Surveillance Open Access
Like 0



After 40 years of limited viral circulation, Reunion Island has since 2018 experienced recurrent dengue outbreaks of increasing intensity and severity.


We aimed to report on the epidemiology and characteristics of dengue in Reunion Island between 2018 and 2021.


Between 2018 and August 2021, we systematically collected data on dengue cases via an automated transmission system between the health authorities and the medical laboratories. We set up additional surveillance systems for dengue-related activity in primary care, in emergency departments and in inpatient departments.


Until 2020, despite numerous cases, outbreaks had a limited public health impact because of few severe cases, low lethality and no heavy burden for the health care system. In 2021, however, the number of severe cases increased (from 0.4% of all cases in 2018 to 0.8% in 2021), as did the number of paediatric cases (from 8% in 2018 to 15% in 2021) and atypical clinical forms of dengue (108 cases of post-dengue maculopathy). Of note, haemorrhagic forms were rare and multi-organ failure was the most frequent severity throughout the study period. In parallel, the dominant serotype switched from DENV2 to DENV1 in 2020 and DENV1 became the only serotype detected in 2021.


These findings indicate that dengue is becoming endemic in Reunion Island. Since comorbidities associated with severity of dengue are common in the population, health authorities should carefully consider the impact of dengue when addressing public health policies.


Article metrics loading...

Loading full text...

Full text loading...



