Evidence-based risk assessment and communication: a new global dengue-risk map for travellers and clinicians.
BACKGROUND
International travel can expose travellers to pathogens not commonly found in their countries of residence, like dengue virus. Travellers and the clinicians who advise and treat them have unique needs for understanding the geographic extent of risk for dengue. Specifically, they should assess the need for prevention measures before travel and ensure appropriate treatment of illness post-travel. Previous dengue-risk maps published in the Centers for Disease Control and Prevention's Yellow Book lacked specificity, as there was a binary (risk, no risk) classification. We developed a process to compile evidence, evaluate it and apply more informative risk classifications.


METHODS
We collected more than 839 observations from official reports, ProMED reports and published scientific research for the period 2005-2014. We classified each location as frequent/continuous risk if there was evidence of more than 10 dengue cases in at least three of the previous 10 years. For locations that did not fit this criterion, we classified locations as sporadic/uncertain risk if the location had evidence of at least one locally acquired dengue case during the last 10 years. We used expert opinion in limited instances to augment available data in areas where data were sparse.


RESULTS
Initial categorizations classified 134 areas as frequent/continuous and 140 areas as sporadic/uncertain. CDC subject matter experts reviewed all initial frequent/continuous and sporadic/uncertain categorizations and the previously uncategorized areas. From this review, most categorizations stayed the same; however, 11 categorizations changed from the initial determinations.


CONCLUSIONS
These new risk classifications enable detailed consideration of dengue risk, with clearer meaning and a direct link to the evidence that supports the specific classification. Since many infectious diseases have dynamic risk, strong geographical heterogeneities and varying data quality and availability, using this approach for other diseases can improve the accuracy, clarity and transparency of risk communication.
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS E-03, Atlanta, GA 30333, USA ejentes@cdc.gov.
Emily S
ES
Jentes
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS E-03, Atlanta, GA 30333, USA.
R Ryan
RR
Lash
Division of Vector-Borne Diseases, CDC, San Juan, Puerto Rico 00920.
Michael A
MA
Johansson
Division of Vector-Borne Diseases, CDC, San Juan, Puerto Rico 00920.
Tyler M
TM
Sharp
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS E-03, Atlanta, GA 30333, USA.
Ronnie
R
Henry
Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Oxford OX3 7BN, UK.
Oliver J
OJ
Brady
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS E-03, Atlanta, GA 30333, USA.
Mark J
MJ
Sotir
Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Oxford OX3 7BN, UK Institute for Health Metrics and Evaluation, University of Washington, Seattle, 2301 Fifth Ave., Suite 600 Seattle, WA 98121.
Simon I
SI
Hay
Division of Vector-Borne Diseases, CDC, San Juan, Puerto Rico 00920.
Harold S
HS
Margolis
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS E-03, Atlanta, GA 30333, USA.
Gary W
GW
Brunette
D001210:Asia, Southeastern / Q000453:epidemiology; D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D003716:Dengue Virus; D055317:Evidence-Based Practice / Q000458:organization & administration*; D006801:Humans; D014195:Travel; D057236:Travel Medicine / Q000379:methods; D014329:Tropical Climate
Dengue; clinical guidance; epidemiology; risk maps