and management of patients with dengue. Control and prevention efforts reached a milestone in June 2021 when the Advisory Committee on Immunization Practices (ACIP) recommended Dengvaxia for routine use in children aged 9 to 16 years living in endemic areas with laboratory confirmation of previous dengue virus infection. Dengvaxia is the first vaccine against dengue to be recommended for use in the United States and one of the first to require laboratory testing of potential recipients to be eligible for vaccination. In this review, we outline dengue pathogenesis, epidemiology, and key clinical features for front-line clinicians evaluating patients presenting with dengue. We also provide a summary of Dengvaxia efficacy, safety, and considerations for use as well as an overview of other potential new tools to control and prevent the growing threat of dengue .

A health problem each time more frequent and dispersed in tropical and subtropical areas of the world, including Peru where it entered in 1990, is dengue. It is produced by the dengue virus with four serotypes and transmitted by Aedes aegypti, a vector that coexists with humans and whose presence is favored by deficient sanitary, social and economic conditions. Manifestations of severe forms of the disease such as shock and bleeding, are related to the frequent co-circulation of the four serotypes and the emergence of new genotypes such as American/Asian serotype 2. The new classification of the disease by WHO as dengue with or without warning signs and severe dengue, is contributing to more timely diagnosis and treatment, enabling reductions in mortality. Of note is the need to highlight the surveillance of acute febrile illness and Aedes indices that contribute to a timely diagnosis and guide vector control measures through sanitary education and environmental management with community and intersectoral participation, in a creative manner according to ecological niches. An alternative for complementary prevention would be vaccination using tetravalent vaccines whose safety and efficacy must be guaranteed before its use in the population under the framework of comprehensive strategies.