1. Urban Growth in Asian Cities

2. 1950-19691970-19791980-2011 Spread of dengue hemorrhagic fever in Asia

3. The spread of dengue hemorrhagic fever in the Americas Adapted from Gubler, 1998 Prior to 1981 1981-2011

4. The changing epidemiology of dengue Source: DengueNet No of Cases Expanding geographic distribution Increased epidemic activity Hyperendemicity Emergence of severe disease

5. New dengue Disease Burden estimates 3.6 billion 3.6 billion 230 million 34 million? 2 million 21,000 Beatty ME, Letson GW, Margolis HS., Phuket, Thailand October 17-19, 2008. At-Risk Population Infections Infections Dengue Fever DHF DSS Deaths

6. Why have we seen such a dramatic increase in epidemic Dengue Hemorrhagic Fever? Demographic Changes (Pop Growth) Demographic Changes (Pop Growth) Environmental Change Environmental Change -Urbanization -Changing lifestyles Modern Transportation (Globalization) Modern Transportation (Globalization) Increased Movement of People, Animals, Commodities and pathogens Increased Movement of People, Animals, Commodities and pathogens Lack of Effective Mosquito Control Lack of Effective Mosquito Control Major Drivers

7. Urban growth in Asian and American Cities, 1950-2010 Mean population of Dhaka, Bangkok, Jakarta, Manila and Saigon. Mean population of Rio de Janeiro, Sao Paulo, San Juan, Caracas and Guayaquil. Population (Millions)

9. The global air network

10. Average annual number of global airline passengers by decade, 1950-2010 IATA 2010 Million of Passenger (Mil) Period

11. Commercial Air Traffic Over a 24 Hour Period

12. Global distribution of dengue virus serotypes, 1970

13. Global distribution of dengue virus serotypes, 1970-2000 1971 1975 1981 DENV – 1; DENV – 2; DENV – 3; DENV – 4 1985 1981 1994 1982 1980 1977 1979

14. Global distribution of dengue virus serotypes, 2011