Dengue is a systemic viral infection transmitted between humans by Aedes mosquitoes. For some patients, dengue is a life-threatening illness. There are currently no licensed vaccines or specific therapeutics, and substantial vector control efforts have not stopped its rapid emergence and global spread. The contemporary worldwide distribution of the risk of dengue virus infection and its public health burden are poorly known. Here we undertake an exhaustive assembly of known records of dengue occurrence worldwide, and use a formal modelling framework to map the global distribution of dengue risk. We then pair the resulting risk map with detailed longitudinal information from dengue cohort studies and population surfaces to infer the public health burden of dengue in 2010. We predict dengue to be ubiquitous throughout the tropics, with local spatial variations in risk influenced strongly by rainfall, temperature and the degree of urbanization. Using cartographic approaches, we estimate there to be 390 million (95% credible interval 284-528) dengue infections per year, of which 96 million (67-136) manifest apparently (any level of disease severity). This infection total is more than three times the dengue burden estimate of the World Health Organization. Stratification of our estimates by country allows comparison with national dengue reporting, after taking into account the probability of an apparent infection being formally reported. The most notable differences are discussed. These new risk maps and infection estimates provide novel insights into the global, regional and national public health burden imposed by dengue. We anticipate that they will provide a starting point for a wider discussion about the global impact of this disease and will help to guide improvements in disease control strategies using vaccine, drug and vector control methods, and in their economic evaluation.

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The global distribution and burden of dengue

Statistical Methods in Medical Research.

Global change includes climate change and climate variability, land use, water storage and irrigation, human population growth and urbanization, trade and travel, and chemical pollution. Impacts on vector-borne diseases, including malaria, dengue fever, infections by other arboviruses, schistosomiasis, trypanosomiasis, onchocerciasis, and leishmaniasis are reviewed. While climate change is global in nature and poses unknown future risks to humans and natural ecosystems, other local changes are occurring more rapidly on a global scale and are having significant effects on vector-borne diseases. History is invaluable as a pointer to future risks, but direct extrapolation is no longer possible because the climate is changing. Researchers are therefore embracing computer simulation models and global change scenarios to explore the risks. Credible ranking of the extent to which different vector-borne diseases will be affected awaits a rigorous analysis. Adaptation to the changes is threatened by the ongoing loss of drugs and pesticides due to the selection of resistant strains of pathogens and vectors. The vulnerability of communities to the changes in impacts depends on their adaptive capacity, which requires both appropriate technology and responsive public health systems. The availability of resources in turn depends on social stability, economic wealth, and priority allocation of resources to public health.

Global Change and Human Vulnerability to Vector-Borne Diseases

Lymphatic filariasis and onchocerciasis.

The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future.

Differential distributions of Aedes aegypti and Ae. mediovittatus (potential inter-epidemic dengue vector) and other mosquitoes colonizing bamboo pots in San Juan, Puerto Rico were studied along an urban-rural gradient. City regions (urban, suburban, and rural) and landscape elements within regions (forest [F], low-density housing [LDH], and high-density housing [HDH]) were identified using satellite imagery. Aedes species extensively overlapped in LDH of urban, suburban, and rural areas. Mosquito species showed their high specificity for landscape elements (96.6% correct classification by discriminant analysis); absence of Ae. mediovittatus in HDH or absence of Ae. aegypti in forests were the main indicator variables. The gradient was explained using a canonical correspondence analysis, which showed the association of Ae. aegypti with HDH in urban areas, Culex quinquefasciatus with LDH in suburbs, and Ae. mediovittatus and other native mosquitoes (Cx. antillummagnorum, Toxorhynchites portoricencis) with less disturbed habitats (forests, LDH).

http://saber.ucv.ve/bitstream/123456789/7314/1/Cox%20et%20al.%20%282007%29.pdf

Habitat segregation of dengue vectors along an urban environmental gradient

Spatial and temporal abundance patterns of anopheline larvae and their relationships with wetland conditions were studied in an endemic malaria area in northeastern Venezuela, where Anopheles aquasalis Curry is the main vector. Larvae were sampled over a 2-yr period in 7 wetland types (brackish and freshwater herbaceous swamps, mangrove swamps, freshwater ponds, clear-cut marsh forests, small irrigation canals, and swamp forests), covering 3 environmental gradients (salinity, aquatic vegetation, and habitat permanence). Twelve variables were quantified to describe each habitat. Two species of anophelines were collected. An. aquasalis was the species with the widest distribution, and its highest abundance was in the seasonal brackish mangrove habitat during the rainy season. An. oswaldoi Peryassu was rarely encountered, but was mainly associated with the dry season and with the permanent freshwater wetlands (such as ponds). Principal components and correlation analyses revealed that the physicochemical (salinity, dissolved oxygen) variables of the wetland were associated most strongly with the spatial distribution of both species. Variations in salinity were strongly associated with the abundance of An. aquasalis. Both the occurrence and abundance of An. oswaldoi were most closely correlated with dissolved oxygen. Changes in seasonal abundance of both species were associated with rainfall. The relevance of these results to vector control in northern Venezuela is discussed.

