/diseases/{disease_code}/distribution/{country_code}

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200Disease - Distribution_/diseases/{disease_code}/distribution/{country_code}_example

1 {
2   "data": {
3     "note": "<b>Time and Place</b>\nThe first dengue-like epidemics were reported in 1635 in Martinique and Guadeloupe, and in 1699 in Panama. {p 23042846}\n - Dengue was later reported in the Caribbean-Latin American region in 1827 (Virgin Islands), presumably imported with African slaves. \n - An outbreak of dengue was reported in Cuba. At this time, the word \"dunga\" was first used, and later changed to \"dengue.\" {p 23042846}\n - A second pandemic during 1848 to 1850 involved Cuba and New Orleans.  \n - A third pandemic struck the region during 1979 to 1880. \nOutbreaks of severe dengue and dengue hemorrhagic fever (DHF) emerged beginning in the 1950s. {p 19366911}\n - Prior to the 1970's only nine countries had experienced severe dengue epidemics - as of 2012, the disease was endemic to over 100 countries.\n - As of 2016, 11 countries had approved routine use of a quadrivalent Dengue vaccine: Indonesia, Thailand, Singapore. Mexico, the Philippines, Brazil, El Salvador, Costa Rica, Paraguay, Guatemala and Peru. {p 27701113}\n\n<b>Dengue and travel</b>\n - 1997 to 2006 - . Risk for dengue among travelers peak in Southeast Asia during June and September, South-central Asia in October, South America in March and the Caribbean in August and October. {p 18598629}\n - 2008 - Dengue accounted for 1.5% of febrile illness among returning European travelers. {p 21083874}\n - 2013 (publication year) - The risk for dengue among travelers to endemic destinations is estimated at 10.2 to 30 per 1,000 person-months; and the disease accounts for up to 16% of febrile illness episodes in this group. {p 24165383}\n - 2018 (publication year) - Dengue is the leading cause of fever among travelers returning from Southeast Asia - 50 cases per 1,000 in non-epidemic years, 159 per 1,000 during epidemic years. {p 30374664}\n\nThe four strains of Dengue fever virus which infect humans emerged from ancestral sylvatic progenitors which continue to persist among non-human primates in Southeast Asia and West Africa.  Rare instances of human infection by sylvatic strains are reported. {p 21666708} {p 25092823} {p 23523817} {p 20212326} {p 19081488} {p 18325274} {m 20160507.4207603}\n\n<b>Dengue in Africa</b>\nDuring 1960 to 2010, a total of 22 countries in Africa reported sporadic cases or outbreaks of dengue; 12 other countries in Africa reported dengue only in travelers. {p 21801609}  A review published in 2012 suggested that dengue is endemic to 34 African countries. {p 22668445}\n - During 1823 to 2014, seven out of ten countries in eastern Africa and three islands in the Indian Ocean experienced dengue outbreaks. {p 26922851}\n - Dengue virus was first isolated in Africa during 1964 to 1968 (Nigeria); and had been identified in 14 African countries as of 2009. {p 19280730} {p 20184854} {m 20100826.3010} {p 20843471} {p 21029541} {p 21338953} {m 20100913.3308} {m 20100222.0597} {m 20100826.3010}\n - Serosurveys suggest that dengue is hyper-endemic in certain areas of West Africa, and probably East Africa as well. \n - Clinical cases are probably misdiagnosed as malaria.\n - Dengue / Chikungunya co-infections are reported in endemic areas. {p 18551940} {p 19581242}\n     \n[Graph 1]\nWorldwide. Dengue, cases\nNotes:\n1. As of 1998, 2.5 billion persons are considered at risk, and two-thirds of the world's population live in areas infested with potential dengue vectors.   \n2. An estimated 500,000 are hospitalized for dengue each year (2010 publication) {m 20101018.3777}\n3. 10,000 to 300,000 cases of dengue per year were estimated for the period 1955 to 1959; 67.7 million in 1987; 20.2 million to 32.3 million per year for the period 1994 to 1996; 50 million to 100 million per year as of 2011. {m 20120130.1025955}   \n4. The global incidence was estimated at 32,747,000 cases in 2005; 79,609,000 in 2015. {p 27733282}\n5. An average of 908 cases were officially reported annually during 1955 to 1959; 15,497 during 1960 to 1969; 122,174 during 1970 to 1979; 295,591 during 1980 to 1989; 514,139 during 1990 to 1998.