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Durand S, Paredes A, Pacheco C, Fernandez R, Herrera J, Cabezas C. Cost of controlling the dengue vector Aedes aegypti in the Peruvian amazon. Rev Peru Med Exp Salud Publica 2024; 41:46-53. [PMID: 38808844 PMCID: PMC11149769 DOI: 10.17843/rpmesp.2024.411.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/07/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE. Motivation for the study. Dengue prevention and control is based on the control of its vector. This study was conducted because of the need to know the costs associated with Aedes aegypti control in a region that carries out planned vector control activities. Main findings. The costs incurred in dengue vector control in the Loreto region in 2017 and 2018 amounted to PEN 4,066,380.25 and PEN 3,807,858.73, respectively. Implications. Knowing the cost of vector control activities will allow us to better plan these activities and have a basis for cost-effectiveness studies with other methods of prevention and control of dengue. To estimate the costs incurred in the control of Aedes aegypti in the Loreto region, during the years 2017 and 2018. MATERIALS AND METHODS. We conducted a partial retrospective economic evaluation of the costs of Aedes aegypti control of the Regional Health Directorate Loreto, during the implementation of the Regional Plan for Surveillance and Control of Aedes aegypti. Documentation such as plans, intervention reports and payment slips were reviewed, and interviews were conducted with professional personnel involved in vector control, on the costs of control interventions. RESULTS. We found that the costs incurred in dengue vector control in the Loreto Region in the two years were: PEN 3,807,858 and PEN 4,066,380 during 2017 and 2018, respectively (USD 1,175,264 and USD 1,1210,232 at the 2017 and 2018 exchange rate). However, the effect of control activities is short-lived. CONCLUSIONS. The high cost involved in vector control with the methods currently used and the short duration of its effect make it unsustainable. Studies should be conducted in order to find other more efficient methods for dengue control.
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Affiliation(s)
- Salomon Durand
- Instituto Peruano de Investigación en Salud, Lima, PeruInstituto Peruano de Investigaciones en SaludLimaPeru
- Regional Health Directorate of Loreto, Iquitos, Peru.Dirección Regional de salud LoretoIquitosPeru
| | - Arles Paredes
- Regional Health Directorate of Loreto, Iquitos, Peru.Dirección Regional de salud LoretoIquitosPeru
| | - Carlos Pacheco
- Regional Health Directorate of Loreto, Iquitos, Peru.Dirección Regional de salud LoretoIquitosPeru
| | - Ray Fernandez
- Regional Health Directorate of Loreto, Iquitos, Peru.Dirección Regional de salud LoretoIquitosPeru
| | - Jose Herrera
- Instituto Peruano de Investigación en Salud, Lima, PeruInstituto Peruano de Investigaciones en SaludLimaPeru
| | - César Cabezas
- Instituto Nacional de Salud, Lima, Peru.Instituto Nacional de SaludLimaPeru
- Universidad Nacional Mayor de San Marcos, Lima, Peru.Universidad Nacional Mayor de San MarcosUniversidad Nacional Mayor de San MarcosLimaPeru
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Chen Y, Xu Y, Wang L, Liang Y, Li N, Lourenço J, Yang Y, Lin Q, Wang L, Zhao H, Cazelles B, Song H, Liu Z, Wang Z, Brady OJ, Cauchemez S, Tian H. Indian Ocean temperature anomalies predict long-term global dengue trends. Science 2024; 384:639-646. [PMID: 38723095 DOI: 10.1126/science.adj4427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 04/09/2024] [Indexed: 05/31/2024]
Abstract
Despite identifying El Niño events as a factor in dengue dynamics, predicting the oscillation of global dengue epidemics remains challenging. Here, we investigate climate indicators and worldwide dengue incidence from 1990 to 2019 using climate-driven mechanistic models. We identify a distinct indicator, the Indian Ocean basin-wide (IOBW) index, as representing the regional average of sea surface temperature anomalies in the tropical Indian Ocean. IOBW is closely associated with dengue epidemics for both the Northern and Southern hemispheres. The ability of IOBW to predict dengue incidence likely arises as a result of its effect on local temperature anomalies through teleconnections. These findings indicate that the IOBW index can potentially enhance the lead time for dengue forecasts, leading to better-planned and more impactful outbreak responses.
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Affiliation(s)
- Yuyang Chen
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, Beijing Normal University, Beijing, China
- Yangtze Eco-Environment Engineering Research Center, China Three Gorges Corporation, Wuhan, China
| | - Yiting Xu
- School of National Safety and Emergency Management, Beijing Normal University, Zhuhai, China
| | - Lin Wang
- Department of Genetics, University of Cambridge, Cambridge, UK
| | - Yilin Liang
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, Beijing Normal University, Beijing, China
| | - Naizhe Li
- School of National Safety and Emergency Management, Beijing Normal University, Zhuhai, China
| | - José Lourenço
- Católica Biomedical Research Center, Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Yun Yang
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, Beijing Normal University, Beijing, China
| | - Qiushi Lin
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, Beijing Normal University, Beijing, China
| | - Ligui Wang
- Center of Disease Control and Prevention, PLA, Beijing, China
| | - He Zhao
- CMA Earth System Modeling and Prediction Centre, China Meteorological Administration, Beijing, China
| | - Bernard Cazelles
- Institut de Biologie de l'École Normale Supérieure UMR 8197, Eco-Evolutionary Mathematics, École Normale Supérieure, Paris, France
- Unité Mixte Internationnale 209, Mathematical and Computational Modeling of Complex Systems, Sorbonne Université, Paris, France
| | - Hongbin Song
- Center of Disease Control and Prevention, PLA, Beijing, China
| | - Ziyan Liu
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, Beijing Normal University, Beijing, China
| | - Zengmiao Wang
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, Beijing Normal University, Beijing, China
| | - Oliver J Brady
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology and Dynamics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, UMR2000, CNRS, Paris, France
| | - Huaiyu Tian
- State Key Laboratory of Remote Sensing Science, Center for Global Change and Public Health, Beijing Normal University, Beijing, China
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Coronel-Ruiz C, Velandia-Romero ML, Calvo E, Camacho-Ortega S, Parra-Alvarez S, Beltrán EO, Calderón-Pelaez MA, Porras-Ramírez A, Cortés-Muñoz F, Rojas-Hernandez JP, Velasco-Alvarez S, Pinzón-Junca A, Castellanos JE. Improving dengue diagnosis and case confirmation in children by combining rapid diagnostic tests, clinical, and laboratory variables. FRONTIERS IN TROPICAL DISEASES 2023. [DOI: 10.3389/fitd.2023.1118774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
BackgroundDengue is the most widely distributed arboviral disease in tropical and subtropical countries. Most suspected cases are diagnosed according to the clinical criteria, and early diagnosis is difficult. Moreover, in underdeveloped countries, several factors continue to challenge the diagnosis and surveillance of dengue cases. This study aimed to design a diagnostic algorithm using rapid diagnostic tests (RDTs), ELISA tests, and clinical and hematological variables to confirm dengue cases in febrile patients in Colombia.MethodsAltogether, 505 samples were collected. Serum samples were evaluated by RDTs (IgM and IgG antibodies and NS1 antigen), capture IgM and IgG ELISAs, and endpoint hemi-nested RT-PCR assay (qualitative). We statistically analyzed the performance of individual tests to determine the most useful ones to confirm dengue cases accurately.ResultsIndividual results for IgM, IgG, and NS1 RDTs yielded lower sensitivity and specificity values than the reference standard. High sensitivity and specificity were obtained after combining IgM and NS1 ELISA results (96.3% and 96.4%) and NS1 RDT plus IgM ELISA results (90.3% and 96.2%), respectively. Adjusted odds ratios (aORs) were calculated for clinical variables and laboratory tests to differentiate dengue from other febrile illnesses (OFI). This approach showed that myalgia, abdominal tenderness, and platelet count were identified with higher sensitivity to confirm dengue cases. IgM RDT and NS1 RDT differentiated dengue cases from OFI. A positive IgM RDT or a positive NS1 RDT combined with specific signs or symptoms confirmed 81.6% of dengue cases. A combination of clinical findings and a positive NS1 RDT or positive ELISA IgM confirmed 90.6% of the cases.ConclusionOur findings showed that clinical diagnoses in pediatric population alone cannot confirm true dengue cases and needs to be complemented by laboratory diagnostic tests. We also demonstrate the usefulness of combining clinical criteria with RDTs, suggesting that their implementation with the IgM ELISA test improves dengue case confirmation.
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Barboza LA, Chou-Chen SW, Vásquez P, García YE, Calvo JG, Hidalgo HG, Sanchez F. Assessing dengue fever risk in Costa Rica by using climate variables and machine learning techniques. PLoS Negl Trop Dis 2023; 17:e0011047. [PMID: 36638136 PMCID: PMC9879398 DOI: 10.1371/journal.pntd.0011047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/26/2023] [Accepted: 12/20/2022] [Indexed: 01/14/2023] Open
Abstract
Dengue fever is a vector-borne disease affecting millions yearly, mostly in tropical and subtropical countries. Driven mainly by social and environmental factors, dengue incidence and geographical expansion have increased in recent decades. Therefore, understanding how climate variables drive dengue outbreaks is challenging and a problem of interest for decision-makers that could aid in improving surveillance and resource allocation. Here, we explore the effect of climate variables on relative dengue risk in 32 cantons of interest for public health authorities in Costa Rica. Relative dengue risk is forecast using a Generalized Additive Model for location, scale, and shape and a Random Forest approach. Models use a training period from 2000 to 2020 and predicted climatic variables obtained with a vector auto-regressive model. Results show reliable projections, and climate variables predictions allow for a prospective instead of a retrospective study.
