Dengue: emergence as a global public health problem and prospects for control

Dengue causes more illness and death than any other arboviral infection: there are at least 20 million infections in the world each year and several hundred thousand cases of a severe, life-threatening syndrome known as dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS). In recent years, the geographical range of dengue has extended and DHF/DSS is occurring in new areas and with increased incidence. The reasons for the resurgence are complex, but parallel demographic changes and reduced efforts towards disease control. Control of dengue currently depends on controlling its mosquito vector. However, development of a vaccine offers greater hope in the long-term. The dengue group of flaviviruses is unique in that it comprises 4 distinct serotypes which have the potential to cause sequential infections with increased severity. It is reasoned, therefore, that any vaccine should induce solid immunity to all 4 serotypes. Knowledge regarding dengue immunity and pathogenesis is rapidly advancing and it is reasonable to believe that this information can be used to devise a safe and efficacious vaccine for dengue, but it seems unlikely that this will become available in the near future.