Dengue Infections in Colombia: Epidemiological Trends of a Hyperendemic Country

Abstract

Dengue is a major public health problem in hyperendemic countries like Colombia, the understanding of the epidemiological trends is important for the development of efficient public health policies. We conducted a systematic review of the epidemiologic data on dengue in Colombia from 1971 to 2020. A total of 375 relevant citations were identified, 36 of which fulfilled the inclusion criteria. The data of dengue and severe dengue cases, infection fatality rate, and serotype distribution were used to understand and identify gaps in the epidemiological knowledge in Colombia. The epidemiology of dengue in this country was characterized by five main outbreaks in 1998, 2002, 2010, 2013, and 2019 with high fatality rates in comparison with the average values reported in the Americas. The case fatality rate of severe dengue exceeded 2% and all four serotypes co-circulate throughout the country with some regional variations. Overall, the behavior of dengue in Colombia is influenced by multiple factors including seasonal temperature variation and socioeconomic conditions. Additionally, the most important barriers in the epidemiological surveillance of dengue may be due to the insufficient notification rate in some regions and the low active search for the circulation of different serotypes.

Keywords: Colombia; dengue virus; endemic diseases; epidemiology.

Figure 1

Flowchart of the literature search and included studies.

Figure 2

Reported number of probable cases and incidence per 100,000 population of dengue in Colombia between 1978 and the epidemiological week 32 of 2020 [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28].

Figure 3

Dengue case fatality rate between 1990 and 2020: Dengue case fatality rate and dengue cases confirmed in Colombia (A); Comparison between the Dengue case fatality rate in Colombia and the mean Dengue case fatality rate in the Americas reported by the PAHO (B) [5,9,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28].

Figure 4

Reported cases and case fatality rate of severe dengue in Colombia: Total dengue cases and their respective percentages classified by severe dengue cases (A); severe dengue cases and their respective case fatality rate by year. The red dotted line represents the Colombia government’s goal for the infection fatality rate in severe dengue cases (B) [9,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28].

Figure 5

Presence of circulation of Dengue serotypes in Colombia from 1971 to 2020. * No data available [13,35].

Figure 6

Predominance of the dengue virus by serotypes in Colombia: Predominance rate by serotypes in Colombia by year (A); The predominance of dengue virus serotypes by departments in different years (B) [14,15,22,23,24,28,35,36,37].

Figure 7

Reported cases of Dengue disease by region through the five most important outbreaks: Division of the Colombian territory by regions (A); Heat map of Colombian regions according to Dengue reported cases through the most important outbreaks in 1998 (B), 2002 (C), 2010 (D), 2013 (E), and 2019 (F) [13,14,15,16].