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Affiliation(s)
- Luis A. Barboza
- Centro de Investigación en Matemática Pura y Aplicada - Escuela de Matemática, Universidad de Costa Rica, San José, Costa Rica
| | - Shu-Wei Chou-Chen
- Centro de Investigación en Matemática Pura y Aplicada - Escuela de Estadística, Universidad de Costa Rica, San José, Costa Rica
| | - Paola Vásquez
- Centro de Investigación en Matemática Pura y Aplicada, Universidad de Costa Rica, San José, Costa Rica
| | - Yury E. García
- Centro de Investigación en Matemática Pura y Aplicada, Universidad de Costa Rica, San José, Costa Rica
- Department of Public Health Sciences, University of California Davis, California, United States of America
- * E-mail:
| | - Juan G. Calvo
- Centro de Investigación en Matemática Pura y Aplicada - Escuela de Matemática, Universidad de Costa Rica, San José, Costa Rica
| | - Hugo G. Hidalgo
- Centro de Investigaciones Geofísicas and Escuela de Física, Universidad de Costa Rica, San José, Costa Rica
| | - Fabio Sanchez
- Centro de Investigación en Matemática Pura y Aplicada - Escuela de Matemática, Universidad de Costa Rica, San José, Costa Rica
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5
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Junior JBS, Massad E, Lobao-Neto A, Kastner R, Oliver L, Gallagher E. Epidemiology and costs of dengue in Brazil: a systematic literature review. Int J Infect Dis 2022; 122:521-528. [DOI: 10.1016/j.ijid.2022.06.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/02/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
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Cardenas R, Hussain-Alkhateeb L, Benitez-Valladares D, Sánchez-Tejeda G, Kroeger A. The Early Warning and Response System (EWARS-TDR) for dengue outbreaks: can it also be applied to chikungunya and Zika outbreak warning? BMC Infect Dis 2022; 22:235. [PMID: 35255839 PMCID: PMC8902764 DOI: 10.1186/s12879-022-07197-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Americas, endemic countries for Aedes-borne diseases such as dengue, chikungunya, and Zika face great challenges particularly since the recent outbreaks of CHIKV and ZIKV, all transmitted by the same insect vectors Aedes aegypti and Ae. albopictus. The Special Program for Research and Training in Tropical Diseases (TDR-WHO) has developed together with partners an Early Warning and Response System (EWARS) for dengue outbreaks based on a variety of alarm signals with a high sensitivity and positive predictive value (PPV). The question is if this tool can also be used for the prediction of Zika and chikungunya outbreaks. METHODOLOGY We conducted in nine districts of Mexico and one large city in Colombia a retrospective analysis of epidemiological data (for the outbreak definition) and of climate and entomological data (as potential alarm indicators) produced by the national surveillance systems for dengue, chikungunya and Zika outbreak prediction covering the following outbreak years: for dengue 2012-2016, for Zika 2015-2017, for chikungunya 2014-2016. This period was divided into a "run in period" (to establish the "historical" pattern of the disease) and an "analysis period" (to identify sensitivity and PPV of outbreak prediction). RESULTS In Mexico, the sensitivity of alarm signals for correctly predicting an outbreak was 100% for dengue, and 97% for Zika (chikungunya data could not be obtained in Mexico); the PPV was 83% for dengue and 100% for Zika. The time period between alarm and start of the outbreak (i.e. the time available for early response activities) was for Zika 4-5 weeks. In Colombia the sensitivity of the outbreak prediction was 92% for dengue, 93% for chikungunya and 100% for Zika; the PPV was 68% for dengue, 92% for chikungunya and 54% for Zika; the prediction distance was for dengue 3-5 weeks, for chikungunya 10-13 weeks and for Zika 6-10 weeks. CONCLUSION EWARS demonstrated promising capability of timely disease outbreak prediction with an operational design likely to improve the coordination among stakeholders. However, the prediction validity varied substantially across different types of diseases and appeared less optimal in low endemic settings.
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Affiliation(s)
- Rocio Cardenas
- Instituto Departamental de Salud de Norte de Santander-IDS, Norte de Santander, Colombia. .,Centre for Medicine and Society, Master Programme Global Urban Health, Albert-Ludwigs-University Freiburg, Freiburg, Germany.
| | - Laith Hussain-Alkhateeb
- School of Public Health and Community Medicine, Sahlgrenska Academy, Institute of Medicine, Global Health, University of Gothenburg, Gothenburg, Sweden
| | - David Benitez-Valladares
- Programa de Enfermedades Transmitidas por Vector, Centro Nacional de Programas Preventivos y Control de Enfermedades, CENAPRECE, Secretaría de Salud de México, Ciudad de México, México
| | - Gustavo Sánchez-Tejeda
- Programa de Enfermedades Transmitidas por Vector, Centro Nacional de Programas Preventivos y Control de Enfermedades, CENAPRECE, Secretaría de Salud de México, Ciudad de México, México
| | - Axel Kroeger
- Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization in Geneva, Geneva, Switzerland.,Centre for Medicine and Society, Master Programme Global Urban Health, Albert-Ludwigs-University Freiburg, Freiburg, Germany
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7
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Climate change and its impacts on health, environment and economy. One Health 2022. [DOI: 10.1016/b978-0-12-822794-7.00009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cheng J, Bambrick H, Frentiu FD, Devine G, Yakob L, Xu Z, Li Z, Yang W, Hu W. Extreme weather events and dengue outbreaks in Guangzhou, China: a time-series quasi-binomial distributed lag non-linear model. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2021; 65:1033-1042. [PMID: 33598765 DOI: 10.1007/s00484-021-02085-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
Dengue transmission is climate-sensitive and permissive conditions regularly cause large outbreaks in Asia-Pacific area. As climate change progresses, extreme weather events such as heatwaves and unusually high rainfall are predicted more intense and frequent, but their impacts on dengue outbreaks remain unclear so far. This paper aimed to investigate the relationship between extreme weather events (i.e., heatwaves, extremely high rainfall and extremely high humidity) and dengue outbreaks in China. We obtained daily number of locally acquired dengue cases and weather factors for Guangzhou, China, for the period 2006-2015. The definition of dengue outbreaks was based on daily number of locally acquired cases above the threshold (i.e., mean + 2SD of daily distribution of dengue cases during peaking period). Heatwave was defined as ≥2 days with temperature ≥ 95th percentile, and extreme rainfall and humidity defined as daily values ≥95th percentile during 2006-2015. A generalized additive model was used to examine the associations between extreme weather events and dengue outbreaks. Results showed that all three extreme weather events were associated with increased risk of dengue outbreaks, with a risk increase of 115-251% around 6 weeks after heatwaves, 173-258% around 6-13 weeks after extremely high rainfall, and 572-587% around 6-13 weeks after extremely high humidity. Each extreme weather event also had good capacity in predicting dengue outbreaks, with the model's sensitivity, specificity, accuracy, and area under the receiver operating characteristics curve all exceeding 86%. This study found that heatwaves, extremely high rainfall, and extremely high humidity could act as potential drivers of dengue outbreaks.
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Affiliation(s)
- Jian Cheng
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
- Department of Epidemiology and Biostatistics & Anhui Province Key Laboratory of Major Autoimmune Disease, School of Public Health, Anhui Medical University, Anhui, China
| | - Hilary Bambrick
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
| | - Francesca D Frentiu
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Gregor Devine
- Mosquito Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Zhiwei Xu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, 4059, Australia
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Zhongjie Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weizhong Yang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Population Medicine & Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, 4059, Australia.
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Nujum ZT, Beegum MS, Meenakshy V, Vijayakumar K. Cost analysis of dengue from a State in south India. Indian J Med Res 2021; 152:490-497. [PMID: 33707391 PMCID: PMC8157903 DOI: 10.4103/ijmr.ijmr_1641_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background & objectives: Improved dengue cost estimates offer the potential to provide a baseline measure to determine the cost-effectiveness of interventions. The objective of this study was to estimate the cost of dengue prevention, treatment and fatalities in Kerala, India, over a period of one year. Methods: The study was done in Kerala, a southern State in India. Costing of treatment was done from a family perspective. It was found by primary data collection in a sample of 83 dengue patients from Thiruvananthapuram district and estimated for Kerala using the reported number of cases in 2016. Costing of prevention was done from the government perspective for the entire State. In-depth interviews with State programme officers and experts in the field were conducted. The present value of lifetime earnings was used to value lives. Results: The cost of treatment of dengue in the State was ₹137 milion (2.16 million US$). The cost of prevention in the State was ₹535 million (8.3 million US$). The cost of fatalities was the highest among costs at ₹1760 million (27.7 million US$). US$ 38 million was the least possible estimate of total cost of dengue. The total out-of-pocket spending (OOPS) of >60 yr was significantly (P<0.05) higher than other age groups. The total OOPS was significantly (P<0.001) higher in private sector compared to public. Interpretation & conclusions: Although deaths due to dengue were few, the cost of fatalities was 12 times more than the cost of treatment and three times the cost of prevention. Focusing on mortality reduction and disease prevention in elderly would be beneficial.
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Affiliation(s)
- Zinia T Nujum
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
| | - M Saboora Beegum
- Department of Biochemistry, Government Medical College, Thiruvananthapuram, Kerala, India
| | - V Meenakshy
- Deputy Director of Health Services, Kerala, India
| | - K Vijayakumar
- Department of Community Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Shah S, Abbas G, Riaz N, Anees Ur Rehman, Hanif M, Rasool MF. Burden of communicable diseases and cost of illness: Asia pacific region. Expert Rev Pharmacoecon Outcomes Res 2020; 20:343-354. [PMID: 32530725 DOI: 10.1080/14737167.2020.1782196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Communicable diseases such as AIDS/HIV, dengue fever, and malaria have a great burden and subsequent economic loss in the Asian region. The purpose of this article is to review the widespread burden of communicable diseases and related health-care burden for the patient in Asia and the Pacific. AREAS COVERED In Central Asia, the number of new AIDS cases increased by 29%. It is more endemic in the poor population with variations in the cost of illness. Dengue is prevalent in more than 100 countries, including the Asia-Pacific region. In Southeast Asia, the annual economic burden of dengue fever was between $ 610 and $ 1,384 million, with a per capita cost of $ 1.06 to $ 2.41. Globally, 2.9 billion people are at risk of developing malaria, 90% of whom are residents of the Asia and Pacific region. The annual per capita cost of malaria control ranged from $ 0.11 to $ 39.06 and for elimination from $ 0.18 to $ 27. EXPERT OPINION The cost of AIDS, dengue, and malaria varies from country to country due to different health-care systems. The literature review has shown that the cost of dengue disease and malaria is poorly documented.
