Dengue fever: new paradigms for a changing epidemiology.
Dengue fever: new paradigms for a changing epidemiology.
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DOI：
10.1186/1742-7622-2-1
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发表时间：
2005-03-02
影响因子：
2.3
通讯作者：
Schimmer B
中科院分区：
文献类型：
--
作者：
Guha-Sapir D;Schimmer B
登革热是具有公共卫生意义的最重要的节肢动物传播的病毒性疾病。与 20 世纪 50 年代的 9 个报告国家相比，如今的地理分布包括全球 100 多个国家。其中许多人已有 20 年或更长时间没有报告登革热，其中一些人没有已知的登革热病史。世界卫生组织估计，超过 25 亿人面临感染登革热的风险。它于 20 世纪 50 年代首次被认识到，现已成为几个亚洲和南美国家儿童死亡的主要原因。本文回顾了该疾病不断变化的流行病学，重点关注宿主和社会因素，并借鉴了国家和地区期刊以及国际出版物。它不包括疫苗和载体问题。我们选择了文献对普遍观点提出挑战的领域以及对改善贫穷国家的服务提供至关重要的领域。模态年龄、农村传播以及种族和性别相关易感性的社会和生物决定因素的变化对卫生服务具有重大影响。人们对行为风险因素、结果的个人决定因素和严重疾病的主要指标知之甚少，从而影响了控制计划的有效性。早期发现和病例管理实践被认为是生存的关键因素。健全的统计方法的不足影响了关于病死率或特定疾病死亡率的结论，特别是因为这些数据通常基于积极在三级中心寻求治疗的住院患者。迫切需要有针对性的业务研究，例如具有明确业务目标的基于人群的流行病学研究，以在控制和预防方面取得进展。
Dengue is the most important arthropod-borne viral disease of public health significance. Compared with nine reporting countries in the 1950s, today the geographic distribution includes more than 100 countries worldwide. Many of these had not reported dengue for 20 or more years and several have no known history of the disease. The World Health Organization estimates that more than 2.5 billion people are at risk of dengue infection. First recognised in the 1950s, it has become a leading cause of child mortality in several Asian and South American countries. This paper reviews the changing epidemiology of the disease, focusing on host and societal factors and drawing on national and regional journals as well as international publications. It does not include vaccine and vector issues. We have selected areas where the literature raises challenges to prevailing views and those that are key for improved service delivery in poor countries. Shifts in modal age, rural spread, and social and biological determinants of race- and sex-related susceptibility have major implications for health services. Behavioural risk factors, individual determinants of outcome and leading indicators of severe illness are poorly understood, compromising effectiveness of control programmes. Early detection and case management practices were noted as a critical factor for survival. Inadequacy of sound statistical methods compromised conclusions on case fatality or disease-specific mortality rates, especially since the data were often based on hospitalised patients who actively sought care in tertiary centres. Well-targeted operational research, such as population-based epidemiological studies with clear operational objectives, is urgently needed to make progress in control and prevention.