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Sci Rep. 2018 Mar 15;8(1):4629. doi: 10.1038/s41598-018-22590-5.

Estimating the probability of dengue virus introduction and secondary autochthonous cases in Europe.

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School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
London School of Hygiene and Tropical Medicine, London, UK.
College of Natural and Life Sciences, The University of Derby, Derby, UK.
School of Applied Mathematics, Fundação Getúlio Vargas, Rio de Janeiro, Brazil.
School of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
Programme of Scientific Computation, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
Department Public Health and Clinical Medicine, Epidemiology and Global Health, Umea University, SE-901 85, Umea, Sweden.
Harvard Medical School & Boston Children's Hospital & Department of Zoology, University of Oxford, Oxford, UK.
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.


Given the speed of air travel, diseases even with a short viremia such as dengue can be easily exported to dengue naïve 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.

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