Dengue: a trilogy of people, mosquitoes and the virus. Current epidemiology and pathogenesis in (non-)endemic settings

Dengue consists of a spectrum of disease manifestations caused by four serotypes of Dengue virus, the most prevalent arthropod-borne virus affecting humans in the tropics and subtropics. The incidence of dengue and its geographical distribution have increased dramatically in the past 6 decades. While the majority of patients recover following a self-limiting non-severe clinical course, a small proportion progresses to severe, potentially fatal disease. The disease burden is high; the economic impact of dengue is considerable in terms of medical care, mosquito control measures and the loss of working hours. Due to the increase of population sizes, uncontrolled urbanization, migration and mobility of the human host, proliferation of vector breeding sites, unsuccessful vector control and the current lack of an effective vaccine, it is likely that dengue will continue to represent an important public health problem for many years to come. This thesis consists of a series of investigations into the aspects of the human, mosquito and viral factors that contribute to the epidemiology, persistence and pathogenesis of endemic dengue in Vietnam.