Full-Text Report (42 pp, PDF)

Graph, Reported Cases of DHF (1955–1998, worldwide)

Workshop Report:
Background
Surveillance Systems and Problems
Estimating Incidence Rates
Dengue Control Efforts

Pediatric Dengue Vaccine Initiative
Purpose of Burden of Illness studies

Mekong Basin Disease Surveillance (MBDS) Network
Preparatory Activities Prior to the Workshop
Asia | Latin America
Objective of the Workshop
Format of the Workshop
Follow-up to the Workshop
References

Appendix A: Meeting Notes: Planning Dengue Burden of Disease Studies (Bangkok, June 20, 2002)
Appendix B: Guidelines Sent to Potential Principal Investigators
1. Dengue Prospective Community-Based Studies
2. Dengue Economics Studies
3. Dengue Socio-Behavioral Studies
4. Using Routinely Collected Data to Quantify the Burden of Dengue
Appendix C: Workshop Agenda
Appendix D: Workshop Participants and Facilitators

Report: Workshop on Dengue Burden Studies

(Washington, DC, 5-7 November 2002)

Convened by the Pan American Health Organization (PAHO/WHO), the Rockefeller Foundation, and the Pediatric Dengue Vaccine Initiative (PDVI)

Background | Meeting Objective | Recommendations

Background: Dengue has become a major international public health concern, spreading geographically in incidence and severity. Before 1970, only nine countries worldwide reported dengue hemorrhagic fever, a number that has increased more than fourfold and continues to rise. Dengue viruses are now transmitted in nearly 100 tropical countries and it is estimated that each year 50–100 million dengue infections occur with 250,000–500,000 cases of dengue hemorrhagic fever (DHF) and at least 2000–3000 deaths reported, mostly of children. The 20–21st-century dengue pandemic directly grew out of contemporary demographic and lifestyle trends: the population explosion, urbanization and rapid transportation of large numbers of people. In view of the difficulty and expense of national programs of mosquito abatement, dengue vaccines offer a realistic and near-term solution for the control a major global health problem.

Meeting Objective: To review, refine and prepare study proposals to define the epidemiologic, economic and social burden of dengue illnesses. Expected outcomes are several finished country-level budgeted proposals for the study of the burden of dengue.

Recommendations

The workshop deliberations established that the spread of dengue virus is of serious concern to all the countries represented. Participants have the interest and commitment to design and carry out burden of illness studies which have the potential to inform decisions about public health intervention for disease control. Thus, some of the many issues that participants have thought about are listed here:

A wide range of studies should be supported from many different countries to provide comparative data and a flow of information and experience through the dengue affected regions.
Studies need not be limited to measuring the cost of hospital care for severely ill patients.
The socio-cultural dimension to dengue disease in different settings would be informative and useful.
The burden (financial, psychological, social) to a family of having a dengue-ill child needs to be better defined and better recognised.
The cost of improved vector control and disease surveillance needs to be factored into our estimates of burden of illness.
Innovative alternative methods of dengue control need to be considered.
The cost of care and care-giving associated with non-specific febrile illness due to dengue or less severe dengue illness needs to be estimated.
This requires a means of estimating the true incidence of infection and disease which is not DHF.
Most surveillance programs in place are passive and will not provide data on the true incidence of dengue infection since the proportion of very ill to mild cases is thought to be small. It is expected therefore that there are many more dengue infections which are unrecognized, which also contribute to the burden of illness.

Although this workshop was organized to discuss studies about burden of illness, other important issues about dengue disease were found to be of interest as well, and some means of supporting investigations into these should be found.

In particular, some participants pointed out that there was a great difference in clinical outcomes in different settings in some countries. This is due to late recognition of the syndrome, or delayed presentation. Participants called for more training opportunities for clinicians. Although differences in clinical outcomes in different settings is likely to be an equity issue (differences in access to health care, remote from health care centers, inability to afford health care, differences in allocation of resources to healthcare centers) it seems also that socio-cultural studies into the reasons for such differences may contribute to developing more effective health education material.
Accuracy of laboratory diagnosis and standardization of these methods was another issue of concern to some participants.

Participants were also interested in the wider program of research leading towards the management and control of dengue, including questions of pathogenesis, virulence, strain differences and strategies for vaccine design. It is clear that there is much yet to be done to understand dengue, but that the number of vaccine candidates under development should offer us hope that dengue will one day be controlled.

Finally, the participants were given recommendations to prepare final protocols and a date in January 2003 to present the proposal to PDVI for consideration. To start out with, a project from each of the Regions (America and Asia) were to be considered for funding, and the rest pending the availability of further funding.

	The Pan American Health Organization Promoting Health in the Americas