Escolar Documentos
Profissional Documentos
Cultura Documentos
Population growth in tropical developing countries Economic growth in Tropical developing countries Unprecedented urban growth Globalization (modern transportation)
1000000
968,564
60
50 800000 40 600000
479,848
30
400000
295,554
20
200000
908 15,497
122,174
10
Number of countries
DEN-1 DEN-2
Gubler, 1998
DEN-4
DHF
DHF
45 40 35 30
656,240
DENV-2 DENV-4 DENV-1
DENV-2 DENV-3 DENV-1 DENV-4
Number of countries
Number of cases
M orb id ity
M o rb id ity Ca s efa ta lity
C asefatality
2 5
2 0
1 5
1 5 0
1 0 0 5 0 0
1 0 5 0
6 6 9 1 6 9 9 1
0 6 9 1 2 6 9 1 4 6 9 1 8 6 9 1 0 7 9 1 2 7 9 1 4 7 9 1 6 7 9 1 8 7 9 1 0 8 9 1 2 8 9 1 4 8 9 1 6 8 9 1 8 8 9 1 0 9 9 1 2 9 9 1 4 9 9 1 8 9 9 1 0 0 0 2 2 0 0 2 4 0 0 2 6 0 0 2 8 0 0 2
8 5 9 1
Y ear
0 1 0 2
Indonesia
CFR: 0,89%
Reported Incidence though passive surveillance : 2000 30/100,000 population 2004 80/100,000 population 2009 170/ 100,000 population
60
DF Premises index
300
Illness rates per 100,000 250 200
50
30 150 20 100 50 0 1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008 Year 10
Premises index
40
Number of cases recorded from three WHO regions- SEARO, WPRO and AMRO
1600000
AMRO WPRO
1400000
SEARO
1200000
Number of cases
1000000
800000
600000
400000
200000
0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
3500
Number of deaths
3000
2500
2000
1500
1000
500
0
AMRO
WPRO SEARO 2000 92 247 656 2001 140 510 1097 2002 255 364 1035 2003 164 454 1202 2004 71 572 1235 2005 159 749 1766 2006 193 694 1558 2007 317 1159 1966 2008 585 674 1247
16
Burden of Dengue
Total population at risk
3.6 billion people at risk for symptomatic dengue 55% of the world population living in countries at risk for locally acquired dengue infection
Beatty ME, Letson GW, Margolis HS., Phuket, Thailand October 17-19, 2008.
Burden of Dengue
Total dengue infections
270 million dengue infections annually - 230 million asymptomatic infections Social impact of epidemic dengue
Beatty ME, Letson GW, Margolis HS., Phuket, Thailand October 17-19, 2008.
Burden of Dengue
Total symptomatic dengue cases
34 million cases of dengue fever annually 2 million DHF cases annually
Beatty ME, Letson GW, Margolis HS., Phuket, Thailand October 17-19, 2008.
21,000
2 million 34 million
230 million? 3.6 billion
Beatty ME, Letson GW, Margolis HS., Phuket, Thailand October 17-19, 2008.
Yellow Fever*
Japanese Encephalitis* Malaria*
200,000
50,000 500 million
30,000
>10,000 >1 million
>42
>10
>105
* Adapted from: E. Callaway. Dengue fever climbs the social ladder. Nature 2007; 448:734-735.
Beatty ME, Letson GW, Margolis HS., Phuket, Thailand October 17-19, 2008.
Means ( standard deviations) of cost components per dengue case by study site*
22
Estimation of average annual national cost of dengue morbidity and mortality associated with 20012005 official reports*
23
Annual costs and DALYs induced by dengue illness in the Americas in 2010 US$ (20002007)
Area North America Central America & Mexico Andean subregion Brazil Southern cone** Caribbean Total costs (millions of US$) 5.4 [1.8;10.7] 380.8 [212.1;596.7] 538.6 [271.3;877.5] 878.2 [178.8;1996.7] 25.4 [10.1;45.8] 321.4 [224.5;438] Cost breakdown (%) Ambul. cases 45.5% [0;83] 75.6% [56;86] 68.4% [40;84] 78.3% [17;95] 74.4% [39;90] 62.2% [47;74] Hosp. cases 54.5% [17;100] 22.7% [12;41] 29.2% [14;57] 19.5% [4;76] 24.5% [9;59] 31.7% [20;46] Deaths 0.0% [0;0] 1.6% [1;3] 2.2% [1;4] 2.0% [1;9] 1.1% [1;3] 6.1% [4;9] Cost per capita 0.02 [0.01;0.03] 2.74 [1.53;4.3] 4.50 [2.27;7.33] 4.64 [0.94;10.55] 0.41 [0.16;0.73] 8.29 [5.79;11.29] Cost per case $3,154 [1684;4138] $307 [210;398] $326 [218;414] $410 [164;577] $184 [109;227] $713 [592;837] DALYs 18 [7;35] 15 424 [11353;20423] 20 223 [13712;28872] 26 492 [11722;52947] 1 658 [856;3009] 8 957 [7430;10588]
The Americas
2,149.8 [898.4;3965.4]
72.9% [34;88]
24.4% [10;61]
2.6% [1.5;6.8]
2.42 [1.01;4.47]
$382 [236;508]
72 772 [45080;115874]
24
Aggregate financing of projected laboratory positive dengue cases by type of cost and source of financing, average per year (2002-2007)
Source of financing Insurance Households Employers Government Total Column % Direct medical costs $5,369,180 $1,423,469 $0 $4,978,607 $11,771,257 56% Direct nonmedical costs $0 $489,180 $0 $0 $489,180 2% Indirect costs $0 $6,688,721 $1,676,545 $456,641 $8,821,907 42% All types of costs $5,369,180 $8,601,370 $1,676,545 $5,435,248 $21,082,343 100%
Thailand based on officially reported cases only, $48 million Armien B et al.: Am J Trop Med Hyg 2008, 79(3):364371. Kongsin S et al.; Dengue Bulletin 2010, in press. Perez C et al.: Dengue Bulletin 2010, in press. Halasa Y et al.: Unpublished data Index mundi, CIA factbook - http://www.indexmundi.com/puerto_rico/gdp_per_capita_(ppp).html
26
Beatty ME, Letson GW, Margolis HS., Phuket, Thailand October 17-19, 2008.
90 133 127
[1] Immediate cost = cost of illness + cost of intervention programmes as defined in 1.1 [2] Investment Commission of India (2008) [3] Tourism Malaysia (2008) [4] Tourism Authority of Thailand (2008) *Tiina Murtola1,2, Tapasvi Puw ar3, Robert Field1, Hong-Fei Gong2, Dileep Mavalankar3, Donald S. Shepard4, S.S. Vasan1,2. Quantifying the Impact of Chikungunya and Dengue on Tourism Revenues. 2nd International Conference on Tourism, Indian Institute of M 30
Areas with recent dengue transmission Areas infested with Aedes aegypti
Dengue has significant public health, economic and social impact on populations in endemic countries Dengue is grossly under reported in most endemic countries Dengue disease burden and cost are likewise grossly under estimated There is a desperate need for good population-based estimates of the economic cost of dengue Surveillance for dengue is very poor in most dengue endemic countries