Dengue fever outbreaks

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Worldwide dengue distribution, 2006. Red: Epidemic dengue. Blue: Aedes aegypti.
Disability-adjusted life year for dengue fever per 100,000 inhabitants in 2004.
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  < 10
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  30-40
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  100–200
  > 200
Average annual number of DF cases and DHF cases reported to WHO

As of 2010 dengue fever is believed to infect 50 to 100 million people worldwide a year with 1/2 million life-threatening infections.[1] It dramatically increased in frequency between 1960 and 2010, by 30 fold.[2] This increase is believed to be due to a combination of urbanization, population growth, increased international travel, and global warming.[1] The geographical distribution is around the equator with 70% of the total 2.5 billion people living in endemic areas from Asia and the Pacific.[2] Many people in outbreaks are not virally tested, therefore their infections may also be due to chikungunya, a coinfection of both, or even other similar viruses.

Recent outbreaks[edit]

The first recognized dengue epidemics occurred almost simultaneously in Asia, Africa, and North America in the 1780s, shortly after the identification and naming of the disease in 1779. A pandemic began in Southeast Asia in the 1950s, and by 1975 DHF had become a leading cause of death among children in the region. The first case of DHF was reported in Manila, Philippines around 1953 through 1954.[3] A small child with dengue fever started to bleed uncontrollably. Other children then became victims to the new symptom.[4] Epidemic dengue has become more common since the 1980s. By the late 1990s, dengue was the most important mosquito-borne disease affecting humans after malaria, with around 40 million cases of dengue fever and several hundred thousand cases of dengue hemorrhagic fever each year. Significant outbreaks of dengue fever tend to occur every five or six months. The cyclical rise and fall in numbers of dengue cases is thought to be the result of seasonal cycles interacting with a short-lived cross-immunity[clarification needed] for all four strains in people who have had dengue. When the cross-immunity wears off the population is more susceptible to transmission whenever the next seasonal peak occurs. Thus over time there remain large numbers of susceptible people in affected populations despite previous outbreaks due to the four different serotypes of dengue virus and the presence of unexposed individuals from childbirth or immigration.

There is significant evidence, originally suggested by S.B. Halstead in the 1970s, that dengue hemorrhagic fever is more likely to occur in people who have secondary infections by another one of dengue fever's four serotypes. One model to explain this process is known as antibody-dependent enhancement (ADE), which allows for increased uptake and virion replication during a secondary infection with a different strain. Through an immunological phenomenon, known as original antigenic sin, the immune system is not able to adequately respond to the stronger infection, and the secondary infection becomes far more serious.[5]

Reported cases of dengue are an under-representation of all cases when accounting for subclinical cases and cases where the patient did receive medical treatment.

There was a serious outbreak in Rio de Janeiro in February 2002 affecting around one million people and killing sixteen. On March 20, 2008, the secretary of health of the state of Rio de Janeiro, Sérgio Côrtes, announced that 23,555 cases of dengue, including 30 deaths, had been recorded in the state in less than three months. Côrtes said, "I am treating this as an epidemic because the number of cases is extremely high." Federal Minister of Health, José Gomes Temporão also announced that he was forming a panel to respond to the situation. Cesar Maia, mayor of the city of Rio de Janeiro, denied that there was serious cause for concern, saying that the incidence of cases was in fact declining from a peak at the beginning of February.[6] By April 3, 2008, the number of cases reported rose to 55,000 [7]

In Singapore, there are 4,000–5,000 reported cases of dengue fever or dengue haemorrhagic fever every year. In the year 2004, there were seven deaths from dengue shock syndrome.[8] Since beginning of 2013, there were 510 cases in Singapore in the week ending 20 April, the highest weekly number recorded since the major outbreak in 2005. Over 30,000 People's Association volunteers were mobilised in a national campaign to get members of the public to do their part to stamp out dengue.[9]

