Dengue is a vector-borne viral disease caused by the positive-stranded RNA flavivirus dengue virus (DENV), which comprises four antigenically distinct serotypes (DENV-1 through DENV-4). It is the most rapidly spreading mosquito-transmitted viral disease and is endemic across more than 100 tropical and subtropical countries, where Aedes mosquitoes sustain transmission cycles.[1][2][3]
Disease overview
Dengue
登革热
Dengue is a mosquito-borne viral infection widespread in warm tropical and subtropical regions, caused by any of four antigenically distinct dengue virus serotypes transmitted principally by Aedes mosquitoes. The disease produces a spectrum of illness ranging from asymptomatic or mild febrile episodes to severe hemorrhagic complications and fatalities. In recent decades dengue has expanded geographically, with intensifying outbreaks; WHO graded the situation as a Grade 3 emergency in 2023 amid rising transmission in multiple countries. No antiviral therapy exists, and prevention relies on vector control and, where available, vaccination, making sustained surveillance and integrated programmatic responses central to containment efforts.[1][2][3]
Read the full clinical and epidemiological profile6
Clinical manifestations form a broad continuum from unnoticeable infection through classic dengue fever to severe dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). After an incubation of roughly 4–10 days, symptomatic patients typically present with flu-like illness that may include high fever, severe headache, retro-orbital pain, myalgia, arthralgia, nausea, and rash. As disease advances, patients may develop respiratory distress, mucosal bleeding, plasma leakage with a rapid drop in blood pressure, thrombocytopenia, and leucopenia, and in the most critical presentations, shock and death.[1][2][3]
Dengue is endemic throughout tropical and subtropical regions and is now the most important mosquito-borne tropical infectious disease after malaria in its global public-health impact. Recent estimates place annual cases at approximately 400 million worldwide, with roughly 22,000 deaths, and historic burden estimates have cited up to 100 million cases of dengue fever and 500,000 cases of DHF per year. Transmission exhibits seasonal patterns, typically peaking during and immediately after rainy seasons, and is amplified by high mosquito densities, co-circulation of multiple serotypes (hyperendemicity), rising urban temperatures, heat waves, and gaps in sustained vector-control programmes. WHO escalated dengue to a Grade 3 emergency in 2023 in response to expanding outbreaks across multiple countries.[1][4][3]
Dengue is principally transmitted to humans through the bites of infected female Aedes mosquitoes. The four DENV serotypes circulate in tropical and subtropical settings, and many infected individuals remain asymptomatic yet still contribute to onward transmission through mosquito vectors. Epidemic intensity is shaped by mosquito abundance, environmental conditions such as precipitation, humidity, and warm temperatures that shorten viral incubation and alter vector feeding behaviour.[1][2][3]
Because no universally effective antiviral therapy exists, prevention depends on vector control, sustained surveillance, and integrated public-health programmes that reduce Aedes mosquito populations and limit human–vector contact. A first licensed tetravalent dengue vaccine (CYD Denvaxia) has been introduced in some settings but is not approved everywhere, and additional vaccine candidates remain under development. Strengthening programmatic approaches, addressing unplanned urbanisation, and maintaining adequate staffing for surveillance and control are highlighted as core elements of prevention strategy.[1][2][3][5]
- 1World Health Organization. Dengue and severe dengue [Internet]. cited 3 Sept 2026.Available from: https://www.who.int/health-topics/dengue-and-severe-dengue
- 2Sinha S et al. Dengue virus pathogenesis and host molecular machineries. J Biomed Sci. 2024 Apr 22. PMID: 38649998. doi: 10.1186/s12929-024-01030-9.PubMed: https://pubmed.ncbi.nlm.nih.gov/38649998/
- 3Roy SK et al. Dengue virus: epidemiology, biology, and disease aetiology. Can J Microbiol. 2021 Oct. PMID: 34171205. doi: 10.1139/cjm-2020-0572.PubMed: https://pubmed.ncbi.nlm.nih.gov/34171205/
- 4Gubler DJ et al. Dengue and dengue hemorrhagic fever. Clin Microbiol Rev. 1998 Jul. PMID: 9665979. doi: 10.1128/CMR.11.3.480.PubMed: https://pubmed.ncbi.nlm.nih.gov/9665979/
- 5Khan MB et al. Dengue overview: An updated systemic review. J Infect Public Health. 2023 Oct. PMID: 37595484. doi: 10.1016/j.jiph.2023.08.001.PubMed: https://pubmed.ncbi.nlm.nih.gov/37595484/
- A90
- 1D2Z.0
Coverage
Reporting countries and regions
AustraliaAU
AustriaAT
BelgiumBE
BrazilBR
BulgariaBG
ChinaCN
CroatiaHR
CyprusCY
CzechiaCZ
DenmarkDK
EstoniaEE
FinlandFI
FranceFR
GermanyDE
GreeceGR
Hong Kong, ChinaHK
HungaryHU
IcelandIS
IrelandIE
ItalyIT
JapanJP
LatviaLV
LiechtensteinLI
LithuaniaLT
LuxembourgLU
MaltaMT
NetherlandsNL
New ZealandNZ
NorwayNO
PolandPL
PortugalPT
RomaniaRO
SingaporeSG
SlovakiaSK
SloveniaSI
South KoreaKR
SpainES
SwedenSE
SwitzerlandCH
Taiwan, ChinaTW
United KingdomGB
United StatesUS
Trends by reporting country
Monthly patterns over time
Research Radar
Recent related research
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Showing 5 of 87 related publications.
