Estimating the probability of dengue virus introduction and secondary autochthonous cases in Europe
Abstract
Given the speed of air travel, diseases even with a short viremia such as dengue can be easily exported to dengue naive areas within 24 hours. We set out to estimate the risk of dengue virus introductions via travelers into Europe and number of secondary autochthonous cases as a result of the introduction. We applied mathematical modeling to estimate the number of dengue-viremic air passengers from 16 dengue-endemic countries to 27 European countries, taking into account the incidence of dengue in the exporting countries, travel volume and the probability of being viremic at the time of travel. Our models estimate a range from zero to 167 air passengers who are dengue-viremic at the time of travel from dengue endemic countries to each of the 27 receiving countries in one year. Germany receives the highest number of imported dengue-viremic air passengers followed by France and the United Kingdom. Our findings estimate 10 autochthonous secondary asymptomatic and symptomatic dengue infections, caused by the expected 124 infected travelers who arrived in Italy in 2012. The risk of onward transmission in Europe is reassuringly low, except where Aedes aegypti is present. ; HealthTheme of the Seventh Framework Programme of the European Community ; project ZikaPLAN - European Union's Horizon research and innovation programme ; International Research Consortium on Dengue Risk Assessment Management and Surveillance (IDAMS) (European Commission) ; Univ Sao Paulo, Sch Med, Sao Paulo, Brazil ; London Sch Hyg & Trop Med, London, England ; Univ Derby, Coll Nat & Life Sci, Derby, England ; Fundacao Getulio Vargas, Sch Appl Math, Rio De Janeiro, Brazil ; Fundacao Oswaldo Cruz, Programme Sci Computat, Rio De Janeiro, Brazil ; Univ Fed Sao Paulo, Hosp Sao Paulo, Escola Paulista Med, Sao Paulo, SP, Brazil ; St Michaels Hosp, Li Ka Shing Knowledge Inst, Toronto, ON, Canada ; Umea Univ, Dept Publ Hlth & Clin Med Epidemiol & Global Hlth, SE-90185 Umea, Sweden ; Harvard Med Sch, Boston, MA USA ; Boston Childrens Hosp, Boston, MA USA ; Univ Oxford, Dept Zool, Oxford, England ; Heidelberg Univ, Inst Publ Hlth, Heidelberg, Germany ; Nanyang Technol Univ, Lee Kong Chian Sch Med, Singapore, Singapore ; Univ Fed Sao Paulo, Hosp Sao Paulo, Escola Paulista Med, Sao Paulo, SP, Brazil ; PEC: 282589 ; ZikaPLAN: 734584 ; IDAMS: 21803 ; Web of Science
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