  1. World Health Organization (WHO). Fact sheets – dengue and severe dengue. Geneva: WHO; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue
  2. Du M, Jing W, Liu M, Liu J. The global trends and regional differences in incidence of dengue infection from 1990 to 2019: an analysis from the global burden of disease study 2019. Infect Dis Ther. 2021;10(3):1625-43.  https://doi.org/10.1007/s40121-021-00470-2  PMID: 34173959 
  3. Normile D. Tropical medicine. Surprising new dengue virus throws a spanner in disease control efforts. Science. 2013;342(6157):415.  https://doi.org/10.1126/science.342.6157.415  PMID: 24159024 
  4. Wilder-Smith A, Ooi EE, Horstick O, Wills B. Dengue. Lancet. 2019;393(10169):350-63.  https://doi.org/10.1016/S0140-6736(18)32560-1  PMID: 30696575 
  5. Guzman MG, Halstead SB, Artsob H, Buchy P, Farrar J, Gubler DJ, et al. Dengue: a continuing global threat. Nat Rev Microbiol. 2010;8(12) Suppl;S7-16.  https://doi.org/10.1038/nrmicro2460  PMID: 21079655 
  6. Rivera L, Biswal S, Sáez-Llorens X, Reynales H, López-Medina E, Borja-Tabora C, et al. Three-year efficacy and safety of Takeda’s dengue vaccine candidate (TAK-003). Clin Infect Dis. 2022;75(1):107-17.  https://doi.org/10.1093/cid/ciab864  PMID: 34606595 
  7. European Medicines Agency (EMA). Dengvaxia: EPAR– risk management plan summary. Amsterdam: EMA; 2022. Available from: https://www.ema.europa.eu/en/medicines/human/EPAR/dengvaxia
  8. Coulanges P, Clercy Y, Jousset FX, Rodhain F, Hannoun C. (Dengue at Reunion: isolation of a strain at the Pasteur Institute of Madagascar). Dengue à la Réunion: isolement d’une souche à l’Institut Pasteur de Madagascar. Bull Soc Pathol Exot. 1979;72:205-9.
  9. 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 
  10. World Health Organization (WHO). International Classification of Diseases. ICD-11 for mortality and morbidity statistics (Version: 01/2023). Geneva: WHO; 2023. Available from: https://icd.who.int/browse11/l-m/en
  11. Centers for Disease Control and Prevention (CDC). Epidemiology glossary. Atlanta: CDC; 2015. Available from: https://www.cdc.gov/reproductivehealth/data_stats/glossary.html
  12. Nunes PCG, Daumas RP, Sánchez-Arcila JC, Nogueira RMR, Horta MAP, Dos Santos FB. 30 years of fatal dengue cases in Brazil: a review. BMC Public Health. 2019;19(1):329.  https://doi.org/10.1186/s12889-019-6641-4  PMID: 30898104 
  13. Flamand C, Fritzell C, Prince C, Abboud P, Ardillon V, Carvalho L, et al. Epidemiological assessment of the severity of dengue epidemics in French Guiana. PLoS One. 2017;12(2):e0172267.  https://doi.org/10.1371/journal.pone.0172267  PMID: 28196111 
  14. Cavalcanti LP, Vilar D, Souza-Santos R, Teixeira MG. Change in age pattern of persons with dengue, northeastern Brazil. Emerg Infect Dis. 2011;17(1):132-4.  https://doi.org/10.3201/eid1701.100321  PMID: 21192876 
  15. Mohd-Zaki AH, Brett J, Ismail E, L’Azou M. Epidemiology of dengue disease in Malaysia (2000-2012): a systematic literature review. PLoS Negl Trop Dis. 2014;8(11):e3159.  https://doi.org/10.1371/journal.pntd.0003159  PMID: 25375211 
  16. Tran A, Mangeas M, Demarchi M, Roux E, Degenne P, Haramboure M, et al. Complementarity of empirical and process-based approaches to modelling mosquito population dynamics with Aedes albopictus as an example-application to the development of an operational mapping tool of vector populations. PLoS One. 2020;15(1):e0227407.  https://doi.org/10.1371/journal.pone.0227407  PMID: 31951601 
  17. Rosenberger KD, Alexander N, Martinez E, Lum LCS, Dempfle CE, Junghanss T, et al. Severe dengue categories as research endpoints-results from a prospective observational study in hospitalised dengue patients. PLoS Negl Trop Dis. 2020;14(3):e0008076.  https://doi.org/10.1371/journal.pntd.0008076  PMID: 32130212 
  18. Katzelnick LC, Gresh L, Halloran ME, Mercado JC, Kuan G, Gordon A, et al. Antibody-dependent enhancement of severe dengue disease in humans. Science. 2017;358(6365):929-32.  https://doi.org/10.1126/science.aan6836  PMID: 29097492 
  19. Sangkaew S, Ming D, Boonyasiri A, Honeyford K, Kalayanarooj S, Yacoub S, et al. Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis. Lancet Infect Dis. 2021;21(7):1014-26.  https://doi.org/10.1016/S1473-3099(20)30601-0  PMID: 33640077 
  20. Su DH, Bacsal K, Chee SP, Flores JV, Lim WK, Cheng BC, et al. Prevalence of dengue maculopathy in patients hospitalized for dengue fever. Ophthalmology. 2007;114(9):1743-7.  https://doi.org/10.1016/j.ophtha.2007.03.054  PMID: 17561258 
  21. Ng AW, Teoh SC. Dengue eye disease. Surv Ophthalmol. 2015;60(2):106-14.  https://doi.org/10.1016/j.survophthal.2014.07.003  PMID: 25223497 
  22. Chee E, Sims JL, Jap A, Tan BH, Oh H, Chee SP. Comparison of prevalence of dengue maculopathy during two epidemics with differing predominant serotypes. Am J Ophthalmol. 2009;148(6):910-3.  https://doi.org/10.1016/j.ajo.2009.06.030  PMID: 19800610 
  23. Prince HE, Yeh C, Lapé-Nixon M. Utility of IgM/IgG ratio and IgG avidity for distinguishing primary and secondary dengue virus infections using sera collected more than 30 days after disease onset. Clin Vaccine Immunol. 2011;18(11):1951-6.  https://doi.org/10.1128/CVI.05278-11  PMID: 21880858 
  24. Gouagna LC, Damiens D, Oliva CF, Boyer S, Le Goff G, Brengues C, et al. Strategic approach, advances, and challenges in the development and application of the SIT for area-wide control of Aedes albopictus mosquitoes in Reunion Island. Insects. 2020;11(11):770.  https://doi.org/10.3390/insects11110770  PMID: 33171885 
  25. Kittayapong P, Ninphanomchai S, Limohpasmanee W, Chansang C, Chansang U, Mongkalangoon P. Combined sterile insect technique and incompatible insect technique: The first proof-of-concept to suppress Aedes aegypti vector populations in semi-rural settings in Thailand. PLoS Negl Trop Dis. 2019;13(10):e0007771.  https://doi.org/10.1371/journal.pntd.0007771  PMID: 31658265 
  26. Bellini R, Medici A, Puggioli A, Balestrino F, Carrieri M. Pilot field trials with Aedes albopictus irradiated sterile males in Italian urban areas. J Med Entomol. 2013;50(2):317-25.  https://doi.org/10.1603/ME12048  PMID: 23540120 
  27. Hafsia S, Haramboure M, Wilkinson DA, Baldet T, Yemadje-Menudier L, Vincent M, et al. Overview of dengue outbreaks in the southwestern Indian Ocean and analysis of factors involved in the shift toward endemicity in Reunion Island: A systematic review. PLoS Negl Trop Dis. 2022;16(7):e0010547.  https://doi.org/10.1371/journal.pntd.0010547  PMID: 35900991 
  28. Cochet A, Calba C, Jourdain F, Grard G, Durand GA, Guinard A, et al. Autochthonous dengue in mainland France, 2022: geographical extension and incidence increase. Euro Surveill. 2022;27(44):2200818.  https://doi.org/10.2807/1560-7917.ES.2022.27.44.2200818  PMID: 36330819 
  29. Bhoomiboonchoo P, Nisalak A, Chansatiporn N, Yoon IK, Kalayanarooj S, Thipayamongkolgul M, et al. Sequential dengue virus infections detected in active and passive surveillance programs in Thailand, 1994-2010. BMC Public Health. 2015;15(1):250.  https://doi.org/10.1186/s12889-015-1590-z  PMID: 25886528 

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error