\n\n<b>Prevalence surveys</b>  \n\n<b>Seroprevalence surveys</b>\n\n[Graph 2]\nWorldwide. Dengue, deaths\nNotes:\n1. Also see reference - {p 23245604}\n\n<b>Severe Dengue (Dengue Hemorrhagic Fever; DHF; DSS)</b>\nAs of 2012, four serotypes of Dengue virus had been identified.  Although the existence of fifth serotype was reported in Malaysia in 2013, the clinical significance of this strain appears to be minimal. {m 20131023.2016569} {m 20140910.2762015}\n - Severe dengue is more often associated with secondary Dengue 2 infection than with the other serotypes. {p 26085471}\n - The risk for DHF is 0.2% during the first attack of dengue, but increases 10-fold during reinfection by a second dengue serotype. {p 9665979}  Rarely, a given patient may be co-infected by two serotypes simultaneously. {p 3970307}\n - A long time interval between attacks of dengue may actually increase the risk of dengue hemorrhagic fever. {p 18420239}\n - It is estimated that over 100,000 of DHF occur each year worldwide.\n - 715,238 cases of DHF and 21,345 deaths were reported worldwide during 1956 to 1980; 1,263,321 cases of DHF and 15,940 deaths during 1986 to 1990.\n - The world's first epidemic of DHF was reported in the Philippines during 1953 to 1954. \n - The first outbreak of DHF in the Americas was reported in 1981, from Cuba. {p 23444620}\n - The incidence of DHF is higher in Asia than in other dengue-endemic areas, with two-thirds of regional cases reported from Viet Nam and Thailand. \n - Over 100,000 dengue deaths were estimated for Asia in 1995.\n - 12,300 fatal cases were estimated globally for 2005; 18,400 for 2015. {p 27733281}\n\n[Graph 3]\nAmericas Region Dengue, cases\nNotes:\n1. 700,000 cases of dengue were reported in the region during 1978 to 1980; 1,033,417 during 1980 to 1989; 2,725,405 during 1990 to 1999; 4,732,594 during 2000 to 2007. {p 20065008}\n2. Additional references: 1997 {p 9376243}  1980 to 2007 {p 20065008}  2000 {p 11206025}  2010 {p 23042846}\n3. Literature review of Dengue in the Americas region (2017 publication) - see reference {p 28392806}\n   Individual years:\n   1996 - Included outbreaks in Brazil, Costa Rica, Dominican Republic, Haiti, Mexico, Nicaragua, Panama, Puerto Rico and Venezuela. \n   1998 - 72.2% of cases reported by Brazil\n   2002 - 17,457 cases (333 DHF, 28 fatal) were reported in the Caribbean region. \n   2010 - 344,346 cases (144 fatal) were reported to April. {m 20100503.1439}\n   2011 - 979,774 cases (672 fatal) were reported to October. {m 20110214.0498} {m 20110325.0938} {m 20111108.3320}\n   2012 - 892,000 cases (23,925 DHF or serious, 521 fatal) were reported to December. {m 20120910.1288590} {m 20121226.1466200}\n   2013 - 2,294,721 cases (1,244 fatal) were reported to December. {m 20131230.2143626}\n   2014 - 1,081,067 cases (624 fatal) were reported to November. {m 20140905.2749605} {m 20141215.3034560}\n   2015 - 2,326,829 cases (10,276 severe dengue, 1,181 fatal) were reported. {m 20150331.3268841} {m 20150409.3287116} {m 20150424.3318712} {m 20150503.3338106} {m 20150510.3352790} {m 20150518.3368812} {m 20150628.3470407} {m 20150705.3487558} {m 20150712.3505744} {m 20150721.3523120} {m 20150928.3675184} {m 20151008.3701661} {m 20151027.3747794} {m 20151109.3779255} {m 20151124.3816818} {m 20151202.3835995} {m 20151210.3854285} {m 20160127.3970962} {m 20160207.4001446}\n   2016 - 2,246,033 cases (3,939 severe dengue, 928 fatal) were reported to November 23. {m 20160217.4028506} {m 20160225.4049661} {m 20160303.4065700} {m 20160320.4106717} {m 20160326.4120839} {m 20160605.4266936} {m 20160703.4323211} {m 20160712.4338859} {m 20160802.4386550} {m 20160802.4386550} {m 20160822.4432070} {m 20161209.4680856}\n   2017 - 772,000 cases (2,228 severe dengue, 346 fatal) were reported to December 15. {m 20170503.5009234} {m 20170606.5088227} {m 20170626.5131785} {m 20170704.5148921} {m 20170905.5297066} {m 20170921.5331578} {m 20170926.5342813}  (Analysis of declining dengue rates in the Americas Region during 2017 - see reference {p 30624838} )\n   2018 - 561,233 suspected and confirmed cases (336 fatal) were reported. {m 20180419.5757769} {m 20181109.6135133}\n   2019 - 2,414,182 cases (978 fatal) were reported to September 30. {m 20190329.6392078} {m 20190508.6461377} {m 20190604.6502068} {m 20190822.6635695}\n     \n[Graph 4]\nAmericas Region Dengue - severe, cases\nNotes:\n1. The first documented outbreak of DHF in the Americas was reported in Cuba, in 1981. {p 25091743}\n2. 