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Fact Sheet

Clinical Features

  • Sudden onset of fever, severe headache, myalgias and arthralgias, leukopenia, thrombocytopenia and hemorrhagic manifestations
  • Occasionally produces shock and hemorrhage, leading to death

Etiologic Agent

  • Dengue viruses (DENV 1, DENV 2, DENV 3, and DENV 4) - flaviviruses


  • Variable, depending on epidemic activity.
  • Globally, there are an estimated 50 to 100 million cases of dengue fever (DF) and several hundred thousand cases of dengue hemorrhagic fever (DHF) per year
  • Case fatality rate can be as high as 10%. Can be reduced to as low as 1% with early recognition and proper treatment.
  • In 2007, 900,782 cases of DF and 26,413 cases of DHF reported in Americas. Outbreaks were reported in 11 countries.
  • Between 100 to 200 suspected cases introduced into U.S. each year by travelers


  • None


  • $250 million estimated in Puerto Rico in past 10 years


  • Mosquito-borne (Aedes Aegypti)

Risk Groups

  • Residents of or visitors to tropical and subtropical environments, especially urban and suburban areas
  • Increased severe and fatal disease in children under 15 years
  • No cross-immunity from each serotype
  • A person can potentially experience four dengue infections


  • DF and DHF are designated as reportable disease by law in US
  • Dengue Branch responsible for laboratory-based surveillance
  • Laboratory-based surveillance in endemic areas outside of US and it territories  


  • Resurgent disease in tropical and subtropical areas worldwide 
  • Epidemics have increased in size and frequency
  • Transmission in continental U.S. last reported in 2005 first since 1986
  • Since first epidemic in 1981, DHF now reported from 18 countries in the Americas
  • Evolution of disease pattern in Americas similar to SE Asia in 1950s and 1960s


  • Increased incidence associated with increased urbanization
  • More rapid dispersal of viruses via increased air travel
  • Vector control methods used to respond to an epidemics have not  shown evidence of effectiveness
  • Severe hemorrhagic disease poorly understood by physicians
  • Need to increase effective epidemic prevention methods
  • Need to increase community participation in prevention and control programs

Research Opportunities and Priorities

  • Develop improved laboratory-based international surveillance
  • Develop rapid, sensitive and specific diagnostic tests
  • Develop more effective community-based prevention programs
  • Develop tetravalent dengue vaccine
  • Dengue Branch, designated WHO Reference Center
  • Increased  medical community education