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Affiliation(s)
- Shahid Shah
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University Faisalabad , Faisalabad, Pakistan
| | - Ghulam Abbas
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Government College University Faisalabad , Faisalabad, Pakistan
| | - Nabeel Riaz
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University Faisalabad , Faisalabad, Pakistan
| | - Anees Ur Rehman
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, University Sains Penang , Gelugor, Malaysia
| | - Muhammad Hanif
- Faculty of Pharmacy, Bahauddin Zakariya University , Multan, Pakistan
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Suwantika AA, Kautsar AP, Supadmi W, Zakiyah N, Abdulah R, Ali M, Postma MJ. Cost-Effectiveness of Dengue Vaccination in Indonesia: Considering Integrated Programs with Wolbachia-Infected Mosquitos and Health Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124217. [PMID: 32545688 PMCID: PMC7345186 DOI: 10.3390/ijerph17124217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 02/01/2023]
Abstract
Despite the fact that morbidity and mortality rates due to dengue infection in Indonesia are relatively high, a dengue vaccination has not yet been introduced. Next to vaccination, Wolbachia-infected mosquitoes and health education have been considered to be potential interventions to prevent dengue infection in Indonesia. This study was aimed to analyse the cost-effectiveness of dengue vaccination in Indonesia whilst taking Wolbachia and health education programs into account. An age-structured decision tree model was developed to assess the cost-effectiveness. Approximately 4,701,100 children were followed-up in a 10-year time horizon within a 1-year analytical cycle. We compared three vaccination strategies: one focussing on vaccination only, another combining vaccination and a Wolbachia program, and a third scenario combining vaccination and health education. All scenarios were compared with a no-intervention strategy. The result showed that only vaccination would reduce dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) by 123,203; 97,140 and 283 cases, respectively. It would save treatment cost at $10.3 million and $6.2 million from the healthcare and payer perspectives, respectively. The combination of vaccination and a Wolbachia program would reduce DF, DHF and DSS by 292,488; 230,541; and 672 cases, respectively. It would also save treatment cost at $24.3 million and $14.6 million from the healthcare and payer perspectives, respectively. The combination of vaccination and health education would reduce DF, DHF, and DSS by 187,986; 148,220; and 432 cases, respectively. It would save treatment cost at $15.6 million and $9.4 million from the healthcare and payer perspectives, respectively. The incremental cost-effectiveness ratios (ICERs) from the healthcare perspective were estimated to be $9995, $4460, and $6399 per quality-adjusted life year (QALY) gained for the respective scenarios. ICERs from the payer perspective were slightly higher. It can be concluded that vaccination combined with a Wolbachia program was confirmed to be the most cost-effective intervention. Dengue infection rate, vaccine efficacy, cost of Wolbachia program, underreporting factor for hospitalization, vaccine price and mortality rate were considered to be the most influential parameters affecting the ICERs.
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Affiliation(s)
- Auliya A Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 40132, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung 40132, Indonesia
- Center for Health Technology Assessment, Universitas Padjadjaran, Bandung 40132, Indonesia
| | - Angga P Kautsar
- Department of Pharmaceutical and Pharmacy Technology, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 40132, Indonesia
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen 9713 AV, The Netherlands
| | - Woro Supadmi
- Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta 55164, Indonesia
| | - Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 40132, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung 40132, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 40132, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung 40132, Indonesia
| | - Mohammad Ali
- Faculty of Educational Sciences, Universitas Pendidikan Indonesia, Bandung 40154, Indonesia
| | - Maarten J Postma
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung 40132, Indonesia
- Unit of Pharmaco-Therapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen 9713 AV, The Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, Groningen, University of Groningen, Groningen 9747 AE, The Netherlands
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Andreata-Santos R, Alves RPDS, Pereira SA, Pereira LR, de Freitas CL, Pereira SS, Venceslau-Carvalho AA, Castro-Amarante MF, Favaro MTP, Mathias-Santos C, Amorim JH, Ferreira LCDS. Transcutaneous Administration of Dengue Vaccines. Viruses 2020; 12:v12050514. [PMID: 32384822 PMCID: PMC7290698 DOI: 10.3390/v12050514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 12/28/2022] Open
Abstract
In the present study, we evaluated the immunological responses induced by dengue vaccines under experimental conditions after delivery via a transcutaneous (TC) route. Vaccines against type 2 Dengue virus particles (DENV2 New Guinea C (NGC) strain) combined with enterotoxigenic Escherichia coli (ETEC) heat-labile toxin (LT) were administered to BALB/c mice in a three-dose immunization regimen via the TC route. As a control for the parenteral administration route, other mouse groups were immunized with the same vaccine formulation via the intradermic (ID) route. Our results showed that mice vaccinated either via the TC or ID routes developed similar protective immunity, as measured after lethal challenges with the DENV2 NGC strain. Notably, the vaccine delivered through the TC route induced lower serum antibody (IgG) responses with regard to ID-immunized mice, particularly after the third dose. The protective immunity elicited in TC-immunized mice was attributed to different antigen-specific antibody properties, such as epitope specificity and IgG subclass responses, and cellular immune responses, as determined by cytokine secretion profiles. Altogether, the results of the present study demonstrate the immunogenicity and protective properties of a dengue vaccine delivered through the TC route and offer perspectives for future clinical applications.
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Affiliation(s)
- Robert Andreata-Santos
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Rúbens Prince dos Santos Alves
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Sara Araujo Pereira
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Lennon Ramos Pereira
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Carla Longo de Freitas
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Samuel Santos Pereira
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Alexia Adrianne Venceslau-Carvalho
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Maria Fernanda Castro-Amarante
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Marianna Teixeira Pinho Favaro
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Camila Mathias-Santos
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
| | - Jaime Henrique Amorim
- Center for Biological and Health Sciences, Federal University of Western Bahia, Bahia 47810-047, Brazil;
| | - Luís Carlos de Souza Ferreira
- Vaccine Development Laboratory, Microbiology Department, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil; (R.A.-S.); (R.P.d.S.A.); (S.A.P.); (L.R.P.); (C.L.d.F.); (S.S.P.); (A.A.V.-C.); (M.F.C.-A.); (M.T.P.F.); (C.M.-S.)
- Correspondence: ; Tel.: +55-11-3091-7356
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Rawson T, Wilkins KE, Bonsall MB. Optimal control approaches for combining medicines and mosquito control in tackling dengue. ROYAL SOCIETY OPEN SCIENCE 2020; 7:181843. [PMID: 32431854 PMCID: PMC7211884 DOI: 10.1098/rsos.181843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/23/2020] [Indexed: 05/03/2023]
Abstract
Dengue is a debilitating and devastating viral infection spread by mosquito vectors, and over half the world's population currently live at risk of dengue (and other flavivirus) infections. Here, we use an integrated epidemiological and vector ecology framework to predict optimal approaches for tackling dengue. Our aim is to investigate how vector control and/or vaccination strategies can be best combined and implemented for dengue disease control on small networks, and whether these optimal strategies differ under different circumstances. We show that a combination of vaccination programmes and the release of genetically modified self-limiting mosquitoes (comparable to sterile insect approaches) is always considered the most beneficial strategy for reducing the number of infected individuals, owing to both methods having differing impacts on the underlying disease dynamics. Additionally, depending on the impact of human movement on the disease dynamics, the optimal way to combat the spread of dengue is to focus prevention efforts on large population centres. Using mathematical frameworks, such as optimal control, are essential in developing predictive management and mitigation strategies for dengue disease control.
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Affiliation(s)
- Thomas Rawson
- Mathematical Ecology Research Group, Department of Zoology, University of Oxford, Oxford OX1 3PS, UK
- Author for correspondence: Thomas Rawson e-mail:
| | - Kym E. Wilkins
- School of Mathematical Sciences, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Michael B. Bonsall
- Mathematical Ecology Research Group, Department of Zoology, University of Oxford, Oxford OX1 3PS, UK
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Thompson R, Martin Del Campo J, Constenla D. A review of the economic evidence of Aedes-borne arboviruses and Aedes-borne arboviral disease prevention and control strategies. Expert Rev Vaccines 2020; 19:143-162. [PMID: 32077343 DOI: 10.1080/14760584.2020.1733419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Aedes-borne arboviruses contributes substantially to the disease and cost burden.Areas covered: We performed a systematic review of the economic evidence surrounding aedes-borne arboviruses and strategies to prevent and control these diseases to inform disease control policy decisions and research directions. We searched four databases covering an 18-year period (2000-2018) to identify arboviral disease-related cost of illness studies, cost studies of vector control and prevention strategies, cost-effectiveness analyses and cost-benefit analyses. We identified 74 published studies that revealed substantial global total costs in yellow fever virus and dengue virus ranging from 2.1 to 57.3 billion USD. Cost studies of vector control and surveillance programs are limited, but a few studies found that costs of vector control programs ranged from 5.62 to 73.5 million USD. Cost-effectiveness evidence was limited across Aedes-borne diseases, but generally found targeted dengue vaccination programs cost-effective. This review revealed insufficient economic evidence for vaccine introduction and implementation of surveillance and vector control programs.Expert opinion: Evidence of the economic burden of aedes-borne arboviruses and the economic impact of strategies for arboviral disease prevention and control is critical to inform policy decisions and to secure continued financial support for these preventive and control measures.
