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Dengue is a disease with major impacts on public health in tropical and subtropical countries. In Europe, in the past decade, few autochthonous outbreaks were described.


We aimed to identify factors associated with frequency of dengue virus infection among European travellers and at assessing how surveillance data could support preparedness against autochthonous outbreaks within Europe.


We performed a descriptive analysis of travel-related dengue cases reported by European countries from 2015 through 2019. Using flight passenger data, we calculated travellers’ infection rates (TIR). We investigated the following associations: (i) between TIR and incidence rate in selected countries of infection and (ii) between number of travel-related cases and occurrence of autochthonous outbreaks within Europe.


There were 11,478 travel-related dengue cases and the TIR was 2.8 cases per 100,000 travellers. Most cases were infected in Asia (71%), predominantly in south-eastern Asia. The TIR was highest among travellers returning from Asia (6.1/100,000). There was an association between the incidence rate in the country of infection and the TIR but no association between the number of travel-related cases and occurrence of autochthonous outbreaks in Europe.


The likelihood of infection in travellers is a function of the ongoing epidemiological situation in the country of exposure. The number of travel-related cases alone is not sufficient to estimate the likelihood of autochthonous outbreaks where vectors are present in Europe. Additional contributing factors such as adequate vectorial capacity and suitable environmental conditions are required.


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  1. Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature. 2013;496(7446):504-7.  https://doi.org/10.1038/nature12060  PMID: 23563266 
  2. Osman S, Preet R. Dengue, chikungunya and Zika in GeoSentinel surveillance of international travellers: a literature review from 1995 to 2020. J Travel Med. 2020;27(8):taaa222.  https://doi.org/10.1093/jtm/taaa222  PMID: 33258476 
  3. World Health Organization Regional Office for Europe (WHO/Europe). Dengue in the WHO European Region. Copenhagen: WHO/Europe. [Accessed: 14 Apr 2021]. Available from: https://www.euro.who.int/__data/assets/pdf_file/0006/246165/Fact-sheet-Dengue-Eng.pdf
  4. Adhami J, Reiter P. Introduction and establishment of Aedes (Stegomyia) albopictus skuse (Diptera: Culicidae) in Albania. J Am Mosq Control Assoc. 1998;14(3):340-3. PMID: 9813831 
  5. European Centre for Disease Prevention and Control (ECDC), European Food Safety Authority (EFSA). Aedes albopictus: current known distribution, March 2021. Stockholm: ECDC; 2021. Available from: https://www.ecdc.europa.eu/en/publications-data/aedes-albopictus-current-known-distribution-march-2021
  6. Lambrechts L, Scott TW, Gubler DJ. Consequences of the expanding global distribution of Aedes albopictus for dengue virus transmission. PLoS Negl Trop Dis. 2010;4(5):e646.  https://doi.org/10.1371/journal.pntd.0000646  PMID: 20520794 
  7. Latreille AC, Milesi P, Magalon H, Mavingui P, Atyame CM. High genetic diversity but no geographical structure of Aedes albopictus populations in Réunion Island. Parasit Vectors. 2019;12(1):597.  https://doi.org/10.1186/s13071-019-3840-x  PMID: 31856896 
  8. Santé publique France. Dengue à la Réunion : Poursuite de la baisse, Point de situation au 09 août 2021 [Accessed on 14 December 2021]. Saint-Maurice: Santé publique France, 2021. Available from: https://www.santepubliquefrance.fr/regions/ocean-indien/documents/bulletin-regional/2021/surveillance-de-la-dengue-a-la-reunion.-point-au-9-aout-2021
  9. European Centre for Disease Prevention and Control (ECDC). Autochthonous transmission of dengue virus in mainland EU/EEA, 2010-present. Stockholm: ECDC. [Accessed: 14 Dec 2021]. Available from: https://www.ecdc.europa.eu/en/all-topics-z/dengue/surveillance-and-disease-data/autochthonous-transmission-dengue-virus-eueea