Dengue fever occurs widely in the tropics, including the Southern United States,[10] northern Argentina, northern Australia, Bangladesh, Barbados, Bolivia,[11] Belize, Brazil, Cambodia, Colombia, Costa Rica, Cuba, Dominican Republic, French Polynesia, Guadeloupe, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras, India, Indonesia, Jamaica, Laos, Malaysia, Melanesia,[clarification needed] Mexico, Micronesia, Nicaragua, Pakistan, Panama, Paraguay,[12] The Philippines, Puerto Rico, Samoa,[13] Western Saudi Arabia, Singapore, Sri Lanka, Suriname, Taiwan, Thailand, Trinidad and Tobago, Venezuela and Vietnam, and increasingly in southern China.[14]

A 2010 outbreak in Puerto Rico resulted in 5382 confirmed infections and 20 deaths. Nearby Guadeloupe and Martinique, in the French Caribbean, were affected as well: over 40000 clinical cases in each island required medical assistance (the outbreak peaked in August 2010 and was practically over by October). .[15][16] A considerable number of cases were recorded in the French/Dutch island of St.Martin/Sint Marteen as well, where dengue is endemic.[17] There was an outbreak in Pakistan with more than 5000 confirmed infections and a mortality rate of 31. The 2010 and 2009 dengue outbreaks in Key West Florida [18][19] are similar to the 2005 Texas (25 cases) and 2001 Hawaii (122 cases) outbreaks, which were locally sustained on American soil and not a result of travelers returning from endemic areas.[20]

American visitors to and visitors from dengue-endemic regions will continue to present a potential pathway for the dengue virus to enter the United States and infect populations that have not been exposed to the virus for several decades.[20][21] The health risks and rapidly escalating costs to the United States of unmonitored, unvaccinated and disease carrying travelers, legal and illegal, has been recently considered.[20][22]

An outbreak of dengue fever was declared in Cairns, located in the tropical north of Queensland, Australia on 1 December 2008. As of 3 March 2009 there were 503 confirmed cases of dengue fever, in a residential population of 152,137. Outbreaks were subsequently declared the neighbouring cities and towns of Townsville (outbreak declared 5 January 2009), Port Douglas (6 February 2009), Yarrabah (19 February 2009), Injinoo (24 February 2009), Innisfail (27 February 2009) and Rockhampton (10 March 2009). There have been occurrences of dengue types one, two, three, and four in the region. On March 4, 2009, Queensland Health had confirmed an elderly woman had died from dengue fever in Cairns, in the first fatality since the epidemic began last year. The statement said that although the woman had other health problems, she tested positive for dengue and the disease probably contributed to her death.

An epidemic broke out in Bolivia in early 2009, in which 18 people died and 31,000 were infected.

In 2009, in Argentina, a dengue outbreak was declared the northern provinces of Chaco, Catamarca, Salta, Jujuy, and Corrientes, with over 9673 cases reported as of April 11, 2009 by the Health Ministry.[23] Some travelers from the affected zones have spread the fever as far south as Buenos Aires.[24] Major efforts to control the epidemic in Argentina are focused on preventing its vector (the Aedes mosquitoes) from reproducing. This is addressed by asking people to dry out all possible water reservoirs from where mosquitoes could proliferate (which is, in other countries, known as "descacharrado"). There were information campaigns concerning prevention of the dengue fever; and the government is fumigating with insecticide in order to control the mosquito population.[citation needed]

One of the South Asian countries still suffering highly from this problem is Sri Lanka.[25]

An outbreak caused by serotype DENV-1 occurred in 2002 on Easter Island. Subsequent outbreaks occurred in 2006–2007 and 2008, 2009 and 2011 with decreasing magnitude over time. The male:female ratio in reported cases was approximately 1:1 and the average age at infection was 31.38 ± 18.37 in both sexes.[26]

2010[edit]

In many undeveloped regions, "authorities do not have adequate facilities to detect dengue cases."[27] Notably, in the Philippines where patients seek herbal medication in lieu of hospitals for treating dengue, death rates as evidenced below are statistically far greater than other affected areas. As many cases go unreported, higher statistics here do not necessarily indicate a larger outbreak. In 2010, Latin America alone reported a sum of 1.5 million cases.[28]

