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
Meta-Analysis
. 2017 Jul 12:7:317.
doi: 10.3389/fcimb.2017.00317. eCollection 2017.

Global Epidemiology of Dengue Outbreaks in 1990-2015: A Systematic Review and Meta-Analysis

Congcong Guo  1 , Zixing Zhou  1 , Zihao Wen  1 , Yumei Liu  1   2 , Chengli Zeng  1 , Di Xiao  1 , Meiling Ou  1   2 , Yajing Han  1   2 , Shiqi Huang  1 , Dandan Liu  1 , Xiaohong Ye  1   2 , Xiaoqian Zou  1   2 , Jing Wu  1   2 , Huanyu Wang  3   4 , Eddy Y Zeng  5 , Chunxia Jing  1   5 , Guang Yang  2   5
Affiliations
Meta-Analysis

Global Epidemiology of Dengue Outbreaks in 1990-2015: A Systematic Review and Meta-Analysis

Congcong Guo et al. Front Cell Infect Microbiol. .

Abstract

Dengue is an arthropod-borne infectious disease caused by dengue virus (DENV) infection and transmitted by Aedes mosquitoes. Approximately 50-100 million people are infected with DENV each year, resulting in a high economic burden on both governments and individuals. Here, we conducted a systematic review and meta-analysis to summarize information regarding the epidemiology, clinical characteristics, and serotype distribution and risk factors for global dengue outbreaks occurring from 1990 to 2015. We searched the PubMed, Embase and Web of Science databases through December 2016 using the term "dengue outbreak." In total, 3,853 studies were identified, of which 243 studies describing 262 dengue outbreaks met our inclusion criteria. The majority of outbreak-associated dengue cases were reported in the Western Pacific Region, particularly after the year 2010; these cases were primarily identified in China, Singapore and Malaysia. The pooled mean age of dengue-infected individuals was 30.1 years; of the included patients, 54.5% were male, 23.2% had DHF, 62.0% had secondary infections, and 1.3% died. The mean age of dengue patients reported after 2010 was older than that of patients reported before 2010 (34.0 vs. 27.2 years); however, the proportions of patients who had DHF, had secondary infections and died significantly decreased after 2010. Fever, malaise, headache, and asthenia were the most frequently reported clinical symptoms and signs among dengue patients. In addition, among the identified clinical symptoms and signs, positive tourniquet test (OR = 4.86), ascites (OR = 13.91) and shock (OR = 308.09) were identified as the best predictors of dengue infection, DHF and mortality, respectively (both P < 0.05). The main risk factors for dengue infection, DHF and mortality were living with uncovered water container (OR = 1.65), suffering from hypotension (OR = 6.18) and suffering from diabetes mellitus (OR = 2.53), respectively (all P < 0.05). The serotype distribution varied with time and across WHO regions. Overall, co-infections were reported in 47.7% of the evaluated outbreaks, and the highest pooled mortality rate (2.0%) was identified in DENV-2 dominated outbreaks. Our study emphasizes the necessity of implementing programs focused on targeted prevention, early identification, and effective treatment.

Keywords: clinical characteristic; dengue; epidemiology; meat-analysis; outbreak; risk factor; serotype; systematic review.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flowchart of literature selection process in this study.
Figure 2
Figure 2
Global dengue outbreaks distribution from 1990–2015.
Figure 3
Figure 3
Meta-analysis: forest plot of the associations between risk factors and dengue infection, DHF and mortality in dengue outbreaks.
Figure 4
Figure 4
Meta-analysis: forest plot of the associations between symptoms and signs and dengue infection, DHF and mortality in dengue outbreaks.
Figure 5
Figure 5
Global serotypes distribution in dengue outbreaks from 1990–2015.
See this image and copyright information in PMC

References

    1. Amarasinghe A., Kuritsk J. N., Letson G. W., Margolis H. S. (2011). Dengue virus infection in Africa. Emerg. Infect. Dis. 17, 1349–1354. 10.3201/eid1708.101515 - DOI - PMC - PubMed
    1. Barcelos F. L. (2014). Dengue virus 2 American-Asian Genotype identified during the 2006/2007 outbreak in Piaui, Brazil reveals a Caribbean route of introduction and dissemination of dengue virus in Brazil (vol 9, e104516, 2014). PLoS ONE 9:516 10.1371/journal.pone.0104516 - DOI - PMC - PubMed
    1. Barde P. V., Shukla M. K., Kori B. K., Chand G., Jain L., Varun B. M., et al. . (2015). Emergence of dengue in tribal villages of Mandla district, Madhya Pradesh, India. Indian J. Med. Res. 141, 584–590. 10.4103/0971-5916.159517 - DOI - PMC - PubMed
    1. Bordignon J., Probst C. M., Mosimann A. L., Pavoni D. P., Stella V., Buck G. A., et al. . (2008). Expression profile of interferon stimulated genes in central nervous system of mice infected with dengue virus Type-1. Virology 377, 319–329. 10.1016/j.virol.2008.04.033 - DOI - PubMed
    1. Callaway E. (2016). Rio fights Zika with biggest release yet of bacteria-infected mosquitoes. Nature 539, 17–18. 10.1038/nature.2016.20878 - DOI - PubMed