Literature links are provided for discovery and do not alter or validate the surveillance series above.
Data access
Page dataset index with source links and update metadata.
Official sourcesAuthority, cadence, notes117
Austria AGES Radar for Infectious Diseases
Austria
AGES Radar monthly national source. Internal ingestion retains native categories; public release is disabled pending licence review.
Australia NINDSS
Australia
Australian national notifiable diseases surveillance dashboard.
Australia NINDSS — Australian Capital Territory
Australian Capital Territory, Australia
Australian NINDSS monthly state/territory notifications for Australian Capital Territory, kept separate from the Australia national aggregate.
Australia NINDSS — New South Wales
New South Wales, Australia
Australian NINDSS monthly state/territory notifications for New South Wales, kept separate from the Australia national aggregate.
Australia NINDSS — Northern Territory
Northern Territory, Australia
Australian NINDSS monthly state/territory notifications for Northern Territory, kept separate from the Australia national aggregate.
Australia NINDSS — Queensland
Queensland, Australia
Australian NINDSS monthly state/territory notifications for Queensland, kept separate from the Australia national aggregate.
Australia NINDSS — South Australia
South Australia, Australia
Australian NINDSS monthly state/territory notifications for South Australia, kept separate from the Australia national aggregate.
Australia NINDSS — Tasmania
Tasmania, Australia
Australian NINDSS monthly state/territory notifications for Tasmania, kept separate from the Australia national aggregate.
Australia NINDSS — Victoria
Victoria, Australia
Australian NINDSS monthly state/territory notifications for Victoria, kept separate from the Australia national aggregate.
Australia NINDSS — Western Australia
Western Australia, Australia
Australian NINDSS monthly state/territory notifications for Western Australia, kept separate from the Australia national aggregate.
ECDC Surveillance Atlas — Belgium Annual Baseline
Belgium
Belgium annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Bulgaria Annual Baseline
Bulgaria
Bulgaria annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Brazil DATASUS SINAN
Brazil
Brazil Ministry of Health DATASUS/SINAN public DBC microdata aggregated to national monthly notification counts.
Switzerland FOPH IDD
Switzerland
Switzerland FOPH/BAG IDD mandatory reporting API normalized to national case rows. Monthly series may use the dashboard CHFL aggregate where CH-only monthly series are not exposed.
China CDC Weekly
China
Monthly notifiable infectious disease reports published by China CDC.
National Disease Control and Prevention Administration
China
Official China public health bulletin and query portal.
PubMed
China
Biomedical literature discovery feed used as supplementary context.
Public Health Science Data Center
Anhui, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Anhui, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Beijing, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Beijing, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Chongqing, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Chongqing, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Fujian, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Fujian, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Guangdong, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Guangdong, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Gansu, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Gansu, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Guangxi, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Guangxi, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Guizhou, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Guizhou, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Henan, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Henan, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Hubei, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Hubei, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Hebei, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Hebei, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Hainan, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Hainan, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Heilongjiang, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Heilongjiang, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Hunan, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Hunan, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Jilin, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Jilin, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Jiangsu, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Jiangsu, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Jiangxi, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Jiangxi, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Liaoning, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Liaoning, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Inner Mongolia, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Inner Mongolia, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Ningxia, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Ningxia, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Qinghai, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Qinghai, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Sichuan, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Sichuan, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Shandong, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Shandong, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Shanghai, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Shanghai, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Shaanxi, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Shaanxi, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Shanxi, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Shanxi, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Tianjin, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Tianjin, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Xinjiang, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Xinjiang, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Yunnan, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Yunnan, China
Province-level statutory infectious disease report published by the responsible health authority.
Public Health Science Data Center
Zhejiang, China
Chinese province-level historical monthly observations; this higher-priority source overlays overlapping official monthly reports.
Provincial statutory infectious disease monthly report
Zhejiang, China
Province-level statutory infectious disease report published by the responsible health authority.