Country Region Confirmed Cases Dengue
(Year: 2010)
Suspected Cases
(Year: 2010)
Reported Deaths
(Year: 2010)
Compared with previous year Figures as of**
 World (sum of all regions) 1,785,059 N.A. 2,398
 Brazil 1,011,548 656 406,269 mid Oct[29]
 Colombia 121,600 161 Sep 24[30]
 Indonesia N/A N/A 155,000 and 1386 deaths[31] no date
 Philippines 119,789 724 49,319 (up 140%) Nov 17[32]
 Venezuela 124,931 65,869 all of 2010[33]
 Thailand 108,863 131 up 134.7% on sep 27[34] Nov 20[35]
 Vietnam ~80,000 59 105,370 (whole year) Sep [36]
 Honduras 69,745 81 13,351 (whole year) December 2010[37]
 Malaysia 45,037 133 39,537 dec 17[38]
 Sri Lanka 26,824 192 mid Jul[39]
 Costa Rica 21,000 N/A 3,326 end Aug[40]
 Laos 14,659 39 7,214(whole year) aug 28[41]
 Puerto Rico 13,990 22 Sep 18[42]
 Paraguay 13,678 6138 n/a n/a sep 30[43]
 Mexico 12,240 20 15,032 week 32 (sep)[44]
 Indonesia Bali 10,230 29 N/A Jan–Oct[45]
 Dominican Republic 8,839 41 3,000 Sep 3[46]
 El Salvador 6,458 15,068 1 n/a week 28[47]
 India Delhi 5,837 8 1,153 Nov 9 [48]
 Pakistan 7,000+ 35 Nov 22[49]
 Indonesia North Sumatra 5,805 N/A 4,643 (whole year) Sep [50]
 Indonesia Semarang 5,284 43 3,883 Oct 12 [51]
 Singapore 5,103 41 4,497 dec 11[52]
 Cambodia 3,771 10 2,355 to July[53]
 Saudi Arabia Jeddah 2219 N/A dec 16[54]
 France Martinique 644 41970 17 Nov 22 [16]
 France Guadeloupe 418 44000 5 Nov 22 [55]
 Guatemala 1,925 11,800 25 1 sep[56]
 Indonesia Yogyakarta 1123 688 (whole year) Sep 26[57]
 Taiwan 1211 2 1052 Nov 1[58]
 Trinidad and Tobago 1,200 4 N/A end aug[59]
 India Uttar Pradesh 496 8 Oct 20[60]
   Nepal Chitwan 280 Oct 17, 2010[61]
 United States 198 (24-2010FL, 27-2009FL, 25-2005TX, 122-2001HI) [19][20][62] 2 (2010, suspected)[63][64] Cases down 11% from 2009[62] Aug 3, 2010 [65]
 France Mayotte 75 N/A Sep 1[46]
 Australia Queensland 13 0 1 Nov 3, 2010[66]

2011[edit]

Philippines dengue case load for Q1 2011 was some 5% higher than the preceding year, at 18,885 cases and 115 deaths.[67] For 2011 until April 16, Brazil has recorded some 56,882 cases with 39 deaths, Paraguay with 27,000 cases and 31 deaths.[68]

A notable case was that of Trinidad and Tobago's first female Prime Minister, Kamla Persad-Bissessar, who was diagnosed with dengue fever in August 2011,[69] prompting investigation into the possibility of an epidemic on the twin-island republic. In 2012 there have been numerous outbreaks reported for the first time in the Island of Madeira.

Some 52,008 cases of dengue fever were recorded in Thailand from Jan to Oct 16, 2012, with 50 deaths.[70]

2013[edit]

Record dengue outbreaks reported in 2013 in many countries: Brazil (double deaths over 2012),[71] Singapore, and Thailand (worst in 20 years),[72] among others. San Pedro Sula, Honduras declared a dengue 'state of emergency',[73] and Central America had its worst outbreaks since 2008.[74] Polynesia experienced an 'unprecedented' series of outbreaks (14), along with Chikungunya and Zika virus.

