Threats of Zika virus transmission for Asia and its Hindu-Kush Himalayan region

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Dhimal, Meghnath
Dahal, Sushma
Dhimal, Mandira Lamichhane
Mishra, Shiva Raj
Karki, Khem B
Aryal, Krishna Kumar
Haque, Ubydul
Kabir, Md Iqbal
Guin, Pradeep
Butt, Azeem Mehmood
Harapan, Harapan
Liu, Qi-Yong
Chu, Cordia
Montag, Doreen
Groneberg, David Alexander
Pandey, Basu Dev
Kuch, Ulrich
Mueller, Ruth
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Asia and its Hindu Kush Himalayan (HKH) region is particularly vulnerable to environmental change, especially climate and land use changes further influenced by rapid population growth, high level of poverty and unsustainable development. Asia has been a hotspot of dengue fever and chikungunya mainly due to its dense human population, unplanned urbanization and poverty. In an urban cycle, dengue virus (DENV) and chikungunya virus (CHIKV) are transmitted by Aedes aegypti and Ae. albopictus mosquitoes which are also competent vectors of Zika virus (ZIKV). Over the last decade, DENV and CHIKV transmissions by Ae. aegypti have extended to the Himalayan countries of Bhutan and Nepal and ZIKV could follow in the footsteps of these viruses in the HKH region. The already established distribution of human-biting Aedes mosquito vectors and a naïve population with lack of immunity against ZIKV places the HKH region at a higher risk of ZIKV. Some of the countries in the HKH region have already reported ZIKV cases. We have documented an increasing threat of ZIKV in Asia and its HKH region because of the high abundance and wide distribution of human-biting mosquito vectors, climate change, poverty, report of indigenous cases in the region, increasing numbers of imported cases and a naïve population with lack of immunity against ZIKV. An outbreak anywhere is potentially a threat everywhere. Therefore, in order to ensure international health security, all efforts to prevent, detect, and respond to ZIKV ought to be intensified now in Asia and its HKH region. To prepare for possible ZIKV outbreaks, Asia and the HKH region can also learn from the success stories and strategies adopted by other regions and countries in preventing ZIKV and associated complications. The future control strategies for DENV, CHIKV and ZIKV should be considered in tandem with the threat to human well-being that is posed by other emerging and re-emerging vector-borne and zoonotic diseases, and by the continuing urgent need to strengthen public primary healthcare systems in the region.

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Infectious Diseases of Poverty

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© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Public health

Aedes aegypti

Aedes albopictus

Chikungunya virus

Dengue virus

Hindu Kush Himalayas

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Dhimal, M; Dahal, S; Dhimal, ML; Mishra, SR; Karki, KB; Aryal, KK; Haque, U; Kabir, MI; Guin, P; Butt, AM; Harapan, H; Liu, QY; Chu, C; Montag, D; Groneberg, DA; Pandey, BD; Kuch, U; Müller, R, Threats of Zika virus transmission for Asia and its Hindu-Kush Himalayan region, Infectious Diseases of Poverty, 2018, 7 (1), pp. 40:1-40:7