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Review
. 2014 Nov 20;8(11):e3306.
doi: 10.1371/journal.pntd.0003306. eCollection 2014 Nov.

Approaches to refining estimates of global burden and economics of dengue

Donald S Shepard  1 , Eduardo A Undurraga  1 , Miguel Betancourt-Cravioto  2 , María G Guzmán  3 , Scott B Halstead  4 , Eva Harris  5 , Rose Nani Mudin  6 , Kristy O Murray  7 , Roberto Tapia-Conyer  2 , Duane J Gubler  8
Affiliations
Review

Approaches to refining estimates of global burden and economics of dengue

Donald S Shepard et al. PLoS Negl Trop Dis. .

Abstract

Dengue presents a formidable and growing global economic and disease burden, with around half the world's population estimated to be at risk of infection. There is wide variation and substantial uncertainty in current estimates of dengue disease burden and, consequently, on economic burden estimates. Dengue disease varies across time, geography and persons affected. Variations in the transmission of four different viruses and interactions among vector density and host's immune status, age, pre-existing medical conditions, all contribute to the disease's complexity. This systematic review aims to identify and examine estimates of dengue disease burden and costs, discuss major sources of uncertainty, and suggest next steps to improve estimates. Economic analysis of dengue is mainly concerned with costs of illness, particularly in estimating total episodes of symptomatic dengue. However, national dengue disease reporting systems show a great diversity in design and implementation, hindering accurate global estimates of dengue episodes and country comparisons. A combination of immediate, short-, and long-term strategies could substantially improve estimates of disease and, consequently, of economic burden of dengue. Suggestions for immediate implementation include refining analysis of currently available data to adjust reported episodes and expanding data collection in empirical studies, such as documenting the number of ambulatory visits before and after hospitalization and including breakdowns by age. Short-term recommendations include merging multiple data sources, such as cohort and surveillance data to evaluate the accuracy of reporting rates (by health sector, treatment, severity, etc.), and using covariates to extrapolate dengue incidence to locations with no or limited reporting. Long-term efforts aim at strengthening capacity to document dengue transmission using serological methods to systematically analyze and relate to epidemiologic data. As promising tools for diagnosis, vaccination, vector control, and treatment are being developed, these recommended steps should improve objective, systematic measures of dengue burden to strengthen health policy decisions.

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Conflict of interest statement

This study was supported in part by a research agreement between Sanofi Pasteur and Brandeis University. This does not alter our adherence to all PLOS NTDs policies on sharing data and materials.

Figures

Figure 1
Figure 1. Review summary, PRISMA 2009 flow diagram.
Notes: * Search includes articles published in the Web of Science, MEDLINE, or in WHO's Dengue Bulletin published between 1995 and 09/09/2013 in English, Spanish, French, or Portuguese, using the keyword “dengue” with the following list of keywords: surveillance, incidence, reporting, sensitivity, capture recapture, cohort, economics, costs, burden, Aedes aegypti, and control. Source: PRISMA flow diagram based on .
Figure 2
Figure 2. Countries and regions with evidence of dengue virus infections and cohort studies with published results since 1995.
Notes: The map shows the approximate location of comprehensive cohort studies, based on a geographical area, that have examined dengue infections since 1995 for at least a year or a dengue season, although not all studies compare lab-confirmed dengue episodes with episodes reported to the surveillance system. In some locations (e.g., Kamphaeng Phet) there has been more than one cohort study. Sources: , , , , , , , –.
See this image and copyright information in PMC

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Grants and funding

This study was supported in part by a research agreement between Sanofi Pasteur and Brandeis University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.