In only 7 weeks, in Brazil some 205,000 cases of dengue were reported, a record.[75] In Peru, nearly 400 cases have been reported until March 2013; two of them were fatal.[76] Since the beginning of 2013, in Paraguay 35 people have died after contracting dengue fever and almost 70,000 are still infected.[77] As of June, 150,000 people in Thailand have come down with it, with 50 deaths, and some 44 deaths in Laos and 11,000 cases, 14,000 cases in Singapore but only 6 deaths, 22 deaths in Malaysia and 10,500 cases[78] while 42,500 cases in Philippines with about 200 deaths.[79]

2014[edit]

Dengue deaths have tripled in Malaysia until Feb 2014 over 2013, after tripling 2013 over 2012.[80]

Due to Typhoon Haiyan striking the Philippines early 2014, stagnant waters and heavy rain have been on constant watch due to mosquitoes breeding and causing epidemics around the area.[81]

Yoyogi Park in Tokyo became a breeding ground for dengue fever carrying mosquitoes. On September 2, the Japanese health ministry confirmed that 34 people had been infected.[82]

A study claims India has 6 million unreported dengue cases annually,[83] while in Guangdong, China, a 15-fold increase over last year and 5-fold increase of mosquitos has left the normally lightly hit region stunned.[84] Likewise Taiwan also had a 10-fold increase in cases this year.[85]

2015[edit]

Outbreaks have intensified in nearly all tropical areas, with endemic extent, deaths, and caseloads all reporting new highs, with the Americas reporting a whopping 2 million symptomatic cases.[86] In tropical/subtropical Asia, nearly all nations had reported explosive increases.[87][88][89] With one sole exception, China's caseload has plunged to less than a tenth of the prior year due to massive releases of sterilized mosquitos.

Dengue appeared in the Hawaiian Islands in late 2015, with at least 190 cases confirmed by year end. Most cases were reported on the island of Hawaii (the "Big Island").[90][91]

2016[edit]

Argentina is registering a Dengue fever outbreak in late January 2016 with 13 of 24 provinces affected.[92][93][94]

In Thailand, officials are anticipating as many cases in 2016 as occurred during a large outbreak in 1978, the largest ever recorded.[95] Since the beginning of the year, more than 8,000 cases have occurred,[96] compared with just over 4,000 cases over the same period in 2015.[97]

References[edit]

