The 2012 Madeira dengue outbreak: epidemiological determinants and future epidemic potential.
The 2012 Madeira dengue outbreak: epidemiological determinants and future epidemic potential.
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DOI：
10.1371/journal.pntd.0003083
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发表时间：
2014-08
影响因子：
3.8
通讯作者：
Recker M
中科院分区：
文献类型：
--
作者：
Lourenço J;Recker M
登革热是一种全球重要性日益增加的病媒病毒性疾病，通常与世界各地的热带和亚热带地区有关。然而，城市化、全球化和气候趋势正在促进蚊子媒介的地理传播，从而增加了病毒在以前未受影响的地区建立自己并引起大规模流行病的风险。2012年10月3日，葡萄牙马德拉自治区报告了两起本土登革热感染。在接下来的七个月里，这场首次“欧洲”登革热疫情造成了2000多例本地病例和81例输出病例。在这里，使用内流行病学数学框架，我们估计，登革热传入马德拉岛发生在第一个正式病例前一个月左右，在航空旅行最大流入期间，秋季自然下降的温度是2012年12月初爆发死亡的决定因素。使用关键的估计，再加上当地的气候数据，我们进一步提出，有很少的支持登革热在这个岛上的地方性，但未来的流行病爆发的可能性很高，当5月和8月之间播种时，检测到输入病例是至关重要的马德拉岛的公共卫生规划。2012年，欧洲第一次登革热疫情发生在大西洋马德拉岛。由于与旅游业的密切联系，在短短三个月内，欧洲大陆就出现了81例病例。虽然造成这次疫情的蚊子媒介埃及伊蚊在欧洲大陆已经灭绝，但气候和全球化趋势使登革热的第二媒介白纹伊蚊最近在法国、德国、意大利和西班牙的定居变得容易。在这一流行病之前，登革热只是零星地实现了短链传播。然而，完全易感人群的存在使其可能传入欧洲成为一个主要的公共卫生问题。在这里，使用数学方法，我们分析了马德拉的登革热疫情，重点是引进，传播和持久性的必要条件。我们发现，自然温度周期是2012年疫情消亡的决定性因素，通常预计11月至4月期间会严重破坏登革热传播，这表明地方性的可能性较弱。另一方面，马德拉岛在夏季剩余的几个月里很可能发生零星和潜在的大规模流行病，特别是如果病毒在温暖季节早期引入。
Dengue, a vector-borne viral disease of increasing global importance, is classically associated with tropical and sub-tropical regions around the world. Urbanisation, globalisation and climate trends, however, are facilitating the geographic spread of its mosquito vectors, thereby increasing the risk of the virus establishing itself in previously unaffected areas and causing large-scale epidemics. On 3 October 2012, two autochthonous dengue infections were reported within the Autonomous Region of Madeira, Portugal. During the following seven months, this first ‘European’ dengue outbreak caused more than 2000 local cases and 81 exported cases to mainland Europe. Here, using an ento-epidemiological mathematical framework, we estimate that the introduction of dengue to Madeira occurred around a month before the first official cases, during the period of maximum influx of airline travel, and that the naturally declining temperatures of autumn were the determining factor for the outbreak's demise in early December 2012. Using key estimates, together with local climate data, we further propose that there is little support for dengue endemicity on this island, but a high potential for future epidemic outbreaks when seeded between May and August—a period when detection of imported cases is crucial for Madeira's public health planning. In 2012, Europe saw its first dengue epidemic taking place on the Atlantic island of Madeira. Due to strong tourism links, 81 cases were introduced into continental Europe in a short period of three months. Although Aedes aegypti, the mosquito-vector responsible for this particular outbreak, is extinct in mainland Europe, climatic and globalization trends have eased the recent establishment of Aedes albopictus, dengue's secondary vector, in France, Germany, Italy and Spain. Before this epidemic, dengue had only sporadically achieved short chains of transmission. The presence of fully susceptible populations, however, makes the possible introduction into Europe a major public health concern. Here, using a mathematical approach, we analysed Madeira's dengue outbreak, focusing on the necessary conditions for introduction, spread and persistence. We find that natural temperature cycles were the determining factor for the 2012's outbreak demise, and are generally expected to severely disrupt dengue transmission between November and April, suggesting weak potential for endemicity. On the other hand, Madeira demonstrates a high potential for sporadic and potentially large epidemics in the remaining summer months, especially if the virus is introduced early during the warm season.
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