美国登革热的流行病学和负担：系统评价。

Epidemiology and burden of dengue fever in the United States: a systematic review.

机构信息

Division of Infectious Diseases and Travel Medicine, Mount Auburn Hospital, 330 Mount Auburn Street Suite 413 Cambridge, MA 02138, USA.

Associate Professor of Medicine, Harvard Medical School, 25 Shattuck Street Boston, MA 02115, USA.

出版信息

J Travel Med. 2023 Nov 18;30(7). doi: 10.1093/jtm/taad127.

DOI:10.1093/jtm/taad127

PMID:37792822

Abstract

BACKGROUND

Dengue is currently a global concern. The range of dengue vectors is expanding with climate change, yet United States of America (USA) studies on dengue epidemiology and burden are limited. This systematic review sought to characterize the epidemiology and disease burden of dengue within the USA.

METHODS

Studies evaluating travel-related and endemic dengue in US states and territories were identified and qualitatively summarized. Commentaries and studies on ex-US cases were excluded. MEDLINE, Embase, Cochrane Library, Latin American and Caribbean Center of Health Sciences Information, Centre for Reviews and Dissemination and Clinicaltrials.gov were searched through January 2022.

RESULTS

116 studies were included. In US states, dengue incidence was generally low, with spikes occurring in recent years in 2013-16 (0.17-0.31 cases/100,000) and peaking in 2019 (0.35 cases/100,000). Most cases (94%, n = 7895, 2010-21) were travel related. Dengue was more common in Puerto Rico (cumulative average: 200 cases/100,000, 1980-2015); in 2010-21, 99.9% of cases were locally acquired. There were <50 severe cases in US states (2010-17); fatal cases were even rarer. Severe cases in Puerto Rico peaked in 1998 (n = 173) and 2021 (n = 76). Besides lower income, risk factors in US states included having birds in residence, suggesting unspecified environmental characteristics favourable to dengue vectors. Commonly reported symptoms included fever, headache and rash; median disease duration was 3.5-11 days. Hospitalization rates increased following 2009 World Health Organization disease classification changes (pre-2009: 0-54%; post-2009: 14-75%); median length of stay was 2.7-8 days (Puerto Rico) and 2-3 days (US states). Hospitalization costs/case (2010 USD) were$14 350 (US states),$1764-$5497 (Puerto Rico) and$4207 (US Virgin Islands). In Puerto Rico, average days missed were 0.2-5.3 (work) and 2.5 (school).

CONCLUSIONS

Though dengue risk is ongoing, treatments are limited, and dengue's economic burden is high. There is an urgent need for additional preventive and therapeutic interventions.

摘要

背景

登革热目前是一个全球性的问题。随着气候变化，登革热媒介的范围正在扩大，但美国（USA）关于登革热流行病学和负担的研究有限。本系统评价旨在描述美国境内登革热的流行病学和疾病负担。

方法

确定并定性总结了评估美国各州和领地与旅行相关和地方性登革热的研究。排除了关于美国境外病例的评论和研究。通过 2022 年 1 月在 MEDLINE、Embase、Cochrane 图书馆、拉丁美洲和加勒比卫生科学信息中心、评论传播中心和 Clinicaltrials.gov 进行了搜索。

结果

纳入了 116 项研究。在美国各州，登革热的发病率通常较低，近年来在 2013-16 年（0.17-0.31 例/100,000）和 2019 年（0.35 例/100,000）出现高峰。大多数病例（94%，n=7895，2010-21）与旅行有关。波多黎各（1980-2015 年累积平均数：200 例/100,000）更为常见；2010-21 年，99.9%的病例为本地获得。美国各州的重症病例数不到 50 例（2010-17 年）；罕见致命病例。波多黎各的重症病例在 1998 年（n=173）和 2021 年（n=76）达到高峰。除了收入较低外，美国各州的危险因素还包括居住鸟类，表明存在不明的有利于登革热媒介的环境特征。常见的报告症状包括发热、头痛和皮疹；中位数疾病持续时间为 3.5-11 天。自 2009 年世界卫生组织疾病分类变更后（2009 年前：0-54%；2009 年后：14-75%），住院率增加；中位住院时间为 2.7-8 天（波多黎各）和 2-3 天（美国各州）。2010 年美元（USD）/例的住院费用/case（2010 年 USD）为 14350 美元（美国各州）、1764-5497 美元（波多黎各）和 4207 美元（美属维尔京群岛）。在波多黎各，平均缺勤天数为 0.2-5.3（工作）和 2.5（上学）。