  1. ^ a b Whitehorn J, Farrar J (2010). "Dengue". Br. Med. Bull. 95: 161–73. doi:10.1093/bmb/ldq019. PMID 20616106. 
  2. ^ a b WHO 2009 pg.3
  3. ^ Gubler, Duane. "Dengue and Dengue Hemorrhagic Fever". Retrieved 20 April 2014. 
  4. ^ Dobson, Mary (2013). Disease: The Extraordinary Stories Behind History's Deadliest Killers. New York: Metro Books. pp. 152–155. ISBN 9781435151666. 
  5. ^ Rothman AL (2004). "Dengue: defining protective versus pathologic immunity". J. Clin. Invest. 113 (7): 946–51. doi:10.1172/JCI21512. PMC 379334free to read. PMID 15057297. 
  6. ^ Fernanda Pontes (20 March 2008). "Secretário estadual de Saúde Sérgio Côrtes admite que estado vive epidemia de dengue". O Globo Online (in Portuguese). 
  7. ^ CNN (3 April 2008). "Thousands hit by Brazil outbreak of dengue". CNN. 
  8. ^ "International Journal of Infectious Diseases – Fatal dengue hemorrhagic fever in adults during a dengue epidemic in Singapore". International Journal of Infectious Diseases. 11: 263–267. 2004-09-31. doi:10.1016/j.ijid.2006.02.012. Retrieved 2012-11-09.  Check date values in: |date= (help)
  9. ^ [1]
  10. ^ "Locally Acquired Dengue – Key West, Florida, 2009–2010". Cdc.gov. Retrieved 2012-11-09. 
  11. ^ Schipani, Andres (2009-02-03). "Dengue fever outbreak in Bolivia". BBC. Retrieved 2009-02-26. 
  12. ^ Reuters, "Dengue Fever Hits Paraguay", New York Times" (March 4, 2007)
  13. ^ [2] Archived June 17, 2012, at the Wayback Machine.
  14. ^ "Zhuhai reports outbreak of dengue fever". China Daily. 200-09-06. Retrieved 2009-11-18.  Check date values in: |date= (help)
  15. ^ "INVS Bulletin" (PDF). 
  16. ^ a b [3] Archived December 7, 2010, at the Wayback Machine.
  17. ^ (PDF) http://www.invs.sante.fr/surveillance/dengue/points_sbsm/2010/pe_st_martin_2010_21_dengue.pdf.  Missing or empty |title= (help)
  18. ^ Maugh II, Thomas H. (2010-07-14). "Dengue fever outbreak feared in Key West [Updated]". Los Angeles Times. 
  19. ^ a b "Global Health, Local Knowledge". HealthMap. 2012-10-26. Retrieved 2012-11-09. 
  20. ^ a b c d "The Dengue Threat to the United States". Upmc-biosecurity.org. Retrieved 2012-11-09. 
  21. ^ "CDC reports that recent outbreak of dengue cases are the first locally acquired cases in Florida since 1934. | Natural Unseen Hazards Blog". Naturalunseenhazards.wordpress.com. 2010-05-21. Retrieved 2012-11-09. 
  22. ^ "Another reason to stop illegal immigration: Health risks". Democratic Underground. 2000-12-27. Retrieved 2012-11-09. 
  23. ^ [4] Archived December 20, 2010, at the Wayback Machine.
  24. ^ "Refuerzan las medidas para frenar el brote de dengue - 10.04.2009 - lanacion.com". Lanacion.com.ar. Retrieved 2012-11-09. 
  25. ^ Sri Lanka
  26. ^ Canals M, González C, Canals A, Figueroa D (2012). "Epidemiological dynamics of dengue on Easter Island". Rev Chilena Infectol. 29 (4): 388–94. doi:10.1590/S0716-10182012000400004. 
  27. ^ "11 die due to viral, malaria and dengue fever in Kanpur, IBN Live News". Ibnlive.in.com. 2010-09-19. Retrieved 2012-11-09. 
  28. ^ "Over 1.5 Million Latin Americans Infected by Dengue in 2010 — MercoPress". En.mercopress.com. 2011-01-17. Retrieved 2012-11-09. 
  29. ^ "Dengue fever deaths on the rise in Brazil". Vaccine News Daily. 2010-11-12. Retrieved 2012-11-09. 
  30. ^ http://www.elheraldo.com.co/ELHERALDO/BancoConocimiento/0/0van_127600_casos_de_dengue/0van_127600_casos_de_dengue.asp?CodSeccion=25
  31. ^ "cme-fk-uii-2010-kaji-virus-dengue – lintas.me". Lintasberita.com. 2010-07-14. Retrieved 2012-11-09. 
