Fifty years of dengue in India.

Dengue is the most important mosquito-borne, human viral disease in many tropical and sub-tropical areas. In India the disease has been essentially described in the form of case series. We reviewed the epidemiology of dengue in India to improve understanding of its evolution in the last 50 years and support the development of effective local prevention and control measures. Early outbreak reports showed a classic epidemic pattern of transmission with sporadic outbreaks, with low to moderate numbers of cases, usually localized to urban centres and neighbouring regions, but occasionally spreading and causing larger epidemics. Trends in recent decades include: larger and more frequent outbreaks; geographic expansion of endemic transmission; spread of the disease from urban to peri-urban and rural areas; an increasing proportion of severe cases and deaths; and progression to hyperendemicity, particularly in large urban areas. The global picture of dengue in India is currently that of a largely endemic country. Understanding demographic differences in infection rates and severity of dengue has important implications for the planning and implementation of effective public health prevention and control measures and targeting of future vaccination campaigns.