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Dhaka
HCMC
Manila
Jakarta
Bangkok
0 2 4 6 8 10 12 14 16 18
1950
1980
2010
Urban Growth in Asian Cities
1950-1969 1970-1979 1980-2011
Spread of dengue hemorrhagic fever in Asia
The spread of dengue hemorrhagic fever in the Americas
Adapted from Gubler, 1998
Prior to 1981 1981-2011
1955-1959
1960-1969
1970-1979
1980-1989
1990-1999
2000-2009
0
200000
400000
600000
800000
1000000
1200000
The changing epidemiology of dengue
Source: DengueNet
No
of C
ases
• Expanding geographic distribution
• Increased epidemic activity
• Hyperendemicity
• Emergence of severe disease
New dengue Disease Burden estimates
3.6 billion
230 million
34 million?
2 million
21,000
Beatty ME, Letson GW, Margolis HS., Phuket, Thailand October 17-19, 2008.
At-Risk Population
Infections
Dengue Fever
DHF
DSS
Deaths
Why have we seen such a dramatic increase in epidemic Dengue Hemorrhagic Fever?
• Demographic Changes (Pop Growth)• Environmental Change
- Urbanization- Changing lifestyles• Modern Transportation (Globalization)• Increased Movement of People, Animals,
Commodities and pathogens• Lack of Effective Mosquito Control
Major Drivers
Urban growth in Asian and American Cities, 1950-2010
Mean population of Dhaka, Bangkok, Jakarta, Manila and Saigon.Mean population of Rio de Janeiro, Sao Paulo, San Juan, Caracas and Guayaquil.
1950 1980 20100
2
4
6
8
10
12
14
Popu
latio
n (M
illio
ns)
The global air network
Average annual number of global airline passengers by decade, 1950-2010
1950-1960
1970-1980
1980-1990
1990-2000
2000-2009
0200400600800
100012001400160018002000
IATA 2010
Mill
ion
of P
asse
nger
(Mil)
Period
Commercial Air Traffic Over a 24 Hour Period
DEN 1DEN 2
DEN 1DEN 2DEN 3 DEN 4
DEN 1DEN 2
Global distribution of dengue virus serotypes, 1970
Global distribution of dengue virus serotypes, 1970-2000
1971
1975
1981
DENV – 1; DENV – 2; DENV – 3; DENV – 4
1985
1981
1994
1982
1980
1977
1979
DEN 1DEN 2DEN 3 DEN 4
DEN 1DEN 2DEN 3
DEN 1DEN 2DEN 3 DEN 4
DEN 1DEN 2DEN 3 DEN 4
DEN 1DEN 2DEN 3 DEN 4
DEN 1DEN 2DEN 3 DEN 4
DEN 1DEN 2DEN 3 DEN 4
DEN 1DEN 2DEN 3 DEN 4
DEN 1DEN 2DEN 3 DEN 4
Global distribution of dengue virus serotypes, 2011
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