  32. ^ "Death toll from dengue fever hits 724 in the Philippines". Monsters and Critics. 2010-11-18. Retrieved 2012-11-09. 
  33. ^ "Gobierno reportó 104 mil 41 casos de dengue en el paĂs – EconomĂa". Entorno Inteligente. 2012-10-31. Retrieved 2012-11-09. 
  34. ^ "รมว.สธ.เผยยังพบผู้ป่วยไข้เลือดออกอย่างต่อเนื่อง ภาคใต้อัตราป". Ryt9.com. 2010-09-27. Retrieved 2012-11-09. 
  35. ^ "Travel Health Service Year 2010". Travelhealth.gov.hk. Retrieved 2012-11-09. 
  36. ^ Ngoc, Truong. "SGGP English Edition- Dengue fever continues to spread across Vietnam". Saigon-gpdaily.com.vn. Retrieved 2012-11-09. 
  37. ^ "2010: Honduras tuvo peor epidemia de dengue en 30 años". Fox News. 18 December 2010. 
  38. ^ http://www.bernama.com.my/bernama/v5/newsgeneral.php?id=551010
  39. ^ "Pacific.scoop.co.nz » Sri Lanka: Dengue's Human Cost". scoop.co.nz. Retrieved 20 September 2015. 
  40. ^ "Insidecostarica.com – Costa Rica Daily News and Information". insidecostarica.com. Retrieved 20 September 2015. 
  41. ^ "- ANN". asianewsnet.net. Retrieved 20 September 2015. 
  42. ^ "Dengue: entre la preocupación y la dejadez". El Nuevo Dia. Retrieved 20 September 2015. 
  43. ^ http://www.diariovanguardia.com.py/index.php?option=com_content&view=article&id=2562:existe-corte-de-circulacion-viral-en-el-66-de-regiones-sanitarias&catid=56:salud&Itemid=413
  44. ^ http://www.dgepi.salud.gob.mx/denguepano/dengue-2010.html
  45. ^ "Travel Health Service Year 2010". travelhealth.gov.hk. 20 September 2015. Retrieved 20 September 2015. 
  46. ^ a b "ProMED-mail". promedmail.org. Retrieved 20 September 2015. 
  47. ^ http://migenteinforma.org/el-dengue-prolifera-en-las-fronteras-de-guatemala-honduras-y-el-salvador
  48. ^ "35 new dengue cases in Delhi". The Times Of India. Archived from the original on November 13, 2010. 
  49. ^ http://www.dailytimes.com.pk/default.asp?page=2010\11\01\story_1-11-2010_pg1_5
  50. ^ "Waspada Online". Waspada Online. Retrieved 20 September 2015. 
  51. ^ "Penderita DBD di Semarang Meningkat". liputan6.com. Retrieved 20 September 2015. 
  52. ^ http://www.straitstimes.com/BreakingNews/Singapore/Story/STIStory_614132.html
  53. ^ "Search". Phnom Penh Post. Retrieved 20 September 2015. 
  54. ^ Saudi Gazette. "2,219 cases of dengue fever in Jeddah". saudigazette.com.sa. Retrieved 20 September 2015. 
  55. ^ http://www.invs.sante.fr/surveillance/dengue/points_guadeloupe/2010/pep_guadeloupe_2010_28_dengue.pdf
  56. ^ F_121. "Gobierno de Guatemala reporta 25 muertos por dengue". peopledaily.com.cn. Retrieved 20 September 2015. 
  57. ^ "Hujan Terus, Kasus DBD di Yogya Naik 40 Persen". Republika Online. Retrieved 20 September 2015. 
  58. ^ "傳染病統計資料查詢系統". cdc.gov.tw. Retrieved 20 September 2015. 
  59. ^ "Caribbean dengue deaths force new measures in PR – Taiwan News Online". etaiwannews.com. Retrieved 20 September 2015. 
  60. ^ http://www.expressindia.com/latest-news/mystery-fever-health-officials-differ-on-toll/700438/
  61. ^ "You searched for Lawmakers continue surveying dengue-hit areas – The Himalayan Times". The Himalayan Times. Retrieved 20 September 2015. 
  62. ^ a b [http%3A%2F%2Fwww.abola.pt%2Fmundos%2Fver.aspx%3Fid%253D215785&tl=en&sl=pt]
  63. ^ JOY BLACKBURN, reporter, Daily News Staff. "Dengue fever possible cause of death of St. John woman". virginislandsdailynews.com. Retrieved 20 September 2015. 
  64. ^ "Surfing: Irons leaves behind pregnant wife". The New Zealand Herald. 3 November 2010. Retrieved 27 September 2011. 
  65. ^ "Florida confirms 24 cases of dengue fever in Key West". CNN. 2010-08-04. 
  66. ^ "More dengue fever cases uncovered in north Qld". ABC News. Retrieved 20 September 2015. 