  10. European Centre for Disease Prevention and Control (ECDC). The European Surveillance System (TESSy). Stockholm: ECDC. [Accessed: 14 Apr 2021]. [Restricted access]. Available from: https://ecdc.europa.eu/en/publications-data/european-surveillance-system-tessy
  11. European Commission (EC). Commission implementing decision 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions. Luxembourg: Office of the European Union. 6.7.2018:L170/1. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32018D0945&from=EN#page=13
  12. Eurostat. NUTS - Nomenclature of territorial units for statistics. Luxembourg: Luxembourg: Eurostat. [Accessed: 14 Apr 2021]. Available from: http://ec.europa.eu/eurostat/web/nuts/overview
  13. International Air Transport Association (IATA). Market intelligence services (MarketIS). Geneva: IATA. [Accessed: 14 Apr 2021]. Available from: http://www.iata.org/services/statistics/intelligence/Pages/market-intelligence.aspx
  14. Bureau de veille sanitaire. Bulletin de surveillance sanitaire, Polynésie française. Données du 16 au 29 décembre 2019 (semaines 51 et 52). [Bulletin of public health surveillance, French Polynesia. Data from 16 to 29 December 2019 (weeks 51 and 52)]. Papeete: Direction de la santé; 2019. French. Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/BSS-S51%20et%20S52%202019.pdf
  15. Bureau de veille sanitaire. Rapport de surveillance de la dengue en Polynésie française, Année 2016 [Report on surveillance of dengue in French Polynesia, year 2016]. Papeete: Direction de la santé. [Accessed: 14 Apr 2021]. French. Available from: http://www.hygiene-publique.gov.pf/IMG/pdf/rapport_dengue_2016.pdf
  16. Bureau de veille sanitaire. La dengue en Polynésie française, Rapport annuel 2018 [Dengue in French Polynesia, annual report 2018]. Papeete: Direction de la santé. [Accessed: 14 Apr 2021]. French. Available from: https://www.service-public.pf/dsp/wp-content/uploads/sites/12/2019/04/Rapport-dengue-2018.pdf
  17. Bureau de veille sanitaire. La dengue en Polynésie française, Rapport annuel 2017 [Dengue in French Polynesia, annual report 2017]. Papeete: Direction de la santé. [Accessed: 14 Apr 2021]. French. Available from: https://www.service-public.pf/dsp/wp-content/uploads/sites/12/2018/03/Rapport-dengue-2017_DirectionSantePolyn%C3%A9sieFran%C3%A7aise.pdf
  18. Prefecture de la région Réunion, Agence Régionale de santé La Réunion. Point sur la dengue à La Réunion [Update on the dengue situation in La Réunion]. Saint-Denis: Prefecture de la région Réunion; 2020. French. Available from: http://www.reunion.gouv.fr/IMG/pdf/2020-01-07_cp_ars_point_de_situation_dengue.pdf
  19. Vincent M, Larrieu S, Vilain P, Etienne A, Solet JL, François C, et al. From the threat to the large outbreak: dengue on Reunion Island, 2015 to 2018. Euro Surveill. 2019;24(47):1900346.  https://doi.org/10.2807/1560-7917.ES.2019.24.47.1900346  PMID: 31771702 
  20. Bureau of Epidemiology Department of Disease Control. Annual epidemiology surveillance report, Dengue disease. Nonthaburi: Ministry of Public Health; 2018. [Accessed: 14 Apr 2021]. Thai.
  21. Bureau of Epidemiology Department of Disease Control. Annual epidemiology surveillance report, Dengue disease. Nonthaburi: Ministry of public health; 2019. [Accessed: 14 Apr 2021]. Thai.
  22. World Health Organization (WHO). Dengue data application. Geneva: WHO. [Accessed: 14 Dec 2021]. Available at: https://ntdhq.shinyapps.io/dengue5/
  23. Pan American Health Organization (PAHO). PLISA Health Information Platform for the Americas. Reported cases of dengue fever in the Americas. Washington: PAHO. [Accessed: 14 Apr 2021]. Available from: https://www.paho.org/data/index.php/en/mnu-topics/indicadores-dengue-en/dengue-nacional-en/252-dengue-pais-ano-en.html
  24. Institut national de la statistique et des études économiques (INSEE). Les résultats des recensements de la population. [Population census results]. Montrouge: INSEE. [Accessed: 14 Apr 2021]. French. Available from: https://www.insee.fr/fr/information/2008354
