Dengue has been a notifiable disease in China since 1 September 1989. Cases have been reported each year during the past 25 years of dramatic socio-economic changes in China, and reached a historical high in 2014. This study describes the changing epidemiology of dengue in China during this period, to identify high-risk areas and seasons and to inform dengue prevention and control activities. We describe the incidence and distribution of dengue in mainland China using notifiable surveillance data from 1990-2014, which includes classification of imported and indigenous cases from 2005-2014. From 1990-2014, 69,321 cases of dengue including 11 deaths were reported in mainland China, equating to 2.2 cases per one million residents. The highest number was recorded in 2014 (47,056 cases). The number of provinces affected has increased, from a median of three provinces per year (range: 1 to 5 provinces) during 1990-2000 to a median of 14.5 provinces per year (range: 5 to 26 provinces) during 2001-2014. During 2005-2014, imported cases were reported almost every month and 28 provinces (90.3%) were affected. However, 99.8% of indigenous cases occurred between July and November. The regions reporting indigenous cases have expanded from the coastal provinces of southern China and provinces adjacent to Southeast Asia to the central part of China. Dengue virus serotypes 1, 2, 3, and 4 were all detected from 2009-2014. In China, the area affected by dengue has expanded since 2000 and the incidence has increased steadily since 2012, for both imported and indigenous dengue. Surveillance and control strategies should be adjusted to account for these changes, and further research should explore the drivers of these trends. Please see related article: http://dx.doi.org/10.1186/s12916-015-0345-0

https://link.springer.com/content/pdf/10.1186%2Fs12916-015-0336-1.pdf

The changing epidemiology of dengue in China, 1990-2014: a descriptive analysis of 25 years of nationwide surveillance data

The major arboviral diseases in mainland China include Japanese encephalitis, dengue fever, Crimean-Congo hemorrhagic fever (also known as Xinjiang hemorrhagic fever), and tick-borne encephalitis. These and other newly found arbovirus infections due to Banna virus and Tahyna virus contribute to a large and relatively neglected disease burden in China. Here we briefly review the literature regarding these arboviral infections in mainland China with emphasis on their epidemiology, primary vectors, phylogenetic associations, and the prevention programs associated with these agents in China.

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The Neglected Arboviral Infections in Mainland China

Autochthonous dengue infections have not been reported in Ningbo, People's Republic of China since 1929. In August-October 2004, an outbreak of dengue fever was confirmed in Xiaolin, Cixi, Ningbo. Of 83 cases reported, 68 were laboratory confirmed. Fifty-three percent (34 of 64) of the cases had IgM antibodies to dengue virus. Dengue virus serotype-1 was isolated from two cases. The outbreak was linked to a traveler who returned from Thailand. Phylogenetic analysis showed that the Ningbo isolate was closely associated to strains from Thailand. Prevalence of dengue-specific IgG in asymptomatic residents was significantly higher in the epidemic-stricken area than in a control area. High density of Aedes albopictus, which resulted from waterlogging caused by Typhoon Rananim and lifestyle of local residents, was responsible for rapid spread of the virus. Eradication of mosquito infestation might interrupt transmission. This outbreak underscores the importance of maintaining surveillance and control of potential vectors for the control of emerging infectious diseases.

An outbreak of dengue virus serotype 1 infection in cixi, ningbo, people’s republic of china, 2004, associated with a traveler from thailand and high density of aedes albopictus

Laboratory studies were carried out on 3178 patients with signs and symptoms suggestive of dengue infection from April 1986 to December 1987 in the State of Rio de Janeiro, Brazil. The epidemic had two peaks following the first virus isolation and affected the inhabitants of 17 counties. Both sex and all age groups were affected. Dengue virus type 1 was isolated from 1039 sera and the number of confirmed cases was increased to 1874 (59%) by MAC-ELISA. Isolation rate confirmed cases reached 80% in the specimens obtained until the 4th day after the onset of disease and viraemia ranged from 10(3.0) to 10(8.5) TCID50/ml.

https://www.arca.fiocruz.br/bitstream/icict/36030/2/HermanSchtzmayr_RitaNogueira_etal_IOC_1993.pdf

Dengue epidemic in the state of Rio de Janeiro, Brazil: virological and epidemiological aspects

Aedes albopictus is distributed widely in China, as a primary vector of Dengue fever and Chikungunya fever in south of China. Chemical insecticide control is one of the integrated programmes to prevent mosquito-borne diseases. Long-term applications of pyrethroids have resulted in the development of resistance in Ae. albopictus populations in China. However, the susceptibility of Ae. albopictus to pyrethroids in Hainan Island was unclear. Knockdown resistance (kdr), caused by point mutations in the VGSC gene, is one of the mechanisms that confer resistance to DDT and pyrethroids. This study was to investigate the resistance level of Ae. albopictus populations in Haikou City to three pyrethroid insecticides, and elucidate the relationship between the resistant phenotype and kdr mutations. The Aedes albopictus samples were collected in Xinbu Island (XI), Longtang Town (LT), Shishan Town (ST), Baishamen Park (BP), and Flower Market (FM) from Haikou City, Hainan Island, China. The larval susceptibility to deltamethrin, permethrin and beta-cypermethrin was tested by larval bioassays, and adult susceptibility to deltamethrin and DDT was determined by adult bioassays. The degree of resistance was determined by resistance ratio value (RR50 > 3) for larvae and by mortality for adult. The kdr alleles at codon 1534 of the VGSC gene were genotyped. The relationship between kdr genotypes and resistant phenotypes was analyzed by Chi-square test. Out of five populations, assessed by larval bioassays, XI was susceptible to deltamethrin and permethrin; LT was susceptible to permethrin and beta-cypermethrin; and ST was susceptible to permithrin. FM and BP both were resistant to all of the three pyrethroids, and FM showed the highest degree of resistance, with RR50 values from 65.17 to 436.36. A total of 493 individuals from the larval bioassays were genotyped for kdr alleles. Five alleles were detected, including two wildtype alleles, TTC(F) (67.04 %) and TTT(F) (0.41 %), and three mutant alleles, TGC(C) (0.30 %), TCC(S) (31.54 %) and TTG(L) (0.71 %). There was a clear correlation between mutant alleles (or F1534S) and resistant phenotypes (P < 0.01). Two novel kdr mutant alleles F1534S and F1534L were detected in the pyrethroid resistant populations of Ae. albopictus in Haikou Hainan, China. For the first time, the mutant F1534S was associated with pyrethroid resistance in Ae. albopictus.

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First identification of kdr allele F1534S in VGSC gene and its association with resistance to pyrethroid insecticides in Aedes albopictus populations from Haikou City, Hainan Island, China

Virologic and seroepidemiologic studies were carried out during an epidemic of dengue fever on Hainan Island in 1980 Dengue 3 virus was isolated from 46 of 77 acute phase sera and from 1 of 10 pools of adult Aedes aegypti Dengue 1 virus virus was isolated from a single acute phase serum Seroepidemiologic investigations showed that 74% of healthy individuals in the epidemic area had antibody to dengue virus compared to 54% in an area where epidemic dengue had occurred in 1978, and less than or equal to 8% in nonepidemic areas There were no significant differences in antibody prevalence for different sex and age groups

Chang-Hua Zou

Papers

Etiologic and serologic investigations of the 1980 epidemic of dengue fever on Hainan Island, China.