2014 Articles

Air Travel Is Associated with Intracontinental Spread of Dengue Virus Serotypes 1–3 in Brazil

Nunes, Marcio R. T.; Palacios, Gustavo; Rodriguez Faria, Nuno; Costa Sousa, Jr., Edivaldo; Pantoja, Jamilla A.; Rodrigues, Sueli G.; Carvalho, Valeria L.; Medeiros, Daniele B. A.; Savji, Nazir; Baele, Guy; Suchard, Marc A.; Lemey, Philippe; Vasconcelos, Pedro F. C.; Lipkin, W. Ian

Dengue virus and its four serotypes (DENV-1 to DENV-4) infect 390 million people and are implicated in at least 25,000 deaths annually, with the largest disease burden in tropical and subtropical regions. We investigated the spatial dynamics of DENV-1, DENV-2 and DENV-3 in Brazil by applying a statistical framework to complete genome sequences. For all three serotypes, we estimated that the introduction of new lineages occurred within 7 to 10-year intervals. New lineages were most likely to be imported from the Caribbean region to the North and Northeast regions of Brazil, and then to disperse at a rate of approximately 0.5 km/day. Joint statistical analysis of evolutionary, epidemiological and ecological data indicates that aerial transportation of humans and/or vector mosquitoes, rather than Aedes aegypti infestation rates or geographical distances, determine dengue virus spread in Brazil.