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Affiliation(s)
- Ryan Thompson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health (JHBSPH), International Vaccine Access Center (IVAC), Baltimore, MD, USA
| | | | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health (JHBSPH), International Vaccine Access Center (IVAC), Baltimore, MD, USA
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Bayesian Spatial Survival Models for Hospitalisation of Dengue: A Case Study of Wahidin Hospital in Makassar, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030878. [PMID: 32019262 PMCID: PMC7037865 DOI: 10.3390/ijerph17030878] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/18/2020] [Accepted: 01/23/2020] [Indexed: 11/29/2022]
Abstract
Spatial models are becoming more popular in time-to-event data analysis. Commonly, the intrinsic conditional autoregressive prior is placed on an area level frailty term to allow for correlation between areas. We considered a range of Bayesian Weibull and Cox semiparametric spatial models to describe a dataset on hospitalisation of dengue. This paper aimed to extend these two models, to evaluate the suitability of these models for estimation and prediction of the length of stay, compare different spatial priors, and determine factors that significantly affect the duration of hospital stay for dengue fever patients in the case study location, namely Wahidin hospital in Makassar, Indonesia. We compared two different models with three different spatial priors with respect to goodness of fit and generalisability. For all models considered, the Leroux prior was preferred over the intrinsic conditional autoregressive and independent priors, but Cox and Weibull versions had similar predictive performance, model fit, and results. Age and platelet count were negatively associated with the length of stay, while red blood cell count was positively associated with the length of stay of dengue patients at this hospital. Using appropriate Bayesian spatial survival models enables identification of factors that substantively affect the length of stay.
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Laserna A, Barahona-Correa J, Baquero L, Castañeda-Cardona C, Rosselli D. Economic impact of dengue fever in Latin America and the Caribbean: a systematic review. Rev Panam Salud Publica 2019; 42:e111. [PMID: 31093139 PMCID: PMC6386068 DOI: 10.26633/rpsp.2018.111] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/29/2018] [Indexed: 12/18/2022] Open
Abstract
Objectives To assess the economic impact of dengue in Latin America and the Caribbean using a systematic review that includes studies not previously considered by other reviews. Methods Cochrane methodology was used to conduct a systematic review of the cost of dengue in Latin America. PubMed Central, EMBASE, and the Biblioteca Virtual en Salud—which includes scientific, peer-reviewed journals not indexed by other databases—were searched from inception through August 2016. All articles that reported cost of illness data for countries in Latin America were included. Included studies underwent a methodological appraisal using a seven-question instrument designed for cost of illness studies. Extracted data were direct and indirect costs for outpatient and hospitalized cases and total cost of the disease. Values were adjusted to 2015 US dollars using the consumer price index. Results From a total of 848 initial references, 17 studies were included, mainly from Brazil, Colombia, Cuba, Mexico, and Puerto Rico; costs were available for 39 countries. The methodological appraisal showed that 70% of the studies met more than 70% of the evaluated items. The main economic impact of dengue was due to productivity costs. Average annual cost was more than US$ 3 billion. Direct costs represented over 70% of the total share for hospitalized cases. For outpatients, direct medical costs were low, but social costs were significant since indirect costs may account for up to 80% of the total cost. Conclusions Dengue fever has a significant economic impact in Latin America. It is essential to develop new public health interventions, such as dengue vaccination, to decrease the propagation of the disease and its total cost.
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Affiliation(s)
- Andrés Laserna
- School of Medicine, Pontificia Universidad Javeriana, School of Medicine, Bogotá, Colombia
| | - Julián Barahona-Correa
- School of Medicine, Pontificia Universidad Javeriana, School of Medicine, Bogotá, Colombia
| | - Laura Baquero
- School of Medicine, Pontificia Universidad Javeriana, School of Medicine, Bogotá, Colombia
| | | | - Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Medical School, Bogotá, Colombia
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Ouédraogo S, Benmarhnia T, Bonnet E, Somé PA, Barro AS, Kafando Y, Soma DD, Dabiré RK, Saré D, Fournet F, Ridde V. Evaluation of Effectiveness of a Community-Based Intervention for Control of Dengue Virus Vector, Ouagadougou, Burkina Faso. Emerg Infect Dis 2019; 24:1859-1867. [PMID: 30226159 PMCID: PMC6154160 DOI: 10.3201/eid2410.180069] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We evaluated the effectiveness of a community-based intervention for dengue vector control in Ouagadougou, the capital city of Burkina Faso. Households in the intervention (n = 287) and control (n = 289) neighborhoods were randomly sampled and the outcomes collected before the intervention (October 2015) and after the intervention (October 2016). The intervention reduced residents' exposure to dengue vector bites (vector saliva biomarker difference -0.08 [95% CI -0.11 to -0.04]). The pupae index declined in the intervention neighborhood (from 162.14 to 99.03) and increased in the control neighborhood (from 218.72 to 255.67). Residents in the intervention neighborhood were less likely to associate dengue with malaria (risk ratio 0.70 [95% CI 0.58-0.84]) and had increased knowledge about dengue symptoms (risk ratio 1.44 [95% CI 1.22-1.69]). Our study showed that well-planned, evidence/community-based interventions that control exposure to dengue vectors are feasible and effective in urban settings in Africa that have limited resources.
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Ramadona AL, Tozan Y, Lazuardi L, Rocklöv J. A combination of incidence data and mobility proxies from social media predicts the intra-urban spread of dengue in Yogyakarta, Indonesia. PLoS Negl Trop Dis 2019; 13:e0007298. [PMID: 30986218 PMCID: PMC6483276 DOI: 10.1371/journal.pntd.0007298] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 04/25/2019] [Accepted: 03/13/2019] [Indexed: 01/13/2023] Open
Abstract
Only a few studies have investigated the potential of using geotagged social media data for predicting the patterns of spatio-temporal spread of vector-borne diseases. We herein demonstrated the role of human mobility in the intra-urban spread of dengue by weighting local incidence data with geo-tagged Twitter data as a proxy for human mobility across 45 neighborhoods in Yogyakarta city, Indonesia. To estimate the dengue virus importation pressure in each study neighborhood monthly, we developed an algorithm to estimate a dynamic mobility-weighted incidence index (MI), which quantifies the level of exposure to virus importation in any given neighborhood. Using a Bayesian spatio-temporal regression model, we estimated the coefficients and predictiveness of the MI index for lags up to 6 months. Specifically, we used a Poisson regression model with an unstructured spatial covariance matrix. We compared the predictability of the MI index to that of the dengue incidence rate over the preceding months in the same neighborhood (autocorrelation) and that of the mobility information alone. We based our estimates on a volume of 1·302·405 geotagged tweets (from 118·114 unique users) and monthly dengue incidence data for the 45 study neighborhoods in Yogyakarta city over the period from August 2016 to June 2018. The MI index, as a standalone variable, had the highest explanatory power for predicting dengue transmission risk in the study neighborhoods, with the greatest predictive ability at a 3-months lead time. The MI index was a better predictor of the dengue risk in a neighborhood than the recent transmission patterns in the same neighborhood, or just the mobility patterns between neighborhoods. Our results suggest that human mobility is an important driver of the spread of dengue within cities when combined with information on local circulation of the dengue virus. The geotagged Twitter data can provide important information on human mobility patterns to improve our understanding of the direction and the risk of spread of diseases, such as dengue. The proposed MI index together with traditional data sources can provide useful information for the development of more accurate and efficient early warning and response systems. Recent studies have shown that Twitter can be utilized as a tool for health research, and aggregated large-scale social media data can indicate the risk of infectious disease in real-time with high accuracy and at low cost. However, most of these studies relied primarily on content analysis or text mining, while only a few analyzed the networks of Twitter users. None has incorporated user geolocation data to explain health outcomes at an intra-urban level. Currently dengue early warning systems rely on syndromic surveillance, which lacks completeness and timeliness. Effective syndromic surveillance is rarely achieved due to its technical complexity and a general lack of capacity. Researchers have assessed vector indices, meteorological factors and environmental variables as predictors of dengue incidence, but have failed to capture the complexity of transmission as it relates to human behaviors and movements. Here we develop an algorithm to estimate a dynamic mobility-weighted incidence index (MI), which quantifies the level of exposure to virus importation in a given neighborhood. The proposed index is based on publicly available social media and routine disease surveillance data, and provides a low-cost source of information for assessing the risk of spread of communicable diseases, such as dengue. This study suggests that the MI index is of utility and significance for dengue surveillance and early warnings systems and can enhance timely decision-making within the public health system.
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Affiliation(s)
- Aditya Lia Ramadona
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
- Center for Environmental Studies, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yesim Tozan
- College of Global Public Health, New York University, New York, United States of America
| | - Lutfan Lazuardi
- Department of Health Policy and Management, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
- * E-mail:
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Oliveira LNDS, Itria A, Lima EC. Cost of illness and program of dengue: A systematic review. PLoS One 2019; 14:e0211401. [PMID: 30785894 PMCID: PMC6382265 DOI: 10.1371/journal.pone.0211401] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/14/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies on dengue related to the cost of illness and cost of the program are factors to describe the economic burden of dengue, a neglected disease that has global importance in public health. These studies are often used by health managers in optimizing financial resources. A systematic review of studies estimating the cost of dengue was carried out, comparing the costs between the studies and examining the cost drivers regarding the methodological choices. METHODS This study was done according to the guidelines of the Centre for Reviews and Dissemination (CRD). Several databases were searched: Medline, Virtual Health Library and CRD. Two researchers, working independently, selected the studies and extracted the data. The quality of the methodology of the individual studies was achieved by a checklist of 29 items based on protocols proposed by the British Medical Journal and Consolidated Health Economic Evaluation Reporting Standards. A qualitative and quantitative narrative synthesis was performed. RESULTS A literature search yielded 665 publications. Of these, 22 studies are in accordance with previously established inclusion criteria. The cost estimates were compared amongst the studies, highlighting the study design, included population and comparators used (study methodology). The component costs included in the economic evaluation were based on direct and indirect costs, wherein twelve studies included both costs, twelve studies adopted the societal perspective and ten studies used the perspective of the public health service provider, or of a private budget holder. CONCLUSION This study showed that the cost of dengue in 18 countries generated approximately US$ 3.3 billion Purchasing Power Parity (PPP) in 2015. This confirms that the burden of dengue has a great economic impact on countries with common socioeconomic characteristics and similarities in health systems, particularly developing countries, indicating a need for further studies in these countries.
