According to a more precise definition given by the Robert Koch Institute in Germany, hyperendemicity is not necessarily associated with a high incidence rate.
A hyperendemic disease is one which is ubiquitously present with ongoing circulation in an endemic region with a high prevalence rate.
[5] According to another definition discussing malaria, a hyperendemic region is defined to be one with a seasonally high degree of endemicity where immunity does not succeed to prevent the effects of a disease for all age groups.
[6] In the discussion of the dengue fever, a hyperendemic state is characterized by the continuous circulation of multiple viral serotypes in an area where a large pool of susceptible hosts and a competent vector (with or without seasonal variation) are constantly present.
[9][10] Justin Lessler and others from Johns Hopkins University reported a rise in the usage of the ambiguous term "hotspot" in research and policy documents in late 2010s.