Dengue, Urbanization and Globalization: The Unholy Trinity of the 21st Century

摘要

Dengue is the most important arboviral disease of humans with over half of the world's population living in areas of risk. The frequency and magnitude of epidemic dengue have increased dramatically in the past 40 years as the viruses and the mosquito vectors have both expanded geographically in the tropical and sub-tropical regions of the world, creating significant social, economic and public health challenges. Many environmental factors have contributed to this emergence of epidemic dengue, but only three have been the principal drivers: 1) urbanization, 2) globalization and 3) lack of effective mosquito control. The dengue viruses have fully adapted to a human-Aedes aegypti-human transmission cycle in the large urban centers of the tropics, where crowded human populations live in intimate association with equally large mosquito populations. This setting provides the ideal environment for maintenance of the viruses and the periodic generation of epidemic strains, posing a potentially significant risk to public health. Additionally, these cities all have modern airports through which 10s of millions of passengers pass each year, providing the ideal mechanism for transportation of viruses to new cities, regions and continents where there is little or no effective mosquito control. The result is epidemic dengue. This paper will discuss this unholy trinity of environment drivers (urbanization, globalization and lack of effective vector control methods) and their impact on public health, along with brief updates on dengue vaccine and drug development, options for mosquito control, and prospects for the future.