Dengue is an acute febrile disease caused by the mosquito-borne dengue viruses (DENVs), consisting of four serotypes (DENV 1 to 4), that are members of the flaviviridae family, genus flavivirus (1). All four DENV serotypes have emerged from sylvatic strains in the forests of South-East Asia (2).
DENV is presently the most common cause of arboviral disease globally, and all four serotypes of DENV can be found worldwide. More than 100 countries are endemic, primarily affecting 2.5 billion inhabitants in the tropical and subtropical regions (Fig. 1) as well as 120 million travelers to these regions every year (3). The World Health Organization (WHO) estimates an annual incidence of approximately 100 million infections, with approximately 500,000 people with dengue hemorrhagic fever (DHF) requiring hospitalization, a large proportion being children. DHF may develop into dengue shock syndrome (DSS) whereof the mortality rate is approximately 1–2.5%. Successful treatment of patients with DHF and DSS is labor intensive and expensive, but without proper treatment, fatality rates may exceed 20% (4).