Factors associated with distribution of Anopheles aquasalis and Anopheles oswaldoi (Diptera: Culicidae) in a malarious area, northeastern Venezuela.

Here we analyze patterns of human infection with Onchocerca volvulus (the cause of river blindness) in different continents and ecologies. In contrast with some geohelminths and schistosome parasites whose worm burdens typically exhibit a humped pattern with host age, patterns of O. volvulus infection vary markedly with locality. To test the hypothesis that such differences are partly due to heterogeneity in exposure to vector bites, we develop an age- and sex-structured model for intensity of infection, with parasite regulation within humans and vectors. The model is fitted to microfilarial data from savannah villages of northern Cameroon, coffee fincas of central Guatemala, and forest-dwelling communities of southern Venezuela that were recorded before introducing ivermectin treatment. Estimates of transmission and infection loads are compared with entomological and epidemiological field data. Host age- and sex-heterogeneous exposure largely explains locale-specific infection patterns in onchocerciasis (whereas acquired protective immunity has been invoked for other helminth infections). The basic reproductive number, R0, ranges from 5 to 8, which is slightly above estimates for other helminth parasites but well below previously presented values.

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Human infection patterns and heterogeneous exposure in river blindness.

Parasite-vector interactions shape the population dynamics of vector-borne infections and contribute to observed epidemiological patterns. Also, parasites and their vectors may co-evolve, giving rise to locally adapted combinations or complexes with the potential to stabilise the infection. Here, we focus on Onchocerca-Simulium interactions with particular reference to the transmission dynamics of human onchocerciasis. A wide range of simuliid species may act as vectors of Onchocerca volvulus, each exerting their own influence over the local epidemiology and the feasibility of controlling/eliminating the infection. Firstly, current understanding of the processes involved in parasite acquisition by, and development within, different Simulium species in West Africa and Latin America will be reviewed. A description of how Onchocerca and Simulium exert reciprocal effects on each other's survival at various stages of the parasite's life cycle within the blackfly, and may have adapted to minimise deleterious effects on fitness and maximise transmission will be given. Second, we describe the interactions in terms of resultant (positive and negative) density-dependent processes that regulate parasite abundance, and discuss their incorporation into mathematical models that provide useful qualitative insight regarding transmission breakpoints. Finally, we examine the interactions' influence upon the evolution of anthelmintic resistance, and conclude that local adaptation of Onchocerca-Simulium complexes will influence the feasibility of eliminating the parasite reservoir in different foci.

Onchocerca-Simulium interactions and the population and evolutionary biology of Onchocerca volvulus.

Mosquito-borne pathogen transmission exhibits spatial-temporal variability caused by ecological interactions acting at different scales. We used local spatial statistics and geographically weighted regression (GWR) to determine the spatial pattern of malaria incidence and persistence in northeastern Venezuela. Seven to 11 hot spots of malaria transmission were detected by using local spatial statistics, although disease persistence was explained only for four of those hot spots. The GWR models greatly improved predictions of malaria risk compared with ordinary least squares (OLS) regression models. Malaria incidence was largely explained by the proximity to and number of Anopheles aquasalis habitats nearby (1-3 km), and low-elevation terrains. Disease persistence was associated with greater human population density, lower elevations, and proximity to aquatic habitats. However, there was significant local spatial variation in the relationship between malaria and environmental variables. Spatial modeling improves the understanding of the causal factors operating at several scales in the transmission of malaria.

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Maria Eugenia Grillet

Papers

Habitat segregation of dengue vectors along an urban environmental gradient

Factors associated with distribution of Anopheles aquasalis and Anopheles oswaldoi (Diptera: Culicidae) in a malarious area, northeastern Venezuela.

Human infection patterns and heterogeneous exposure in river blindness.

Onchocerca-Simulium interactions and the population and evolutionary biology of Onchocerca volvulus.

Disentangling the effect of local and global spatial variation on a mosquito-borne infection in a neotropical heterogeneous environment.