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