Dengue Viruses (Flaviviridae)
Dengue fever/dengue hemorrhagic fever is the most important arboviral disease of humans. In the past 50 years, there has been a dramatic global re-emergence of dengue fever with expanding geographic distribution of both the viruses and the mosquito vectors, resulting in increased frequency and magnitude of epidemic activity and the emergence of severe and fatal dengue disease. Dengue is primarily a tropical urban disease. In 2020, between 3 and 4 billion people live in areas at risk for infection by dengue viruses and annually there are an estimated 400 million infections globally. Dengue hemorrhagic fever is a leading cause of hospitalization and death among children in many Southeast Asian countries. In addition to the public health impact, epidemic dengue places a heavy economic and social burden on endemic countries. It is estimated that the annual disease costs in southeast Asia and South America are over 2 billion US$, mainly in loss in productivity. There are four antigenically related, but distinct dengue virus serotypes (DENV-1, DENV-2, DENV-3, and DENV-4), all of which can cause mild to severe and fatal disease in humans. A virus which is closely related to DENV-4, was isolated in Borneo in 2007. Genetic and antigenic relationships suggest this may be a new serotype (DENV-5), but the data needed to confirm this are pending. All four original serotypes have similar natural histories, including an enzootic cycle involving nonhuman primates and canopy dwelling mosquitoes in Asia, and an urban cycle involving humans as the primary vertebrate host and Aedes aegypti mosquitoes of the subgenus Stegomyia, as the primary urban mosquito vector globally in the topics. These viruses make up the dengue complex within the family Flaviviridae, genus Flavivirus. This article reviews the history, epidemiology, biology, clinical features, pathogenesis, and prevention and control of dengue viruses.
