Dengue in Latin America: A Persistent and Growing Public Health Challenge

Abstract

Over the last 50 years, dengue has been a growing public health challenge. Half of the World's population lives in areas of risk; Latin America and the Caribbean (LAC) are not exceptions. Aedes aegypti, the main vector of dengue in the Americas, is widely spread, and autochthonous transmission of dengue virus (DENV) has been documented in all American countries except for Chile and Uruguay. In 2013, the largest epidemic of dengue in the history of the Americas accounted for a total of 2.3 million reported cases, 37,898 of them severe, including 1,318 deaths. Despite different and enormous efforts, prevention and control programs have not been effective enough to halt dengue in the LAC region. Difficulties to implement and accomplish successful dengue control programs lie in diverse realms. Some of these relate to the biology of DENV: other to social and environmental factors favoring vector density and other to health systems, like the appropriate entomology or epidemiologic surveillance systems and access to medical services to detect and confirm clinical cases. Implementing multisectoral approaches of vector control has been particularly challenging. Complex dynamics of all such determinants, within and between countries, lead to the continuous increase of dengue incidence in the region, resulting in major health and economic burden. In this chapter we summarize the epidemiology of dengue in LAC, compare it to that in other regions, and discuss existing evidence supporting the urgent need for developing and implementing integrated multisectoral strategies to effectively control dengue in this region.