60 cases of DHF (involving only 5 countries) were reported in the Americas during 1968 to 1980; 37,030 (24 countries) during 1981 to 1985; 13,398 during 1980 to 1989; 58,419 during 1990 to 1999; 111,724 during 2000 to 2007. {p 20065008}\n3. 42,246 cases of DHF (582 fatal) were reported in the Americas during 1981 to 1996.\n4. Three to five dengue epidemics were reported in each of the French territories (French Guiana, Guadeloupe, Martinique, Saint Martin and Saint Barthelmy) during 2000 to 2012. {p 25375627}\n\n[Graph 5]\nAmericas Region Dengue, deaths\nNotes:\n1. 242 fatal cases were reported during 1980 to 1989; 577 during 1990 to 1999; 1,391 during 2000 to 2007. {p 20065008}\n\n[Graph 6]\nSoutheast Asian Region Dengue, cases\nNotes:\n1. Also see reference - {p 21537064}\n\n[Graph 7]\nSoutheast Asian Region Dengue, deaths\n\n[Graph 8]\nWestern Pacific Region Dengue, cases\nNotes:\n1. 33 of 37 countries in the Western Pacific region report dengue.  \n2. 552,088 cases were reported in the region during 1993 to 1997.\n   Individual years:\n   1998 - 78,608 cases were reported in the region during January to July.\n\n[Graph 9]\nWestern Pacific Region Dengue, deaths\nNotes:\n   Individual years:\n   1998 - 246 fatal cases were reported in the region during January to July.\n\n<b>Dengue in Europe</b> {p 23962447} {p 27254392}\n43% of cases reported in Europe in 2008 originated from Southeast Asia, 14% Latin America, 11% the Caribbean and 4% Africa. {m 20090629.2353}\n - In 2010, autochthonous cases of dengue were reported in France {p 20929659} {m 20100915.3345} {m 20100921.3399} {m 20100927.3506} and Croatia. {p 20946759} {p 21392489} {p 25474491} {m 20101012.3697}\n - During 2012 to 2013 - An outbreak (2,168 cases) of dengue was reported in Madeira, Portugal. {p 23113325} {p 23231893} {p 23324429} {p 23410256} {p 23962447} {p 24473797} {p 24602277} {p 25144749} {p 25399556} {p 25767886} {m 20121021.1356313} {m 20121006.1328158} {m 20121107.1397801} {m 20121112.1404829} {m 20121121.1417734} {m 20121124.1422925} {m 20121205.1439368} {m 20121212.1447452} {m 20121216.1453952} {m 20121230.1475399} {m 20130208.1535624} {m 20130215.1544402} {m 20130318.1591291}  42 cases were reported among travelers who returned from Madeira to Germany, Sweden, France and the United Kingdom.   Molecular studies suggested that dengue virus introduced from Venezuela was the source of the outbreak in Madeira. {p 25843502}\n - In 2013, a case of autochthonous dengue was reported in France. {p 24342514} {m 20131209.2101186} {m 20131223.2132849}\n - In 2015, an outbreak of autochthonous dengue was reported in France. {p 27254729} {m 20160602.4259981}\n - In 2017, no cases of autochthonous dengue were reported to December.\n\n<b>Dengue in the Middle East and North Africa</b> -\n - 81 outbreaks were reported from 9 countries during 1941 to 2015; and <i>Aedes aegypti</i> and/or <i>Ae. albopictus</i> was reported in 15 countries. {p 27926925}\n\n[Graph 10]\nEuropean Union. Dengue, cases\nNotes:\n   Individual years:\n   2008 - Dengue accounted for 1.5% of febrile illness among returning European travelers. {p 21083874}\n\n<b>Reservoirs</b>\nDengue virus has been identified in a variety of primates {p 24105916} , and in neo-tropical forest mammals belonging to the Rodentia, Marsupialia and Chiroptera {p 18945183}\n\n<b>Vectors</b>\n - <i>Stegomyia (Aedes) aegypti</i> was eradicated from 21 countries in the American Region during 1948 to 1962; however, as of 1996, the mosquito was found in all countries in the area, except Bermuda, Canada, Chile and Uruguay. {p 23916878} {p 3042180}\n     <i>Stegomyia (Aedes) albopictus</i> {p 22272602} has recently been found in Europe: Albania in 1979, Italy in 1990, France in 1998, Belgium in 2000, Spain in 2004 and Germany in 2011. {p 22297138} {p 22535696} {m 20120126.1023077}  As of 2003, <i>S. albopictus</i> was also present in 10 American countries: Brazil, the Cayman Islands, the Dominican Republic, El Salvador, Guatemala, Mexico, Nicaragua, Panama, Trinidad and the United States. {p 23916878} {p 26126267}\n     <i>S. albopictus</i> was first reported in the United States in 1985 {p 23270144} , and in Africa in 1989 (South Africa) and had been identified on the continent only 4 times to 2003 - in Nigeria, South Africa and Equatorial Guinea.