  25. The World Bank (WB). Population, total. Washington: WB. [Accessed: 14 Apr 2021]. Available from: https://data.worldbank.org/indicator/SP.POP.TOTL
  26. Ministère des Solidarités et de la Santé. Cartes de présence du moustique tigre (Aedes albopictus) en France métropolitaine. [Distribution maps of the tiger mosquito (Aedes albopictus) in mainland France]. Paris: Ministère des Solidarités et de la Santé. [Accessed: 14 Dec 2021]. French. Available at: https://solidarites-sante.gouv.fr/sante-et-environnement/risques-microbiologiques-physiques-et-chimiques/especes-nuisibles-et-parasites/article/cartes-de-presence-du-moustique-tigre-aedes-albopictus-en-france-metropolitaine
  27. Eurostat. Population on 1 January by age group, sex and NUTS 3 region. Luxembourg: Eurostat. [Accessed: 14 Apr 2021]. Available from: https://ec.europa.eu/eurostat/web/products-datasets/product?code=demo_r_pjangrp3
  28. United Nations Statistics Division (UNSD). Standard country or area codes for statistical use. New York: UNSD. [Accessed: 14 Apr 2021]. Available from: https://unstats.un.org/unsd/methodology/m49
  29. Raafat N, Blacksell SD, Maude RJ. A review of dengue diagnostics and implications for surveillance and control. Trans R Soc Trop Med Hyg. 2019;113(11):653-60.  https://doi.org/10.1093/trstmh/trz068  PMID: 31365115 
  30. van Meer MPA, Mögling R, Klaasse J, Chandler FD, Pas SD, van der Eijk AA, et al. Re-evaluation of routine dengue virus serology in travelers in the era of Zika virus emergence. J Clin Virol. 2017;92:25-31.  https://doi.org/10.1016/j.jcv.2017.05.001  PMID: 28505571 
  31. Tavakolipoor P, Schmidt-Chanasit J, Burchard GD, Jordan S. Clinical features and laboratory findings of dengue fever in German travellers: A single-centre, retrospective analysis. Travel Med Infect Dis. 2016;14(1):39-44.  https://doi.org/10.1016/j.tmaid.2016.01.007  PMID: 26876059 
  32. Rocklöv J, Lohr W, Hjertqvist M, Wilder-Smith A. Attack rates of dengue fever in Swedish travellers. Scand J Infect Dis. 2014;46(6):412-7.  https://doi.org/10.3109/00365548.2014.887222  PMID: 24716463 
  33. Neumayr A, Muñoz J, Schunk M, Bottieau E, Cramer J, Calleri G, et al. , for TropNet. Sentinel surveillance of imported dengue via travellers to Europe 2012 to 2014: TropNet data from the DengueTools Research Initiative. Euro Surveill. 2017;22(1):30433.  https://doi.org/10.2807/1560-7917.ES.2017.22.1.30433  PMID: 28080959 
  34. Je S, Bae W, Kim J, Seok SH, Hwang ES. Epidemiological characteristics and risk factors of dengue infection in Korean travelers. J Korean Med Sci. 2016;31(12):1863-73.  https://doi.org/10.3346/jkms.2016.31.12.1863  PMID: 27822922 
  35. Huang X, Yakob L, Devine G, Frentiu FD, Fu SY, Hu W. Dynamic spatiotemporal trends of imported dengue fever in Australia. Sci Rep. 2016;6(1):30360.  https://doi.org/10.1038/srep30360  PMID: 27460696 
  36. Rivera A, Adams LE, Sharp TM, Lehman JA, Waterman SH, Paz-Bailey G. Travel-associated and locally acquired dengue cases - United States, 2010-2017. MMWR Morb Mortal Wkly Rep. 2020;69(6):149-54.  https://doi.org/10.15585/mmwr.mm6906a1  PMID: 32053577 
  37. Domingo C, Niedrig M, Gascón J, Palacios G, Reyes N, Malo MJ, et al. Molecular surveillance of circulating dengue genotypes through European travelers. J Travel Med. 2011;18(3):183-90.  https://doi.org/10.1111/j.1708-8305.2011.00501.x  PMID: 21539658 
  38. Gossner CM, Fournet N, Dias JG, Martínez BF, Del Manso M, Young JJ, et al. Risks related to chikungunya infections among European Union travelers, 2012-2018. Emerg Infect Dis. 2020;26(6):1067-76.  https://doi.org/10.3201/eid2606.190490  PMID: 32441244 
  39. World Health Organization (WHO). Disease outbreak news: Dengue fever – Côte d’Ivoire. Geneva: WHO; 2017. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/04-august-2017-dengue-cote-d-ivoire-en
  40. Gouvernement de Côte d’Ivoire. Epidémie de dengue: L’INHP rassure qu'il n'y a pas de flambé des cas. [Dengue epidemic: the INHP reassures there is no outbreak of cases]. Abidjan: Gouvernement de Côte d’Ivoirel 2019. French. Available from: http://www.gouv.ci/_actualite-article.php?recordID=10025