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Affiliation(s)
- Luana Nice da Silva Oliveira
- Faculty of Pharmacy, Center for Economics and Health Assessments, Institute of Health Technology Assessment, Federal University of Goiás, Goiás, Brazil
| | - Alexander Itria
- Institute of Tropical Pathology and Public Health, Department of Collective Health, Federal University of Goiás, Goiás, Brazil
- Center of Economics and Health Assessments, Institute of Health Technology Assessment, Federal University of Goiás, Goiás, Brazil
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Nadjib M, Setiawan E, Putri S, Nealon J, Beucher S, Hadinegoro SR, Permanasari VY, Sari K, Wahyono TYM, Kristin E, Wirawan DN, Thabrany H. Economic burden of dengue in Indonesia. PLoS Negl Trop Dis 2019; 13:e0007038. [PMID: 30629593 PMCID: PMC6343936 DOI: 10.1371/journal.pntd.0007038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 01/23/2019] [Accepted: 11/29/2018] [Indexed: 12/22/2022] Open
Abstract
Background Dengue is associated with significant economic expenditure and it is estimated that the Asia Pacific region accounts for >50% of the global cost. Indonesia has one of the world’s highest dengue burdens; Aedes aegypti and Aedes albopictus are the primary and secondary vectors. In the absence of local data on disease cost, this study estimated the annual economic burden during 2015 of both hospitalized and ambulatory dengue cases in Indonesia. Methods Total 2015 dengue costs were calculated using both prospective and retrospective methods using data from public and private hospitals and health centres in three provinces: Yogyakarta, Bali and Jakarta. Direct costs were extracted from billing systems and claims; a patient survey captured indirect and out-of-pocket costs at discharge and 2 weeks later. Adjustments across sites based on similar clinical practices and healthcare landscapes were performed to fill gaps in cost estimates. The national burden of dengue was extrapolated from provincial data using data from the three sites and applying an empirically-derived epidemiological expansion factor. Results Total direct and indirect costs per dengue case assessed at Yogyakarta, Bali and Jakarta were US$791, US$1,241 and US$1,250, respectively. Total 2015 economic burden of dengue in Indonesia was estimated at US$381.15 million which comprised US$355.2 million for hospitalized and US$26.2 million for ambulatory care cases. Conclusion Dengue imposes a substantial economic burden for Indonesian public payers and society. Complemented with an appropriate weighting method and by accounting for local specificities and practices, these data may support national level public health decision making for prevention/control of dengue in public health priority lists. Dengue, an infection transmitted by mosquitos, is a public health concern particularly in tropical/subtropical areas and the Asia Pacific region where it is associated with a significant cost to society. Indonesia has one of the world’s highest dengue burdens but Indonesia-specific data on cost are lacking. To estimate the annual economic burden of dengue in Indonesia, this study collected data from public/private hospitals and health centres in three provinces (Yogyakarta, Bali and Jakarta) during 2015. We estimated cost of illness using the societal perspective: calculations of costs included those that were directly paid by the healthcare system, as well as costs incurred by the patients (or their family/care givers) and their lost productivity. The costs from the three provinces were then used as the basis for extrapolating cost of illness in Indonesia. The authors confirmed that dengue imposed a substantial economic burden for Indonesian public payers and society. Based on 2015 data, the authors estimated total economic burden of dengue in Indonesia at US$381.15 million. Of this, US$355.2 million related to patients treated in hospitals and US$26.2 million was for patients treated in health centres. Establishing a better understanding of the burden of dengue in Indonesia will help to guide public health decision-making at a national level and support prevention and control initiatives for this disease.
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Affiliation(s)
- Mardiati Nadjib
- Health Policy and Administration Department, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
- * E-mail:
| | - Ery Setiawan
- Centre for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Septiara Putri
- Centre for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | | | | | - Sri Rezeki Hadinegoro
- Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Vetty Yulianty Permanasari
- Centre for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Kurnia Sari
- Centre for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Tri Yunis Miko Wahyono
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Erna Kristin
- Department of Pharmacology & Therapy, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Hasbullah Thabrany
- Centre for Health Economics and Policy Studies, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
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21
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Husnayain A, Fuad A, Lazuardi L. Correlation between Google Trends on dengue fever and national surveillance report in Indonesia. Glob Health Action 2019; 12:1552652. [PMID: 31154985 PMCID: PMC6327938 DOI: 10.1080/16549716.2018.1552652] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/21/2018] [Indexed: 11/06/2022] Open
Abstract
Background: Digital traces are rapidly used for health monitoring purposes in recent years. This approach is growing as the consequence of increased use of mobile phone, Internet, and machine learning. Many studies reported the use of Google Trends data as a potential data source to assist traditional surveillance systems. The rise of Internet penetration (54.7%) and the huge utilization of Google (98%) indicate the potential use of Google Trends in Indonesia. No study was performed to measure the correlation between country wide official dengue reports and Google Trends data in Indonesia. Objective: This study aims to measure the correlation between Google Trends data on dengue fever and the Indonesian national surveillance report. Methods: This research was a quantitative study using time series data (2012-2016). Two sets of data were analyzed using Moving Average analysis in Microsoft Excel. Pearson and Time lag correlations were also used to measure the correlation between those data. Results: Moving Average analysis showed that Google Trends data have a linear time series pattern with official dengue report. Pearson correlation indicated high correlation for three defined search terms with R-value range from 0.921 to 0.937 (p ≤ 0.05, overall period) which showed increasing trend in epidemic periods (2015-2016). Time lag correlation also indicated that Google Trends data can potentially be used for an early warning system and novel tool to monitor public reaction before the increase of dengue cases and during the outbreak. Conclusions: Google Trends data have a linear time series pattern and statistically correlated with annual official dengue reports. Identification of information-seeking behavior is needed to support the use of Google Trends for disease surveillance in Indonesia.
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Affiliation(s)
- Atina Husnayain
- E-Health Division, Center for Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Anis Fuad
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Lutfan Lazuardi
- Department of Health Policy Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Hung TM, Clapham HE, Bettis AA, Cuong HQ, Thwaites GE, Wills BA, Boni MF, Turner HC. The Estimates of the Health and Economic Burden of Dengue in Vietnam. Trends Parasitol 2018; 34:904-918. [PMID: 30100203 PMCID: PMC6192036 DOI: 10.1016/j.pt.2018.07.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022]
Abstract
Dengue has been estimated to cause a substantial health and economic burden in Vietnam. The most recent studies have estimated that it is responsible for 39884 disability-adjusted life years (DALYs) annually, representing an economic burden of US$94.87 million per year (in 2016 prices). However, there are alternative burden estimates that are notably lower. This variation is predominantly due to differences in how the number of symptomatic dengue cases is estimated. Understanding the methodology of these burden calculations is vital when interpreting health economic analyses of dengue. This review aims to provide an overview of the health and economic burden estimates of dengue in Vietnam. We also highlight important research gaps for future studies.
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Affiliation(s)
- Trinh Manh Hung
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Hannah E Clapham
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Alison A Bettis
- London Centre for Neglected Tropical Disease Research, London, UK; Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London, Norfolk Place, London W2 1 PG, UK
| | | | - Guy E Thwaites
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Bridget A Wills
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Maciej F Boni
- Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, PA, USA
| | - Hugo C Turner
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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Bangert M, Latheef AT, Dev Pant S, Nishan Ahmed I, Saleem S, Nazla Rafeeq F, Abdulla M, Shamah F, Jamsheed Mohamed A, Fitzpatrick C, Velayudhan R, Shepard DS. Economic analysis of dengue prevention and case management in the Maldives. PLoS Negl Trop Dis 2018; 12:e0006796. [PMID: 30260952 PMCID: PMC6177194 DOI: 10.1371/journal.pntd.0006796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/09/2018] [Accepted: 08/27/2018] [Indexed: 01/17/2023] Open
Abstract
As tourism is the mainstay of the Maldives' economy, this country recognizes the importance of controlling mosquito-borne diseases in an environmentally responsible manner. This study sought to estimate the economic costs of dengue in this Small Island Developing State of 417,492 residents. The authors reviewed relevant available documents on dengue epidemiology and conducted site visits and interviews with public health offices, health centers, referral hospitals, health insurers, and drug distribution organizations. An average of 1,543 symptomatic dengue cases was reported annually from 2011 through 2016. Intensive waste and water management on a resort island cost $1.60 per occupied room night. Local vector control programs on inhabited islands cost $35.93 for waste collection and $7.89 for household visits by community health workers per person per year. Ambulatory care for a dengue episode cost $49.87 at a health center, while inpatient episodes averaged $127.74 at a health center, $1,164.78 at a regional hospital, and $1,655.50 at a tertiary referral hospital. Overall, the cost of dengue illness in the Maldives in 2015 was $2,495,747 (0.06% of gross national income, GNI, or $6.10 per resident) plus $1,338,141 (0.03% of GNI or $3.27 per resident) for dengue surveillance. With tourism generating annual income of $898 and tax revenues of $119 per resident, results of an international analysis suggest that the risk of dengue lowers the country's gross annual income by $110 per resident (95% confidence interval $50 to $160) and its annual tax receipts by $14 per resident (95% confidence interval $7 to $22). Many innovative vector control efforts are affordable and could decrease future costs of dengue illness in the Maldives.
