Table 2. Key determinants for ongoing dengue burden in Queensland (Australia), Singapore, Taiwan, and Florida (US) and recommendations.

	Key determinants	Key recommendations
Queensland, Australia	proximity to endemic countries dramatic increase in imported cases via arrival of viremic residents and tourists in the last ten years absence of a national disease control network low herd immunity transmission associated with old unscreened housing budget cuts cryptic sites (subterranean, elevated) can produce large numbers of Ae. aegypti population growth and movement increase in rainwater tank usage lack of awareness and engagement of residents/tourists	In Queensland and Florida, the Key West/Martin counties outbreaks show that localized transmission, where Ae. aegypti is abundant, can occur. These suggest that vector surveillance and control programs need to be sustained for rapid identification and control of outbreaks. A communicable disease center in Australia is critical for managing and lowering future disease risks. The center would play a key role in engaging state and territory health departments, aiding rapid response to potential threats. The US and European CDCs would be appropriate examples for such a national structure. To be successful, dengue control programs for HICs must also consider the epidemiology of dengue in other endemic countries that may increase virus importations. “Top-down” and “bottom-up” approaches should be combined. Community engagement in reducing vector breeding is crucial, and community members should be encouraged to cooperate with vector control agencies. Control the cryptic larval habitat (elevated and subterranean sites). Control that targets the adult mosquito vector is important. Travel-related risks need to be better managed and incorporated in national strategies for nonendemic countries that experience, or are at risk for, epidemics. Tourism bodies need to be involved in disease prevention in order to diminish possible opposing viewpoints. Education of the public and the medical profession is central to prevention. To avoid institutional memory lost when key employees leave, (“Brain-Drain” effect), transition to their replacements should be prepared to preserve this information. A robust assessment of the economic burden (direct and indirect costs) of dengue infections is highly needed for those countries to justify investing in dengue control programs.
Florida, US	proximity to endemic countries dramatic increase in imported cases in the last ten years transmission associated with old unscreened housing (in Key West) low herd immunity budget cuts usually fines not imposed when breeding sites found population growth and movement lack of awareness and engagement of residents/tourists
Singapore	proximity to other endemic countries all serotypes circulating and high diversity low herd immunity resistance to pyrethroid insecticides in dengue vectors shift from domestic to nondomestic transmission virus importation by tourists and migrant workers important air traffic/travel population growth and movement high level of urbanization unbalanced health care system lack of awareness and engagement of residents/tourists/migrant workers (e.g., excess of litter)
Taiwan	proximity to endemic countries important air traffic/travel population growth and movement high level of urbanization lack of awareness and engagement of residents/tourists (e.g., excess of litter)