  41. Amaya-Larios IY, Martínez-Vega RA, Diaz-Quijano FA, Sarti E, Puentes-Rosas E, Chihu L, et al. Risk of dengue virus infection according to serostatus in individuals from dengue endemic areas of Mexico. Sci Rep. 2020;10(1):19017.  https://doi.org/10.1038/s41598-020-75891-z  PMID: 33149151 
  42. Vongpunsawad S, Intharasongkroh D, Thongmee T, Poovorawan Y. Seroprevalence of antibodies to dengue and chikungunya viruses in Thailand. PLoS One. 2017;12(6):e0180560.  https://doi.org/10.1371/journal.pone.0180560  PMID: 28662144 
  43. Leder K, Torresi J, Libman MD, Cramer JP, Castelli F, Schlagenhauf P, et al. GeoSentinel surveillance of illness in returned travelers, 2007-2011. Ann Intern Med. 2013;158(6):456-68.  https://doi.org/10.7326/0003-4819-158-6-201303190-00005  PMID: 23552375 
  44. Overbosch FW, Schinkel J, Stolte IG, Prins M, Sonder GJB. Dengue virus infection among long-term travelers from the Netherlands: A prospective study, 2008-2011. PLoS One. 2018;13(2):e0192193.  https://doi.org/10.1371/journal.pone.0192193  PMID: 29415063 
  45. Lindholm DA, Myers T, Widjaja S, Grant EM, Telu K, Lalani T, et al. Mosquito exposure and chikungunya and dengue infection among travelers during the chikungunya outbreak in the Americas. Am J Trop Med Hyg. 2017;96(4):903-12.  https://doi.org/10.4269/ajtmh.16-0635  PMID: 28115671 
  46. Lazzarini L, Barzon L, Foglia F, Manfrin V, Pacenti M, Pavan G, et al. First autochthonous dengue outbreak in Italy, August 2020. Euro Surveill. 2020;25(36):2001606.  https://doi.org/10.2807/1560-7917.ES.2020.25.36.2001606  PMID: 32914745 
  47. Franke F, Giron S, Cochet A, Jeannin C, Leparc-Goffart I, de Valk H, et al. Emergences de dengue et de chikungunya en France métropolitaine, 2010-2018. [Autochthonous chikungunya and dengue fever outbreak in mainland France, 2010-2018]. Bull Epidemiol Hebd (Paris). 2019;2019(19-20):9. French. Available from: http://beh.santepubliquefrance.fr/beh/2019/19-20/pdf/2019_19-20_2.pdf
  48. Duong V, Lambrechts L, Paul RE, Ly S, Lay RS, Long KC, et al. Asymptomatic humans transmit dengue virus to mosquitoes. Proc Natl Acad Sci USA. 2015;112(47):14688-93.  https://doi.org/10.1073/pnas.1508114112  PMID: 26553981 
  49. European Centre for Disease Prevention and Control (ECDC). Autochthonous transmission of chikungunya virus in EU/EEA, 2007-present. Stockholm: ECDC. [Accessed: 14 Dec 2021]. Available from: https://www.ecdc.europa.eu/en/all-topics-z/chikungunya-virus-disease/surveillance-and-disease-data/autochthonous-transmission
  50. Gossner CM, Ducheyne E, Schaffner F. Increased risk for autochthonous vector-borne infections transmitted by Aedes albopictus in continental Europe. Euro Surveill. 2018;23(24):1800268.  https://doi.org/10.2807/1560-7917.ES.2018.23.24.1800268  PMID: 29921345 
  51. Cunze S, Kochmann J, Koch LK, Klimpel S. Aedes albopictus and its environmental limits in Europe. PLoS One. 2016;11(9):e0162116.  https://doi.org/10.1371/journal.pone.0162116  PMID: 27603669 
  52. European Centre for Disease Prevention and Control (ECDC), European Food Safety Authority (EFSA). Aedes aegypti: Current known distribution, March 2021. Stockholm: ECDC; 2021. Available from: https://www.ecdc.europa.eu/en/publications-data/aedes-aegypti-current-known-distribution-march-2021
  53. Hunsperger E, Peeling R, Gubler DJ, Ooi EE. Dengue pre-vaccination serology screening for the use of Dengvaxia. J Travel Med. 2019;26(8):taz092.  https://doi.org/10.1093/jtm/taz092  PMID: 31776549 
  54. Durbin AP, Gubler DJ. What is the prospect of a safe and effective dengue vaccine for travellers? J Travel Med. 2019;26(6):tay153.  https://doi.org/10.1093/jtm/tay153  PMID: 30657935 
  55. European Medicines Agency (EMA). Press release: First vaccine for prevention of dengue. Amsterdam: EMA; 2018. Available from: https://www.ema.europa.eu/en/news/first-vaccine-prevention-dengue

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