Perspective Changing Patterns of Dengue Epidemiology and Implications for Clinical Management and Vaccines

Dengue is the most important arboviral disease of humans and has emerged as a global public health problem. The dengue case burden, and the number of countries reporting outbreaks, has increased 10-fold in the last 30 years. The rapidly urbanising developing and middle-income countries of Asia and the Americas are most affected. Disease prevention relies, mostly unsuccessfully, on control of the principal mosquito vector, Aedes aegypti. Whilst there are currently no licensed vaccines for dengue, promising candidates are pro-gressing through clinical development pipelines, and the prospect of a dengue vaccine becoming available in the next 10 years is a real one [1]. The four dengue virus serotypes co-circulate in many endemic areas, and intriguingly, a second infection caused by a serotype different from an individual’s first exposure is associated with greater risk for severe disease. Oscillations in severe dengue incidence have been described in Thailand over the last 30 years, with peaks in incidence and serotype dominance occurring on regular cycles [2]. Interest-ingly, Viet Nam does not necessarily follow the same cyclical pattern [3]