  67. ^ http://newsinfo.inquirer.net/breakingnews/nation/view/20110507-335089/Dengue-wont-go-away
  68. ^ "Etravelblackboard.com". etravelblackboard.com. Retrieved 20 September 2015. 
  69. ^ "Trinidad Express Newspapers: – DENGUE STRIKES KAMLA". trinidadexpress.com. Retrieved 20 September 2015. 
  70. ^ http://www.bangkokpost.com/news/health/318112/warning-against-dengue-fever
  71. ^ "Dengue emergency in Brazil: 573 deaths so far this year says Health ministry". MercoPress. Retrieved 20 September 2015. 
  72. ^ http://www.bangkokpost.com/news/local/375679/worst-dengue-epidemic-in-20-years
  73. ^ "Honduras: MSF fights deadly outbreak of dengue fever". Médecins Sans Frontières (MSF) International. Retrieved 20 September 2015. 
  74. ^ "Central America: Dengue Epidemic Sweeps Region". The Argentina Independent. Retrieved 20 September 2015. 
  75. ^ Vaccine News Report (27 February 2013). "Brazil hit by dengue outbreak". vaccinenewsdaily.com. Retrieved 20 September 2015. 
  76. ^ "Paraguay declares state of emergency due to dengue fever", Healio
  77. ^ "Paraguay: Dengue Fever Epidemic Worsens", The Argentina Independent
  78. ^ Thomson Reuters Foundation. "Dengue fever cases hit a high in parts of Southeast Asia -media". trust.org. Retrieved 20 September 2015. 
  79. ^ "DOH: 42,207 dengue cases, 193 deaths from January to 1st week of June". GMA News Online. Retrieved 20 September 2015. 
  80. ^ "Malaysia warns of dengue fever spike". ABC News. Retrieved 20 September 2015. 
  81. ^ "Philippines On Watch For Infectious Disease Outbreaks". Retrieved 21 April 2014. 
  82. ^ "Japanese models catch Dengue fever after visiting source of outbreak". Retrieved 2 September 2014. 
  83. ^ http://www.abplive.in/health/2014/10/07/article415679.ece/India-has-6-mn-unreported-dengue-cases-study#.VDTzMLRX_9k10/07/article415679.ece/India-has-6-mn-unreported-dengue-cases-study#.VDTzMLRX_9k
  84. ^ "South China province reports 1,661 new dengue fever cases". ecns.cn. Retrieved 20 September 2015. 
  85. ^ "South China dengue outbreak tops 16,000, Taiwan sees 10-times the 2013 case total – Outbreak News Today". outbreaknewstoday.com. Retrieved 20 September 2015. 
  86. ^ http://outbreaknewstoday.com/dengue-in-the-americas-2-million-cases-and-counting-deaths-top-1000/
  87. ^ http://outbreaknewstoday.com/dengue-in-asia-updated-case-counts-for-thailand-the-philippines-taiwan-malaysia-and-others-79486/
  88. ^ http://news.xinhuanet.com/english/2015-10/28/c_134756955.htm
  89. ^ http://focustaiwan.tw/news/asoc/201511260010.aspx
  90. ^ "Seven new confirmed Dengue Fever cases bring total to 202 Friday (Jan 1)". Hawaii 24/7. Retrieved 2016-01-04. 
  91. ^ "Disease Outbreak Control Division | Dengue Outbreak 2015". health.hawaii.gov. Retrieved 2016-01-04. 
  92. ^ ""Ya tenemos un brote epidémico de dengue", aseguró Jorge Lemus". La Nacion. La Nacion. Retrieved 21 January 2016. 
  93. ^ Czubaj, Fabiola. "Con más de 1100 casos, el dengue ya se convirtió en una epidemia". La Nacion. La Nacion. Retrieved 21 January 2016. 
  94. ^ "El mapa del dengue: cómo está la situación provincia por provincia". La Nacion. La Nacion. Retrieved 21 January 2016. 
  95. ^ "Thailand braces for 'mega-outbreak' of Dengue fever". Channel NewsAsia. Retrieved 4 March 2016. 
  96. ^ "PRO/AH> DENGUE/DHF UPDATE (06): AMERICAS, ASIA, INDIAN OCEAN, AFRICA 2016-03-03 10:36:0 Archive Number: 20160303.4065700". Pro-MED-mail. International Society for Infectious Diseases. 
  97. ^ "Dengue fever numbers double from last year". The Nation. Retrieved 4 March 2016.