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Affiliation(s)
- Mathieu Bangert
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | | | - Shushil Dev Pant
- World Health Organization Country Office, Malé, Republic of Maldives
| | | | - Sana Saleem
- Health Protection Agency, Ministry of Health, Malé, Republic of Maldives
| | | | - Moomina Abdulla
- Policy Planning and International Health, Ministry of Health, Malé, Republic of Maldives
| | - Fathimath Shamah
- Policy Planning and International Health, Ministry of Health, Malé, Republic of Maldives
| | - Ahmed Jamsheed Mohamed
- Department of Control of Neglected Tropical Diseases, World Health Organization Regional Office for South East Asia, New Delhi, India
| | - Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Raman Velayudhan
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Donald S. Shepard
- Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, United States of America
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Lai WT, Chen CH, Hung H, Chen RB, Shete S, Wu CC. Recognizing spatial and temporal clustering patterns of dengue outbreaks in Taiwan. BMC Infect Dis 2018; 18:256. [PMID: 29866173 PMCID: PMC5987425 DOI: 10.1186/s12879-018-3159-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 05/23/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Dengue fever is the most common arboviral infection in humans, with viral transmissions occurring in more than 100 countries in tropical regions. A global strategy for dengue prevention and control was established more than 10 years ago. However, the factors that drive the transmission of the dengue virus and subsequent viral infection continue unabated. The largest dengue outbreaks in Taiwan since World War II occurred in two recent successive years: 2014 and 2015. METHODS We performed a systematic analysis to detect and recognize spatial and temporal clustering patterns of dengue incidence in geographical areas of Taiwan, using the map-based pattern recognition procedure and scan test. Our aim was to recognize geographical heterogeneity patterns of varying dengue incidence intensity and detect hierarchical incidence intensity clusters. RESULTS Using the map-based pattern recognition procedure, we identified and delineated two separate hierarchical dengue incidence intensity clusters that comprise multiple mutually adjacent geographical units with high dengue incidence rates. We also found that that dengue incidence tends to peak simultaneously and homogeneously among the neighboring geographic units with high rates in the same cluster. CONCLUSION Beyond significance testing, this study is particularly desired by and useful for health authorities who require optimal characteristics of disease incidence patterns on maps and over time. Among the integrated components for effective prevention and control of dengue and dengue hemorrhagic fever are active surveillance and community-based integrated mosquito control, for which this study provides valuable inferences. Effective dengue prevention and control programs in Taiwan are critical, and have the added benefit of controlling the potential emergence of Zika.
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Affiliation(s)
- Wei-Ting Lai
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Hsiun Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Hsin Hung
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 University Road Tainan, 701, Tainan, Taiwan
| | - Ray-Bing Chen
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Sanjay Shete
- Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Departments of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chih-Chieh Wu
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 1 University Road Tainan, 701, Tainan, Taiwan.
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de Jong W, Rusli M, Bhoelan S, Rohde S, Rantam FA, Noeryoto PA, Hadi U, Gorp ECMV, Goeijenbier M. Endemic and emerging acute virus infections in Indonesia: an overview of the past decade and implications for the future. Crit Rev Microbiol 2018; 44:487-503. [PMID: 29451044 DOI: 10.1080/1040841x.2018.1438986] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Being the largest archipelago country in the world, with a tropical climate and a unique flora and fauna, Indonesia habitats one of the most diverse biome in the world. These characteristics make Indonesia a popular travel destination, with tourism numbers increasing yearly. These characteristics also facilitate the transmission of zoonosis and provide ideal living and breading circumstances for arthropods, known vectors for viral diseases. A review of the past 10 years of literature, reports of the Ministry of Health, Republic of Indonesia and ProMED-mail shows a significant increase in dengue infection incidence. Furthermore, chikungunya, Japanese encephalitis and rabies are proven to be endemic in Indonesia. The combination of cohort studies, governmental data and ProMED-mail reveals an integrated overview for those working in travel medicine and public health, focusing on both endemic and emerging acute virus infections. This review summarizes the epidemiology of acute virus infections in Indonesia, including outbreak reports, as well as public health response measurements and their potential or efficacy. Knowledge about human behaviour, animal reservoirs, climate factors, environment and their role in emerging virus infection are discussed. We aim to support public health authorities and health care policy makers in a One Health approach.
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Affiliation(s)
- Wesley de Jong
- a Department of Viroscience , Erasmus MC , Rotterdam , the Netherlands
| | - Musofa Rusli
- b Department of Internal Medicine, Division of Tropical & Infectious Disease, Faculty of Medicine , Airlangga University , Surabaya , Indonesia
| | - Soerajja Bhoelan
- c Department of Internal medicine , Havenziekenhuis Institute for Tropical Medicine , Rotterdam , the Netherlands
| | - Sofie Rohde
- a Department of Viroscience , Erasmus MC , Rotterdam , the Netherlands
| | - Fedik A Rantam
- d Institute of Tropical Disease, Airlangga University , Surabaya , Indonesia
| | - Purwati A Noeryoto
- b Department of Internal Medicine, Division of Tropical & Infectious Disease, Faculty of Medicine , Airlangga University , Surabaya , Indonesia
| | - Usman Hadi
- b Department of Internal Medicine, Division of Tropical & Infectious Disease, Faculty of Medicine , Airlangga University , Surabaya , Indonesia
| | - Eric C M van Gorp
- a Department of Viroscience , Erasmus MC , Rotterdam , the Netherlands
| | - Marco Goeijenbier
- a Department of Viroscience , Erasmus MC , Rotterdam , the Netherlands.,c Department of Internal medicine , Havenziekenhuis Institute for Tropical Medicine , Rotterdam , the Netherlands
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A multi-country study of the economic burden of dengue fever: Vietnam, Thailand, and Colombia. PLoS Negl Trop Dis 2017; 11:e0006037. [PMID: 29084220 PMCID: PMC5679658 DOI: 10.1371/journal.pntd.0006037] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 11/09/2017] [Accepted: 10/14/2017] [Indexed: 01/01/2023] Open
Abstract
Background Dengue fever is a major public health concern in many parts of the tropics and subtropics. The first dengue vaccine has already been licensed in six countries. Given the growing interests in the effective use of the vaccine, it is critical to understand the economic burden of dengue fever to guide decision-makers in setting health policy priorities. Methods/Principal findings A standardized cost-of-illness study was conducted in three dengue endemic countries: Vietnam, Thailand, and Colombia. In order to capture all costs during the entire period of illness, patients were tested with rapid diagnostic tests on the first day of their clinical visits, and multiple interviews were scheduled until the patients recovered from the current illness. Various cost items were collected such as direct medical and non-medical costs, indirect costs, and non-out-of-pocket costs. In addition, socio-economic factors affecting disease severity were also identified by adopting a logit model. We found that total cost per episode ranges from $141 to $385 for inpatient and from $40 to $158 outpatient, with Colombia having the highest and Thailand having the lowest. The percentage of the private economic burden of dengue fever was highest in the low-income group and lowest in the high-income group. The logit analyses showed that early treatment, higher education, and better knowledge of dengue disease would reduce the probability of developing more severe illness. Conclusions/Significance The cost of dengue fever is substantial in the three dengue endemic countries. Our study findings can be used to consider accelerated introduction of vaccines into the public and private sector programs and prioritize alternative health interventions among competing health problems. In addition, a community would be better off by propagating the socio-economic factors identified in this study, which may prevent its members from developing severe illness in the long run. Dengue fever has been prevalent in South-East Asia and South America. Despite the increase of dengue fever cases, there continues to be a lack of economic assessment partly due to the absence of vaccines until recent times. Many of the previous economic burden studies for dengue fever were not standardized, making them difficult to compare. We implemented the standardized economic burden survey for dengue fever in a multi-country setting: Vietnam, Thailand, and Colombia. We found that the economic burden of dengue fever is substantial in all three dengue endemic countries. Our study also identified socio-economic factors which are related to the probability of experiencing severe illness. The first live attenuated, tetravalent dengue vaccine (CYD-TDV) has been already licensed in some dengue-endemic countries. As three countries will soon face decisions on whether and how to incorporate current and future vaccine candidates within their budget constraints, the updated economic burden estimates can be used to develop sustainable financing plans.
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Tozan Y, Ratanawong P, Sewe MO, Wilder-Smith A, Kittayapong P. Household costs of hospitalized dengue illness in semi-rural Thailand. PLoS Negl Trop Dis 2017; 11:e0005961. [PMID: 28937986 PMCID: PMC5627959 DOI: 10.1371/journal.pntd.0005961] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 10/04/2017] [Accepted: 09/13/2017] [Indexed: 02/08/2023] Open
Abstract
Background Dengue-related illness is a leading cause of hospitalization and death in Thailand and other Southeast Asian countries, imposing a major economic burden on households, health systems, and governments. This study aims to assess the economic impact of hospitalized dengue cases on households in Chachoengsao province in eastern Thailand. Methods We conducted a prospective cost-of-illness study of hospitalized pediatric and adult dengue patients at three public hospitals. We examined all hospitalized dengue cases regardless of disease severity. Patients or their legal guardians were interviewed using a standard questionnaire to determine household-level medical and non-medical expenditures and income losses during the illness episode. Results Between March and September 2015, we recruited a total of 224 hospitalized patients (<5 years, 4%; 5–14 years, 20%, 15–24 years, 36%, 25–34 years, 15%; 35–44 years, 10%; 45+ years, 12%), who were clinically diagnosed with dengue. The total cost of a hospitalized dengue case was higher for adult patients than pediatric patients, and was US$153.6 and US$166.3 for pediatric DF and DHF patients, respectively, and US$171.2 and US$226.1 for adult DF and DHF patients, respectively. The financial burden on households increased with the severity of dengue illness. Conclusions Although 74% of the households reported that the patient received free medical care, hospitalized dengue illness cost approximately 19–23% of the monthly household income. These results indicated that dengue imposed a substantial financial burden on households in Thailand where a great majority of the population was covered by the Universal Coverage Scheme for health care. Dengue, an arbovirus infection with an explosive epidemic potential, is a major public health problem in Thailand and other developing countries in subtropical and tropical regions. Dengue illness often leads to school and work absenteeism, medical and non-medical expenditures, and foregone income. A growing literature shows that these illness related costs pose a severe economic burden on households, health care systems, and governments. We conducted a prospective cost-of-illness study to assess the costs and impact of hospitalized pediatric and adult dengue cases on households in a highly endemic area in eastern Thailand. We found that the total cost of a hospitalized dengue case accounted for about 19–23% the monthly household income. Although direct medical costs were covered for a majority of hospitalized dengue patients by the Thai Universal Coverage Scheme for health care, direct non-medical and indirect costs were of great economic significance to households. These hidden costs of dengue illness are likely to increase given the shift in the mean age of dengue cases in Thailand and other endemic countries in the region. High household costs of dengue illness justify efforts to improve the coverage of preventive and control measures against dengue in endemic areas.
