Evolution of dengue in Sri Lanka-changes in the virus, vector, and climate.

Despite the presence of dengue in Sri Lanka since the early 1960s, dengue has become a major public health issue, with a high morbidity and mortality. Aedes aegypti and Aedes albopictus are the vectors responsible for the transmission of dengue viruses (DENV). The four DENV serotypes (1, 2, 3, and 4) have been co-circulating in Sri Lanka for more than 30 years. The new genotype of DENV-1 has replaced an old genotype, and new clades of DENV-3 genotype III have replaced older clades. The emergence of new clades of DENV-3 in the recent past coincided with an abrupt increase in the number of dengue fever (DF)/dengue hemorrhagic fever (DHF) cases, implicating this serotype in severe epidemics. Climatic factors play a pivotal role in the epidemiological pattern of DF/DHF in terms of the number of cases, severity of illness, shifts in affected age groups, and the expansion of spread from urban to rural areas. There is a regular incidence of DF/DHF throughout the year, with the highest incidence during the rainy months. To reduce the morbidity and mortality associated with DF/DHF, it is important to implement effective vector control programs in the country. The economic impact of DF/DHF results from the expenditure on DF/DHF critical care units in several hospitals and the cost of case management.