\n     <i>S. Polynesiensis</i> has also been implicated as a dengue vector. {p 543815}\n - Vertical transmission has been demonstrated among mosquitoes. {p 30776139}\n\n<b>Additional routes of transmission</b>\nRare instances of laboratory acquired {p 27057314} , nosocomial {p 30046313} and transfusion-related dengue are reported. {p 18503611} {p 18503610} {p 25728040}\n - Only five cases of transfusion-transmitted dengue (including one case of DHF) had been documented as of 2015. {p 25964876}\n - Dengue hemorrhagic fever has been acquired through blood transfusion. {p 18832256}\n - Cases of dengue acquired through liver {p 27194898} {m 20160602.4259981} , bone marrow and renal transplantation have been reported.\n - Dengue virus has been detected in a donor cornea (India, 2018 publication) {p 30272614}\n - Vertical transmission during pregnancy is common. {p 27760799} {p 1819401} {p 29692297} {p 30979598}\n - Possible transmission through breast feeding has been reported. {p 24156723} {p 23575200}\n\n<b>Talking Points</b>\n - Large outbreaks of dengue are increasingly reported throughout the tropics.\n - 262 outbreaks of dengue were reported in the World's literature during 1990 to 2015. {p 28748176}\n - The following chart depicts four outbreaks - numbering 200,000 or more cases - which occurred in \"non-tropical\" countries.\n\n<b>Notable outbreaks</b>\n\n<b>Reviews and updates:</b> {p 9665979} {p 15710058} {p 15577938} {p 19366911} {p 19747662} {p 19561427} {p 10738676} {p 17993365} {p 7912702} {p 1462664} {p 8903160} {p 9477544} {p 10582094} {p 15148655} {p 15685151} {p 20403310} {p 20400169} {p 20581669} {p 20578515} {p 20402771} {p 21079655} {p 21146601} {p 21308524} {p 21320241} {p 21537064} {p 21801609} {p 21827872} {p 22069516} {p 22137535} {p 22272602} {p 22469290} {p 22500140} {p 22506663} {p 22535696} {p 22541792} {p 22629476} {p 22556068} {p 22556070} {p 22668447} {p 22668445} {p 22709430} {p 22825287} {p 23029573} {p 23042846} {p 23103333} {p 23226436} {p 23437406} {p 23558245} {p 23578479} {p 23856907} {p 23876389} {p 23962447} {p 24076358} {p 23916878} {p 24161879} {p 24195519} {p 24204590} {p 24165378} {p 24165383} {p 24367789} {p 24438016} {p 24639680} {p 24708869} {p 24772398} {p 24781826} {p 24801860} {p 24810901} {p 24889501} {p 24927557} {p 24957139} {p 24966859} {p 25172160} {p 25203960} {p 25253208} {p 25259615} {p 25271370} {p 25287260} {p 25298950} {p 25375627} {p 25399556} {p 25426178} {p 25424928} {p 25474491} {p 25491436} {p 25688023} {p 25688015} {p 25771261} {p 25881272} {p 25960096} {p 25964876} {p 25979287} {p 25989449} {p 26051515} {p 26085471} {p 26126267} {p 26175912} {p 26214040} {p 26438851} {p 3042180} {p 26562299} {p 26601449} {p 26639777} {p 26936191} {p 27007959} {p 27052794} {p 27052666} {p 27115737} {p 27284691} {p 27322480} {p 27457660} {p 27701113} {p 27926925} {p 28035105} {p 28392806} {p 28448507} {p 28612239} {p 28738211} {p 28748176} {p 28806786} {p 29221616} {p 29294035} {p 29301009} {p 29345964} {p 29385613} {p 29391071} {p 29435366} {p 29882167} {p 30011271} {p 30394209} {p 30560735} {p 30869035} {p 31423536}",
4     "references": [
5       {
6         "href": "/references/p/23042846",
7         "citation": "Am J Trop Med Hyg 2012 Oct ;87(4):584-93.",
8         "short_citation": "",
9         "reference_number": "p 23042846"
10       },
11       {
12         "href": "/references/p/23042846",
13         "citation": "Am J Trop Med Hyg 2012 Oct ;87(4):584-93.",
14         "short_citation": "",
15         "reference_number": "p 23042846"
16       },
17       {
18         "href": "/references/p/19366911",
19         "citation": "Clin Microbiol Rev 2009 Apr ;22(2):186-201, Table of Contents.",
20         "short_citation": "",
21         "reference_number": "p 19366911"
22       }
23     ]
24   }
25 }

Returns comprehensive country-relevant referenced information regarding the selected disease including the disease’s history, incidence, distribution, and graphs.

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