Abstract
After a 15-year period of low incidence, dengue has reemerged in Singapore in the past decade. We identify potential causes of this resurgence. A combination of lowered herd immunity, virus transmission outside the home, an increase in the age of infection, and the adoption of a case-reactive approach to vector control contribute to the increased dengue incidence. Singapore's experience with dengue indicates that prevention efforts may not be sustainable. For renewed success, Singapore needs to return to a vector control program that is based on carefully collected entomologic and epidemiologic data. Singapore's taking on a leadership role in strengthening disease surveillance and control in Southeast Asia may also be useful in reducing virus importation.
Highlights
After a 15-year period of low incidence, dengue has reemerged in Singapore in the past decade
Dengue fever (DF) and dengue hemorrhagic fever (DHF) are reemerging diseases that are endemic in the tropical world
We have identified several factors that may have contributed to this resurgence: lowered herd immunity, increasing virus transmission outside the home, more clinically overt infection as a consequence of adult infection, and a shift in the surveillance emphasis of the vector control program
Summary
After a 15-year period of low incidence, dengue has reemerged in Singapore in the past decade. An approved vaccine is not likely to be available for 5 to 7 years; the only way to prevent dengue transmission, is to reduce the population of its principal vector, A. aegypti. We have identified several factors that may have contributed to this resurgence: lowered herd immunity, increasing virus transmission outside the home, more clinically overt infection as a consequence of adult infection, and a shift in the surveillance emphasis of the vector control program.
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