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Affiliation(s)
- Yesim Tozan
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany
- College of Global Public Health, New York University, New York, NY, United States of America
- Center of Excellence for Vectors and Vector-Borne Diseases and Department of Biology, Faculty of Science, Mahidol University, Bangkok, Thailand
- * E-mail: (YT); (PT)
| | - Pitcha Ratanawong
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany
- Center of Excellence for Vectors and Vector-Borne Diseases and Department of Biology, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Maquines Odhiambo Sewe
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Annelies Wilder-Smith
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Pattamaporn Kittayapong
- Division of Social Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
- * E-mail: (YT); (PT)
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Fitzpatrick C, Haines A, Bangert M, Farlow A, Hemingway J, Velayudhan R. An economic evaluation of vector control in the age of a dengue vaccine. PLoS Negl Trop Dis 2017; 11:e0005785. [PMID: 28806786 PMCID: PMC5573582 DOI: 10.1371/journal.pntd.0005785] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/28/2017] [Accepted: 07/06/2017] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Dengue is a rapidly emerging vector-borne Neglected Tropical Disease, with a 30-fold increase in the number of cases reported since 1960. The economic cost of the illness is measured in the billions of dollars annually. Environmental change and unplanned urbanization are conspiring to raise the health and economic cost even further beyond the reach of health systems and households. The health-sector response has depended in large part on control of the Aedes aegypti and Ae. albopictus (mosquito) vectors. The cost-effectiveness of the first-ever dengue vaccine remains to be evaluated in the field. In this paper, we examine how it might affect the cost-effectiveness of sustained vector control. METHODS We employ a dynamic Markov model of the effects of vector control on dengue in both vectors and humans over a 15-year period, in six countries: Brazil, Columbia, Malaysia, Mexico, the Philippines, and Thailand. We evaluate the cost (direct medical costs and control programme costs) and cost-effectiveness of sustained vector control, outbreak response and/or medical case management, in the presence of a (hypothetical) highly targeted and low cost immunization strategy using a (non-hypothetical) medium-efficacy vaccine. RESULTS Sustained vector control using existing technologies would cost little more than outbreak response, given the associated costs of medical case management. If sustained use of existing or upcoming technologies (of similar price) reduce vector populations by 70-90%, the cost per disability-adjusted life year averted is 2013 US$ 679-1331 (best estimates) relative to no intervention. Sustained vector control could be highly cost-effective even with less effective technologies (50-70% reduction in vector populations) and in the presence of a highly targeted and low cost immunization strategy using a medium-efficacy vaccine. DISCUSSION Economic evaluation of the first-ever dengue vaccine is ongoing. However, even under very optimistic assumptions about a highly targeted and low cost immunization strategy, our results suggest that sustained vector control will continue to play an important role in mitigating the impact of environmental change and urbanization on human health. If additional benefits for the control of other Aedes borne diseases, such as Chikungunya, yellow fever and Zika fever are taken into account, the investment case is even stronger. High-burden endemic countries should proceed to map populations to be covered by sustained vector control.
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Affiliation(s)
- Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
- * E-mail:
| | - Alexander Haines
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
- National Guideline Centre, Royal College of Physicians, London, United Kingdom
| | - Mathieu Bangert
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Andrew Farlow
- Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | - Janet Hemingway
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Raman Velayudhan
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Zhang JH, Yuan J, Wang T. Direct cost of dengue hospitalization in Zhongshan, China: Associations with demographics, virus types and hospital accreditation. PLoS Negl Trop Dis 2017; 11:e0005784. [PMID: 28771479 PMCID: PMC5557582 DOI: 10.1371/journal.pntd.0005784] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 08/15/2017] [Accepted: 07/06/2017] [Indexed: 11/24/2022] Open
Abstract
Background Zhongshan City of Guangdong Province (China) is a key provincial and national level area for dengue fever prevention and control. The aim of this study is to analyze how the direct hospitalization costs and the length of stay of dengue hospitalization cases vary according to associated factors such as the demographics, virus types and hospital accreditation. Method This study is based on retrospective census data from the Chinese National Disease Surveillance Reporting System. Totally, the hospital administrative data of 1432 confirmed dengue inpatients during 2013–2014 was obtained. A quantile regression model was applied to analyze how the direct cost of Dengue hospitalization varies with the patient demographics and hospital accreditation across the data distribution. The Length of Stay (LOS) was also examined. Main findings The average direct hospitalization cost of a dengue case in this study is US$ 499.64 during 2013, which corresponded to about 3.71% of the gross domestic product per capita in Zhongshan that year. The mean of the Length of Stay (LOS) is 7.2 days. The multivariate quantile regression results suggest that, after controlling potential compounding variables, the median hospitalization costs of male dengue patients were significantly higher than female ones by about US$ 18.23 (p<0.1). The hospitalization cost difference between the pediatric and the adult patients is estimated to be about US$ 75.25 at the median (p<0.01), but it increases sharply among the top 25 percentiles and reaches US$ 329 at the 90th percentile (p<0.01). The difference between the senior (older than 64 years old) and the adult patients increases steadily across percentiles, especially sharply among the top quartiles too. The LOS of the city-level hospitals is significantly shorter than that in the township-level hospitals by one day at the median (p<0.05), but no significant differences in their hospitalization costs. Conclusions The direct hospitalization costs of dengue cases vary widely according to the associated demographics factors, virus types and hospital accreditations. The findings in this study provide information for adopting hospitalization strategy, cost containment and patient allocation in dengue prevention and control. Also the results can be used as the cost-effective reference for future dengue vaccine adoption strategy in China. There is little literature estimating dengue disease burdens and treatment costs worldwide; however, still fewer studies focus on the hospitalization cost of Dengue. Using the quantile regression method to analyze the administrative data of 1,432 confirmed dengue inpatients in Zhongshan City (Guangdong, China) during 2013 and 2014, this study examines the relationship of the direct cost of Dengue hospitalization and the associated factors. The Length of Stay (LOS) was also examined. The findings in this study will help to explain how the hospitalization cost varies with associated factors, providing information for adopting hospitalization strategy, cost containment and patient allocation in dengue prevention and control, as well as reference for future dengue vaccine cost-effective analysis.
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Affiliation(s)
- Jing Hua Zhang
- School of Business, Macau University of Science and Technology, Taipa, Macau, China
- * E-mail:
| | - Juan Yuan
- Zhongshan Center for Disease Control and Prevention, Zhongshan, China
| | - Tao Wang
- Zhongshan Center for Disease Control and Prevention, Zhongshan, China
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Pang T, Mak TK, Gubler DJ. Prevention and control of dengue-the light at the end of the tunnel. THE LANCET. INFECTIOUS DISEASES 2017; 17:e79-e87. [PMID: 28185870 DOI: 10.1016/s1473-3099(16)30471-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/16/2016] [Accepted: 10/19/2016] [Indexed: 12/20/2022]
Abstract
Advances in the development of new dengue control tools, including vaccines and vector control, herald a new era of desperately needed dengue prevention and control. The burden of dengue has expanded for decades, and now affects more than 120 countries. Complex, large-scale global forces have and will continue to contribute to the expansion of dengue, including population growth, unplanned urbanisation, and suboptimal mosquito control in urban centres. Although no so-called magic bullets are available, there is new optimism following the first licensure of a dengue vaccine and other promising vaccine candidates, and the development of novel vector control interventions to help control dengue and other expanding mosquito-borne diseases such as Zika virus. Implementation of effective and sustainable immunisation programmes to complement existing methods will add complexity to the health systems of affected countries, which have varying levels of robustness and maturity. Long-term high prioritisation and adequate resources are needed. The way forward is full commitment to addressing a complex disease with a set of solutions integrating vaccination and vector control methods. A whole systems approach is thus needed to integrate these various approaches and strategies for controlling dengue within the goal of universal health coverage. The ultimate objective of these interventions will be to reduce the disease burden in a sustainable and equitable manner.
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Affiliation(s)
- Tikki Pang
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore.
| | - Tippi K Mak
- Regional Health & Community Outreach Division, Health Promotion Board, Singapore
| | - Duane J Gubler
- Emerging Infectious Diseases Programme, Duke-NUS Medical School, National University of Singapore, Singapore
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The economic promise of developing and implementing dengue vaccines: Evidence from a systematic review. Vaccine 2016; 34:6133-6147. [PMID: 27810313 DOI: 10.1016/j.vaccine.2016.10.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 10/16/2016] [Accepted: 10/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dengue fever is one of the most rapidly advancing viral vector-borne diseases worldwide and vaccine candidates are in the final stages of clinical trials, representing a decisive opportunity to control the disease. To decide whether and where to support the introduction of new vaccines it is crucial to assess costs imposed by the disease and cost-effectiveness of vaccine programmes. OBJECTIVE To identify economic evidence about dengue fever immunization, by systematic review, to assist future policy decisions and investment. METHODS The electronic search stage was conducted on PubMed/Medline, Embase, Web of Science, Global Health, NHS Economic Evaluation Database (NHS EED) and Latin American and Caribbean Health Sciences Literature (LILACS) databases. Searches were restricted to papers published between January 1970 and February 2016. Selected papers were quality assessed using three recognized checklists. RESULTS Eleven relevant studies were identified and there is economic evidence of a satisfactory quality level, derived through modelling approaches, to conclude that dengue fever vaccines will be economically advantageous when compared to vector preventive strategies, despite uncertainties surrounding vaccine efficacy and costs per vaccine dose. Quality assessment based on checklists showed similar findings and although overall quality was considered satisfactory, there were relevant methodological issues not considered among studies reviewed. CONCLUSION Several uncertainties still remain about effectiveness of dengue fever vaccines; however, the reviewed economic evidence suggests that, when available, the vaccine can be economically advantageous at moderate prices. Future research needs to confirm findings from the economic models by using actual costs and effectiveness data.
