Dengue fever has spread rapidly around the world in recent years. Before 1970 only nine countries had experienced severe epidemics, but dengue is now endemic in more than 100 countries: in Asia, the Pacific, the Caribbean, the Americas and Africa.16,17

The first cases in Europe of locally acquired or ‘autochthonous’ disease, with mosquitos transferring the virus from human to human, were in France and Croatia in 2010 and Madeira in 2012. Dengue fever is not yet categorised as endemic in Europe, as it is presumed the outbreaks arise each time initially from an infected traveller arriving. However, the increasing presence of the Aedes albopictus mosquito makes local transmission more likely.18

While France has seen outbreaks in most years since 2010, Spain had its first three cases of autochthonous dengue in October 2018. The ECDC regarded this as “not unexpected” due to Aedes albopictus having been present in Spain since 2004.