121 doi:10.2217/EBO.13.620 © 2014 Future Medicine Ltd CHAPTER 7 Surveillance of global dengue distribution Jane Messina, Oliver Brady, Simon Hay, Jeremy Farrar & James Whitehorn 1. What is the present global dengue distribution & burden & how is it changing? Dengue is found in 128 countries and is ubiquitous throughout the tropics, with regional and local spatial variations in risk [1] . There is a disproportionate burden of infection borne by Asian countries, which account for 70% of the world’s total burden, recently estimated at 96 million apparent infections [2] . Half of this is attributable to India. The Americas account for approximately half of the remain- ing burden (14%); this is primarily attributable to cases from Brazil and Mexico. While Africa was previously considered at low risk from dengue, more recent esti- mates suggest its burden is comparable with that of the Americas, with signiﬁcant underreporting and misdiagnosis as other symptomatically similar illnesses. While Oceania is also at high risk from dengue, its relative contribution to the global burden is low (<2%). Dengue also appears to be spreading on multiple frontiers, with recent incursions into the southern states of the USA, continental Europe and southern Argentina. Many of the socioeconomic and environmental changes that accompany global development are favorable to the transmission of dengue and thus augur for its continued expansion [3] . ASK THE EXPERTS