Dengue: The Continual Re-Emergence of a Centuries-Old Disease
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Ó 2013 International Association for Ecology and Health (outside the USA)
Cover Essay
Dengue: The Continual Re-Emergence of a Centuries-Old Disease David M. Morens,1 Gregory K. Folkers,1 and Anthony S. Fauci1 National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
INTRODUCTION In 1780, a novel epidemic disease struck Philadelphia, the United States capital at the time. The city’s leading physician, Benjamin Rush, a signer of the Declaration of Independence, marveled at the extreme prostration affecting his patients, who experienced high fevers, arthralgias, myalgias, and often an evanescent rash. Because of intense joint and muscle pains, the new disease came to be known as ‘‘breakbone fever.’’ Rush observed many patients with extreme post-illness lethargy and depression which he referred to as ‘‘dejection of the spirits’’. He wrote that the new disease might just as well be called ‘‘break-heart fever’’ (Rush 1789). Dengue, as it ultimately was named, has remained with us as a continually re-emerging epidemic disease ever since.
DENGUE AS AN EMERGING AND RE-EMERGING INFECTION The two-century-old American emergence of dengue is an interesting starting point for considering determinants of emerging infectious diseases that occur today. Unbeknownst to Rush and his contemporaries at the time, dengue is a mosquito-borne infectious disease caused by any of four related flaviviruses designated dengue types 1 through 4. Dengue viruses are spread by the peri-domestic mosquito Aedes aegypti (also the vector of yellow fever, Published online: March 1, 2013 Correspondence to: David M. Morens, e-mail: [email protected]
which caused a series of fatal epidemics along the East Coast of the United States in the 1790s). In recent decades, dengue has also been transmitted by the related Aedes albopictus, the so-called ‘‘Asian tiger mosquito’’ (Halstead 2007). As early as the eighteenth century, dengue was being spread by human travel and was being introduced into new locales such as Philadelphia by the importation of both mosquitoes and infected crews and passengers arriving from Caribbean islands, with which the young nation of the United States of America had extensive trade relationships. It was strongly suspected that this is how dengue spread, because dengue epidemics in the United States appeared first in East Coast port cities, many of which—like Philadelphia—are in temperate zones that are unable to sustain the mosquito vectors year round. Furthermore, we know several other facts that support this theory of dengue spread: dengue and yellow fever usually began in residential areas close to the docks, only occurred in the summer months, were repeatedly associated with concomitant Caribbean island epidemics, and such epidemics seem to have been most pronounced in places, like Philadelphia, where fresh water was scarce and expensive, leading to onpremise storage of potable water, an ideal environment for Aedes oviposition (egg-depositing).
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