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Table 2 Proposed alert signals (triggers for early response) as suggested by the WHO-TDR expert meeting (June 2012)

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

Trigger Evidence or expert opinion** Feasibility Further research needed***
New predominant serotype introduced +++ Most countries +++
Changes in age group distribution ++ Most countries +++
Increased number of hospitalised/outpatient fever cases/probable dengue* +++ Most countries +++
Increase in vector presence ++ Most countries +++
Increase in news reporting dengue outbreaks, social network comments + Few countries ++++
Climate changes: increase in rainfall/temperature/humidity ++ Most countries +++
Increase in % positive serology* ++++ Most countries +
Increase internal displacement/population mobility + Context dependent ++++
Cluster identified through GIS mapping ++ Few countries ++
Identification of outbreak in a neighboring geographical unit (state, district, province, country)* ++++ Most countries ++
  1. *Particularly useful indicators/ triggers.
  2. ** ++++ very strong; +++ strong; ++fairly strong; + weak.
  3. *** ++++highest priority; +++ high priority; ++ necessary.
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