Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Dec;39(4 Suppl):3-11.
doi: 10.2149/tmh.2011-S05. Epub 2011 Aug 25.

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

Duane J Gubler  1
Affiliations

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

Duane J Gubler. Trop Med Health. 2011 Dec.

Abstract

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 regions of the world. There are many factors that 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 home for maintenance of the viruses and the periodic generation of epidemic strains. 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 discusses this unholy trinity of drivers, along with disease burden, prevention and control and prospects for the future.

Keywords: Dengue; aedes aegypti; globalization; urbanization.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Urban growth in Asian and American cities—1950–2010.
Fig. 2.
Fig. 2.
Reported dengue/DHF cases in Thailand (A), Indonesia (B) and Vietnam (C), by year.
Fig. 3.
Fig. 3.
Reinfestation of tropical America by Aedes aegypti, 1930–2011.
Fig. 4.
Fig. 4.
The emergence of dengue hemorrhagic fever in the Americas associated with introduction of new virus serotypes and the development of hyperendemicity.
Fig. 5.
Fig. 5.
The global distribution of epidemic dengue and the principal vector mosquito, Aedes aegypti, 2011.
Fig. 6.
Fig. 6.
Geographic spread of DHF in the Americas, 1981 (A) and 2011 (B).
Fig. 7.
Fig. 7.
Mean annual number of global airline passengers by decade, 1965–2010.
Fig. 8.
Fig. 8.
The global distribution of dengue virus serotypes, 1970 (A) and 2011 (B).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Henderson DA. Surveillance Systems and Intergovernmental Cooperation. In: Stephen S. Morse, ed. Emerging Viruses. Oxford University Press; pp. 283–289, 1993
    1. Gubler DJ. Aedes aegypti and Aedes aegypti-borne disease control in the 1990s: Top Down or Bottom Up. Am J Trop Med Hyg 1989; 40: 571–578 - PubMed
    1. IOM (Institute of Medicine). 1992. Emerging infections: microbial threats to health in the United States. Washington, DC: National Academy Press. - PubMed
    1. Gubler DJ. The President’s Address: Prevention and control of tropical diseases in the 21st century: Back to the field. Am J Trop Med Hyg 2001; 65(1): v–xi - PubMed
    1. Gubler DJ. The global threat of emergent/reemergent vector-borne diseases. In: Vector-Borne Diseases: understanding the environmental, human health, and ecological connections; Institute of Medicine. Washington, D.C.: The National Academies Press; 2008, pp. 43–64 - PubMed

LinkOut - more resources

-