Open Access Research article

Sharing experiences: towards an evidence based model of dengue surveillance and outbreak response in Latin America and Asia

Shiraz Badurdeen1*, David Benitez Valladares2, Jeremy Farrar3, Ernesto Gozzer4, Axel Kroeger5, Novia Kuswara6, Silvia Runge Ranzinger7, Hien Tran Tinh8, Priscila Leite9, Yodi Mahendradhata10, Ronald Skewes11, Ayesha Verrall12 and on behalf of the European Union, World Health Organization (WHO-TDR) supported IDAMS study group*

Author Affiliations

1 Department of Paediatrics, University of Oxford, Oxford, UK

2 Liverpool School of Tropical Medicine, Liverpool, UK

3 Tropical Medicine, Oxford University Clinical Research Unit in Viet Nam, Oxford, UK

4 Asociado FASPA/UPCH, Av. Honorio Delgado 430 San Martín de Porres, Lima, Perú

5 HO/TDR, Geneva, Switzerland and School of Tropical Medicine, Liverpool, UK

6 Ministry of Health Kuala Lumpur, Kuala Lumpur, Malaysia

7 Public Health Specialist, Stuttgart, Germany

8 Clinical Research, Centre for Tropical Medicine Oxford University Clinical Research Unit Vietnam (OUCRU) Wellcome Trust Major Overseas Programme (MOP), Ho Chi Minh City, Vietnam

9 National Dengue Control Ministry of Health of Brazil Esplanada dos Ministérios, Ed sede, Bloco G, Sala 148, Brasilia/DF 70058-900, Brazil

10 Research & Collaboration, Center for Tropical Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

11 Ministerio de Salud República Dominicana, Santo Domingo, Dominican Republic

12 Department of Medicine, National University Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore 119228, Singapore

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BMC Public Health 2013, 13:607  doi:10.1186/1471-2458-13-607

Published: 24 June 2013



The increasing frequency and intensity of dengue outbreaks in endemic and non-endemic countries requires a rational, evidence based response. To this end, we aimed to collate the experiences of a number of affected countries, identify strengths and limitations in dengue surveillance, outbreak preparedness, detection and response and contribute towards the development of a model contingency plan adaptable to country needs.


The study was undertaken in five Latin American (Brazil, Colombia, Dominican Republic, Mexico, Peru) and five in Asian countries (Indonesia, Malaysia, Maldives, Sri Lanka, Vietnam). A mixed-methods approach was used which included document analysis, key informant interviews, focus-group discussions, secondary data analysis and consensus building by an international dengue expert meeting organised by the World Health Organization, Special Program for Research and Training in Tropical Diseases (WHO-TDR).


Country information on dengue is based on compulsory notification and reporting (“passive surveillance”), with laboratory confirmation (in all participating Latin American countries and some Asian countries) or by using a clinical syndromic definition. Seven countries additionally had sentinel sites with active dengue reporting, some also had virological surveillance. Six had agreed a formal definition of a dengue outbreak separate to seasonal variation in case numbers. Countries collected data on a range of warning signs that may identify outbreaks early, but none had developed a systematic approach to identifying and responding to the early stages of an outbreak. Outbreak response plans varied in quality, particularly regarding the early response. The surge capacity of hospitals with recent dengue outbreaks varied; those that could mobilise additional staff, beds, laboratory support and resources coped best in comparison to those improvising a coping strategy during the outbreak. Hospital outbreak management plans were present in 9/22 participating hospitals in Latin-America and 8/20 participating hospitals in Asia.


Considerable variation between countries was observed with regard to surveillance, outbreak detection, and response. Through discussion at the expert meeting, suggestions were made for the development of a more standardised approach in the form of a model contingency plan, with agreed outbreak definitions and country-specific risk assessment schemes to initiate early response activities according to the outbreak phase. This would also allow greater cross-country sharing of ideas.

Dengue outbreaks; Dengue epidemics; Outbreak response; Outbreak detection