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Dengue is a systemic viral infection transmitted between humans by Aedes mosquitoes[1]. For some patients, dengue is a life-threatening illness[2]. There are currently no licensed vaccines or specific therapeutics, and substantial vector control efforts have not stopped its rapid emergence and global spread[3]. The contemporary worldwide distribution of the risk of dengue virus infection[4] and its public health burden are poorly known[2, 5]. Here we undertake an exhaustive assembly of known records of dengue occurrence worldwide, and use a formal modelling framework to map the global distribution of dengue risk. We then pair the resulting risk map with detailed longitudinal information from dengue cohort studies and population surfaces to infer the public health burden of dengue in 2010. We predict dengue to be ubiquitous throughout the tropics, with local spatial variations in risk influenced strongly by rainfall, temperature and the degree of urbanization. Using cartographic approaches, we estimate there to be 390 million (95% credible interval 284–528) dengue infections per year, of which 96 million (67–136) manifest apparently (any level of clinical or subclinical severity). This infection total is more than three times the dengue burden estimate of the World Health Organization[2]. Stratification of our estimates by country allows comparison with national dengue reporting, after taking into account the probability of an apparent infection being formally reported. The most notable differences are discussed. These new risk maps and infection estimates provide novel insights into the global, regional and national public health burden imposed by dengue. We anticipate that they will provide a starting point for a wider discussion about the global impact of this disease and will help to guide improvements in disease control strategies using vaccine, drug and vector control methods, and in their economic evaluation. [Abstract from Nature]
In response to the growing need to answer the question of cost in order to weigh the benefits of future introduction of vaccines against dengue, the International Vaccine Access Center at Johns Hopkins University (a member of DVI) convened an expert panel in March 2012 to discuss and develop a standardized methodology for estimating costs of dengue in the Americas. The resulting Guidelines aim to ensure robust assessment of the economic burden of dengue infections and to make the results of future dengue cost studies more comparable among Latin-American countries. To date, only a handful of economic studies have been done in the region, and there is great variation even amongst these due to differences at every level of evaluation.
The Guidelines provide an overview of the state of the field of determining the overall economic burden borne by the community as a result of dengue (costing dengue), as well as a discussion of the methods used in costing dengue. There are many considerations that need to be taken in to account when doing such analysis, from understanding the health care system where the study is being conducted to determining the definition of a dengue outbreak. The expert panel concludes that, while there is no single theoretically correct approach to developing guidelines for costing dengue, experts generally adhered to certain principles including:
- The adoption of a societal perspective;
- The inclusion of all relevant costs and effects;
- The use of an adequate sample size, and;
- The optimal collection and valuation of unit cost data for use in multi-country settings.
During the past five decades, the incidence of dengue has increased 30-fold. Some 50–100 million new infections are estimated to occur annually in more than 100 endemic countries, with a documented further spread to previously unaffected areas; every year hundreds of thousands of severe cases arise, including 20 000 deaths; 264 disability-adjusted life years per million population per year are lost , at an estimated cost for ambulatory and hospitalized cases of US$ 514–1394, often affecting very poor populations. The true numbers are probably far worse, since severe underreporting and misclassification of dengue cases have been documented.