Intended for healthcare professionals

Clinical Review

Dengue: an escalating problem

BMJ 2002; 324 doi: (Published 29 June 2002) Cite this as: BMJ 2002;324:1563
  1. Robert V Gibbons (, medical epidemiologist,
  2. David W Vaughn, chief
  1. Department of Virus Diseases, Walter Reed Army Institute of Research, Silver Spring, MD 20910-7500, USA
  1. Correspondence to: R V Gibbons
  • Accepted 1 May 2002

Dengue viruses, single stranded RNA viruses of the family Flaviviridae, are the most common cause of arboviral disease in the world. They are found virtually throughout the tropics (fig 1) and cause an estimated 50-100 million illnesses annually, including 250 000-500 000 cases of dengue haemorrhagic fever—a severe manifestation of dengue—and 24 000 deaths.13 More than two fifths of the world's population (2.5 billion) live in areas potentially at risk for dengue.1 Because travellers to endemic areas are also at risk, healthcare providers should have an understanding of the spectrum of infection, how to diagnose it, and what the appropriate treatment is.

Come then, let us play at unawares

And see who wins in this sly game of bluff

Man or mosquito

D H Lawrence, The Mosquito

Summary points

Dengue is the most common cause of arboviral disease

The disease is more prevalent now than at any other time, and its prevalence is expected to increase

A severe manifestation of dengue is dengue haemorrhagic fever, which is more common after a secondary infection with dengue virus

Dengue is a relatively common cause of fever in travellers to the tropics, but severe disease is rare

A cost effective vaccine is needed for the prevention and control of dengue


Our review was prepared from literature on dengue up to 15 April 2002. We searched Medline (for all English articles using the keyword “dengue”), comprehensive textbooks, the Cochrane Library, the internet, and our own files.


Four dengue virus serotypes are recognised. Infection with one serotype is thought to produce lifelong immunity to that serotype but only a few months immunity to the others. 1 4 Humans and mosquitoes are the principal hosts of dengue virus; the mosquito remains infected for life, but the viruses are only known to cause illness in …

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