ECDC Surveillance Atlas — Cyprus Annual Baseline
Cyprus
Cyprus annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Czechia Annual Baseline
Czechia
Czechia annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Germany RKI SurvStat 2.0
Germany
RKI SurvStat national weekly notification export; raw ZIP exports are retained and recent weeks are overwritten for revisions.
ECDC Surveillance Atlas — Denmark Annual Baseline
Denmark
Denmark annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Estonia Annual Baseline
Estonia
Estonia annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Spain Annual Baseline
Spain
Spain annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Finland THL Infectious Diseases Register
Finland
Finland THL Infectious Diseases Register national monthly case counts. The current month is ingested as provisional and the latest three months are refreshed for source revisions.
ECDC Surveillance Atlas — France Annual Baseline
France
France annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — United Kingdom Annual Baseline
United Kingdom
United Kingdom annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Greece Annual Baseline
Greece
Greece annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Hong Kong, China CHP Notifiable Diseases
Hong Kong, China
Hong Kong, China CHP annual notifiable infectious disease CSVs normalized to national monthly totals
ECDC Surveillance Atlas — Croatia Annual Baseline
Croatia
Croatia annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Hungary Annual Baseline
Hungary
Hungary annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Ireland HPSC Notifiable Diseases Hub
Ireland
Ireland HPSC national weekly notifiable-disease totals from the official ArcGIS FeatureServer. Internal ingestion is enabled; public release remains disabled pending written redistribution permission.
Iceland Directorate of Health Annual Dashboard
Iceland
National annual case notifications by disease. Published values can be revised retrospectively and remain annual period totals.
Iceland Directorate of Health STI Dashboard
Iceland
Monthly STI diagnosis facts from laboratory and registry surveillance; the official dashboard is published on a quarterly schedule.
Iceland Directorate of Health Respiratory Dashboard
Iceland
ISO-week respiratory diagnosis counts. Hospitalizations, samples, and vaccination indicators are separate measures and are not counted as diagnoses.
Iceland Directorate of Health Historical Registry
Iceland
Historical official registry tables for 1997–2021, with annual totals and disease-specific monthly notification facts retained at source grain.
Iceland Directorate of Health Legacy ICD Monthly
Iceland
Historical Saga EHR ICD encounter counts for 1997–2020. This clinical measure is non-comparable with registry notifications and is kept separate.
ECDC Surveillance Atlas — Italy Annual Baseline
Italy
Italy annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
JP NIID Weekly
Japan
Japan weekly infectious disease surveillance via NIID/JIHS.
Korea KDCA EID
South Korea
Korea KDCA notifiable infectious disease OpenAPI or portal/KOSIS downloads aggregated to national monthly notification counts.
ECDC Surveillance Atlas — Liechtenstein Annual Baseline
Liechtenstein
Liechtenstein annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Lithuania Annual Baseline
Lithuania
Lithuania annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Luxembourg Annual Baseline
Luxembourg
Luxembourg annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Latvia Annual Baseline
Latvia
Latvia annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Malta Annual Baseline
Malta
Malta annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Netherlands Annual Baseline
Netherlands
Netherlands annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Norway FHI MSIS Statistics Bank
Norway
Norway FHI MSIS national monthly notifications from the official Allvis frontend API; adapter contract checks guard the unversioned endpoint.
New Zealand PHF Science Monthly Notifiable Diseases
New Zealand
PHF Science (formerly ESR) monthly notifiable disease surveillance data via internal globalID2 crawler
ECDC Surveillance Atlas — Poland Annual Baseline
Poland
Poland annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Portugal Annual Baseline
Portugal
Portugal annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Romania Annual Baseline
Romania
Romania annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Sweden Public Health Agency SmiNet
Sweden
Sweden SmiNet national monthly reported cases from the official Public Health Agency statistics pages; public release is enabled with closed-month publication and revisable recent-month refreshes.
Singapore CDA Weekly Infectious Diseases Bulletin
Singapore
Singapore national weekly case notifications, combining the official data.gov.sg 2012–2022 CSV history with CDA annual workbooks from 2023 onward; 2023 weekly PDFs are retained as a source fallback.
ECDC Surveillance Atlas — Slovenia Annual Baseline
Slovenia
Slovenia annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
ECDC Surveillance Atlas — Slovakia Annual Baseline
Slovakia
Slovakia annual Member-State reported case counts from the ECDC Surveillance Atlas. Missing topic/year cells remain unknown and published zeroes are preserved. Data provided by ECDC based on data reported by EU/EEA Member States.
Taiwan, China CDC NIDSS
Taiwan, China
Taiwan, China monthly notifiable infectious disease open-data CSV feed.
US CDC NNDSS
United States
CDC National Notifiable Diseases Surveillance System provisional data.
US CDC NHSS HIV
United States
CDC NNDSS weekly data plus NHSS annual national HIV diagnoses