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The 2012 dengue outbreak in Madeira: exploring the origins
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.ORCID-id: 0000-0003-0362-5375
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.ORCID-id: 0000-0003-4030-0449
Visa övriga samt affilieringar
2014 (Engelska)Ingår i: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 19, nr 8, s. 20718-Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

In 2012, Madeira reported its first major outbreak of dengue. To identify the origin of the imported dengue virus, we investigated the interconnectivity via air travel between dengue-endemic countries and Madeira, and compared available sequences against GenBank. There were 22,948 air travellers to Madeira in 2012, originating from twenty-nine dengue-endemic countries; 89.6% of these international travellers originated from Venezuela and Brazil. We developed an importation index that takes into account both travel volume and the extent of dengue incidence in the country of origin. Venezuela and Brazil had by far the highest importation indices compared with all other dengue-endemic countries. The importation index for Venezuela was twice as high as that for Brazil. When taking into account seasonality in the months preceding the onset of the Madeira outbreak, this index was even seven times higher for Venezuela than for Brazil during this time. Dengue sequencing shows that the virus responsible for the Madeira outbreak was most closely related to viruses circulating in Venezuela, Brazil and Columbia. Applying the importation index, Venezuela was identified as the most likely origin of importation of dengue virus via travellers to Madeira. We propose that the importation index is a new additional tool that can help to identify and anticipate the most probable country of origin for importation of dengue into currently non-endemic countries.

Ort, förlag, år, upplaga, sidor
2014. Vol. 19, nr 8, s. 20718-
Nationell ämneskategori
Infektionsmedicin
Identifikatorer
URN: urn:nbn:se:umu:diva-87645ISI: 000332376900002OAI: oai:DiVA.org:umu-87645DiVA, id: diva2:711234
Tillgänglig från: 2014-04-09 Skapad: 2014-04-07 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Ingår i avhandling
1. Imported infections’ importance: global change driving Dengue dynamics
Öppna denna publikation i ny flik eller fönster >>Imported infections’ importance: global change driving Dengue dynamics
2016 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Vikten av importerade infektioner : kan globala förändringar förklara Dengue utbrott?
Abstract [en]

Background Dengue is a significant problem of international health concern. According to the World Health Organization in 2012, globally, dengue is “the most important mosquito borne viral disease” with incidence 30 higher than it had been 50 years ago. While most of the burden of disease associated with dengue is located in areas with a tropical and sub-tropical climate, increasing evidence suggests temperate areas are also at risk. Considering the recent introduction of relevant mosquito vectors into Southern Europe, and increasing numbers of imported dengue via travelers, Europe and other temperate areas may be increasingly at risk for dengue emergence, establishment and local transmission in the foreseeable future.

Methods Recent dengue emergence in Madeira and reemergence in Tokyo underline the hypothesis that passenger air-travel can be an important conduit for the importation of vector-borne disease leading to emergence in naïve areas climatically suitable for dengue transmission, including parts of Europe. Combining information on travel with virus genetic similarity was useful in discerning likely pathways of for the importation of infections. Generalizing information learned from outbreaks in Tokyo and Madeira with global epidemic intelligence, global travel networks, and climate change projections, leads to more refined understanding of the magnitude of dengue infectious imported into temperate areas and these virus introduction events’ potential implications for seeding epidemics in the 21st century.

Results While compared to total travel, imported dengue events and epidemics of dengue outside the tropics are rare, our combined evidence and modeled estimations suggest strongly that epidemic dengue emergence in temperate areas is possible and will continue to increase. We found that global change dynamics including warming temperatures in the much of the northern hemisphere and increasing passenger interconnectivity between areas endemic for dengue and dengue free areas are key mechanisms partly explaining these unprecedented epidemiological transitions.

Conclusion While we calibrated our models on information known about dengue, many elements of the methods and conclusions may increase understanding of the potentially global implications for imported infections of other climate-sensitive infectious diseases’ that may have similar parameters. During 2016 and the years to come, techniques developed in this doctoral research will contribute to models used in risk analysis for vector-borne diseases of interest, including the increasing important potential for imported Chikungunya and Zika viruses into a variety of unexposed areas. 

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University, 2016. s. 99
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1793
Nyckelord
Dengue, Zika, Vector-borne Disease, Aedes, Global Change, Climate Change, Viral Evolution, Phylogenetics, Travel, Interconnectivity, Disease Modeling, Madeira, Italy, Japan, Europe
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-118645 (URN)978-91-7601-443-1 (ISBN)
Disputation
2016-04-22, Room 135, Building 9A, Northlands University Hospital (sal 135, byggnad 9A, Norrlands Universitetssjukhus), Umeå, Sweden, 13:00 (Engelska)
Opponent
Handledare
Forskningsfinansiär
EU, FP7, Sjunde ramprogrammet, 282589
Tillgänglig från: 2016-03-31 Skapad: 2016-03-28 Senast uppdaterad: 2018-06-07Bibliografiskt granskad

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http://www.eurosurveillance.org/images/dynamic/EE/V19N08/art20718.pdf

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