Dengue fever: working towards global control considering biological, social, and planetary determinants

We read with great interest the Editorial recently published in The Lancet Infectious Diseases about the global control of dengue.1The Lancet Infectious DiseasesCan we control dengue?.Lancet Infect Dis. 2023; 231095Summary Full Text Full Text PDF Scopus (0) Google Scholar In the Editorial, authors highlighted the effects of climate change and El Niño favouring the spread of this vector-borne disease, and the potential of dengue vaccines and Wolbachia-infected mosquitoes in controlling it. Although we agree with the point of view presented as it covers some of the most important biological and planetary determinants of the disease, we would like to comment on the social determinants of dengue and how they might affect its global control. Although sporadic dengue cases have been reported in the last decades in high-income countries such as Portugal, Italy, France, and Australia, these countries have never had large outbreaks such as those affecting low-income and middle-income countries yearly,2Schaffner F Mathis A Dengue and dengue vectors in the WHO European region: past, present, and scenarios for the future.Lancet Infect Dis. 2014; 14: 1271-1280Summary Full Text Full Text PDF PubMed Scopus (164) Google Scholar, 3Semenza JC Paz S Climate change and infectious disease in Europe: impact, projection and adaptation.Lancet Reg Health Eur. 2021; 9100230Google Scholar, 4Franklinos LHV Jones KE Redding DW Abubakar I The effect of global change on mosquito-borne disease.Lancet Infect Dis. 2019; 19: e302-e312Summary Full Text Full Text PDF PubMed Scopus (218) Google Scholar, 5Martins ABS Correia FGS Cavalcanti LPdG Alencar CH Dengue in northeastern Brazil: a spatial and temporal perspective.Rev Soc Bras Med Trop. 2020; 53e20200435Crossref Scopus (0) Google Scholar, 6Cano-Pérez E Loyola S Malambo-García D Gómez-Camargo D Climatic factors and the incidence of dengue in Cartagena, Colombian Caribbean Region.Rev Soc Bras Med Trop. 2022; 55e00722022Crossref Scopus (0) Google Scholar despite hosting Aedes aegypti and Aedes albopictus in large parts of their territories and having mostly susceptible human populations. A plausible explanation for this difference in incidence rates is the discrepancy between the intensity of mosquito infestations observed in these two different scenarios. In high-income countries, small breeding sites are found inside residences, while in low-income and middle-income countries, large breeding sites are frequently found among inappropriate open waste disposals and water storage receptacles, in places where garbage collection and piped water are not readily available.5Martins ABS Correia FGS Cavalcanti LPdG Alencar CH Dengue in northeastern Brazil: a spatial and temporal perspective.Rev Soc Bras Med Trop. 2020; 53e20200435Crossref Scopus (0) Google Scholar, 7Epelboin Y Chaney SC Guidez A et al.Successes and failures of sixty years of vector control in French Guiana: what is the next step?.Mem Inst Oswaldo Cruz. 2018; 113e170398Crossref Scopus (18) Google Scholar Therefore, from a social medicine perspective, providing regular collection of garbage and access to clean piped water to low-income and middle-income countries affected by dengue fever might eventually produce a large preventive effect not only on dengue control, but also against other vector-borne diseases, such as Zika, chikungunya, and yellow fever. Garbage collection and clean water access would also probably affect waterborne and synanthropic diseases, such as acute gastroenteritis and leptospirosis, and provide additional environmental benefits, such as avoiding contamination of ground water reservoirs. Although dengue vaccines and Wolbachia-infected mosquitoes are expected to have a positive role in controlling dengue globally, it is our perception that basic sanitation services such as access to safe piped water and regular garbage collection, along with measures to mitigate climate change, should be top priorities regarding the issue of dengue control. We declare no competing interests.