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Ebi KL, Nealon J. Dengue in a changing climate. ENVIRONMENTAL RESEARCH 2016; 151:115-123. [PMID: 27475051 DOI: 10.1016/j.envres.2016.07.026] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/10/2016] [Accepted: 07/18/2016] [Indexed: 05/21/2023]
Abstract
Dengue is the world's most important arboviral disease in terms of number of people affected. Over the past 50 years, incidence increased 30-fold: there were approximately 390 million infections in 2010. Globalization, trade, travel, demographic trends, and warming temperatures are associated with the recent spread of the primary vectors Aedes aegypti and Aedes albopictus and of dengue. Overall, models project that new geographic areas along the fringe of current geographic ranges for Aedes will become environmentally suitable for the mosquito's lifecycle, and for dengue transmission. Many endemic countries where dengue is likely to spread further have underdeveloped health systems, increasing the substantial challenges of disease prevention and control. Control focuses on management of Aedes, although these efforts have typically had limited effectiveness in preventing outbreaks. New prevention and control efforts are needed to counter the potential consequences of climate change on the geographic range and incidence of dengue, including novel methods of vector control and dengue vaccines.
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Affiliation(s)
- Kristie L Ebi
- Departments of Global Health and Environmental and Occupational Health Sciences, University of Washington, WA 98015, USA.
| | - Joshua Nealon
- Sanofi Pasteur Asia Pacific Epidemiology, 189767, Singapore.
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Viennet E, Ritchie SA, Williams CR, Faddy HM, Harley D. Public Health Responses to and Challenges for the Control of Dengue Transmission in High-Income Countries: Four Case Studies. PLoS Negl Trop Dis 2016; 10:e0004943. [PMID: 27643596 PMCID: PMC5028037 DOI: 10.1371/journal.pntd.0004943] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Dengue has a negative impact in low- and lower middle-income countries, but also affects upper middle- and high-income countries. Despite the efforts at controlling this disease, it is unclear why dengue remains an issue in affluent countries. A better understanding of dengue epidemiology and its burden, and those of chikungunya virus and Zika virus which share vectors with dengue, is required to prevent the emergence of these diseases in high-income countries in the future. The purpose of this review was to assess the relative burden of dengue in four high-income countries and to appraise the similarities and differences in dengue transmission. We searched PubMed, ISI Web of Science, and Google Scholar using specific keywords for articles published up to 05 May 2016. We found that outbreaks rarely occur where only Aedes albopictus is present. The main similarities between countries uncovered by our review are the proximity to dengue-endemic countries, the presence of a competent mosquito vector, a largely nonimmune population, and a lack of citizens’ engagement in control of mosquito breeding. We identified important epidemiological and environmental issues including the increase of local transmission despite control efforts, population growth, difficulty locating larval sites, and increased human mobility from neighboring endemic countries. Budget cuts in health and lack of practical vaccines contribute to an increased risk. To be successful, dengue-control programs for high-income countries must consider the epidemiology of dengue in other countries and use this information to minimize virus importation, improve the control of the cryptic larval habitat, and engage the community in reducing vector breeding. Finally, the presence of a communicable disease center is critical for managing and reducing future disease risks.
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Affiliation(s)
- Elvina Viennet
- Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
- Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
- * E-mail:
| | - Scott A. Ritchie
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Cairns, Queensland, Australia
| | - Craig R. Williams
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Helen M. Faddy
- Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia
| | - David Harley
- Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
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Runge-Ranzinger S, Kroeger A, Olliaro P, McCall PJ, Sánchez Tejeda G, Lloyd LS, Hakim L, Bowman LR, Horstick O, Coelho G. Dengue Contingency Planning: From Research to Policy and Practice. PLoS Negl Trop Dis 2016; 10:e0004916. [PMID: 27653786 PMCID: PMC5031449 DOI: 10.1371/journal.pntd.0004916] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/21/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Dengue is an increasingly incident disease across many parts of the world. In response, an evidence-based handbook to translate research into policy and practice was developed. This handbook facilitates contingency planning as well as the development and use of early warning and response systems for dengue fever epidemics, by identifying decision-making processes that contribute to the success or failure of dengue surveillance, as well as triggers that initiate effective responses to incipient outbreaks. METHODOLOGY/PRINCIPAL FINDINGS Available evidence was evaluated using a step-wise process that included systematic literature reviews, policymaker and stakeholder interviews, a study to assess dengue contingency planning and outbreak management in 10 countries, and a retrospective logistic regression analysis to identify alarm signals for an outbreak warning system using datasets from five dengue endemic countries. Best practices for managing a dengue outbreak are provided for key elements of a dengue contingency plan including timely contingency planning, the importance of a detailed, context-specific dengue contingency plan that clearly distinguishes between routine and outbreak interventions, surveillance systems for outbreak preparedness, outbreak definitions, alert algorithms, managerial capacity, vector control capacity, and clinical management of large caseloads. Additionally, a computer-assisted early warning system, which enables countries to identify and respond to context-specific variables that predict forthcoming dengue outbreaks, has been developed. CONCLUSIONS/SIGNIFICANCE Most countries do not have comprehensive, detailed contingency plans for dengue outbreaks. Countries tend to rely on intensified vector control as their outbreak response, with minimal focus on integrated management of clinical care, epidemiological, laboratory and vector surveillance, and risk communication. The Technical Handbook for Surveillance, Dengue Outbreak Prediction/ Detection and Outbreak Response seeks to provide countries with evidence-based best practices to justify the declaration of an outbreak and the mobilization of the resources required to implement an effective dengue contingency plan.
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Affiliation(s)
- Silvia Runge-Ranzinger
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
- Special Programme for Research and Training WHO-TDR, Geneva, Switzerland
| | - Axel Kroeger
- Special Programme for Research and Training WHO-TDR, Geneva, Switzerland
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Piero Olliaro
- Special Programme for Research and Training WHO-TDR, Geneva, Switzerland
| | - Philip J. McCall
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Linda S. Lloyd
- Public Health Consultant, San Diego, California, United States of America
| | | | - Leigh R. Bowman
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Olaf Horstick
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
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Villabona-Arenas CJ, de Oliveira JL, de Sousa-Capra C, Balarini K, Pereira da Fonseca CRT, Zanotto PMDA. Epidemiological dynamics of an urban Dengue 4 outbreak in São Paulo, Brazil. PeerJ 2016; 4:e1892. [PMID: 27069820 PMCID: PMC4824887 DOI: 10.7717/peerj.1892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/14/2016] [Indexed: 11/23/2022] Open
Abstract
Background: Dengue studies at the urban scale are scarce and required for guiding control efforts. In Brazil, the burden of dengue is high and challenges city public health administrations with limited resources. Here we studied the dynamics of a dengue epidemic in a single city. Methods: Serum samples from dengue suspected cases were collected and tested, from December 2012 and July 2013 in Guarujá, Brazil. We use incidence series analysis to provide a detailed view of the reproduction number dynamics and a Bayesian analysis to infer the spread of the serotype using geographic and temporal data. Results: We obtained nucleotide sequences from 354 envelope genes and georeferenced 286 samples during the course of the outbreak. Serotype 4 was responsible for the epidemic. We identified at least two major lineages that overlapped in distribution. We observed high reproduction numbers and high cladogenesis prior to the escalation of clinical case notifications. Three densely populated non-adjacent neighborhoods played a pivotal role during the onset and/or course of the epidemic. Discussion: Our findings point to high dengue virus transmission with a substantial proportion of unapparent cases that led to a late recognition of an outbreak. Usually source reductions initiatives tend to be insufficient once an epidemic has been established. Nevertheless, health authorities in Guarujá prioritized vector control on specific places with clusters of georeferenced viremic patients, which appear to have diminished the epidemic impact.
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Affiliation(s)
- Christian Julián Villabona-Arenas
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo , São Paulo , Brazil
| | - Jessica Luana de Oliveira
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo, São Paulo, Brazil; Department of Biomedicine, University of Mogi das Cruzes, Mogi das Cruzes, São Paulo, Brazil
| | - Carla de Sousa-Capra
- Office of Epidemiological Surveillance, Department of Health of Guarujá , Guarujá, São Paulo , Brazil
| | - Karime Balarini
- Clinical Laboratory Analysis Center, ITAPEMA , Guarujá , Brazil
| | | | - Paolo Marinho de Andrade Zanotto
- Laboratory of Molecular Evolution and Bioinformatics, Department of Microbiology, Biomedical Sciences Institute, University of São Paulo , São Paulo , Brazil
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Ramadona AL, Lazuardi L, Hii YL, Holmner Å, Kusnanto H, Rocklöv J. Prediction of Dengue Outbreaks Based on Disease Surveillance and Meteorological Data. PLoS One 2016; 11:e0152688. [PMID: 27031524 PMCID: PMC4816319 DOI: 10.1371/journal.pone.0152688] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/17/2016] [Indexed: 11/24/2022] Open
Abstract
Research is needed to create early warnings of dengue outbreaks to inform stakeholders and control the disease. This analysis composes of a comparative set of prediction models including only meteorological variables; only lag variables of disease surveillance; as well as combinations of meteorological and lag disease surveillance variables. Generalized linear regression models were used to fit relationships between the predictor variables and the dengue surveillance data as outcome variable on the basis of data from 2001 to 2010. Data from 2011 to 2013 were used for external validation purposed of prediction accuracy of the model. Model fit were evaluated based on prediction performance in terms of detecting epidemics, and for number of predicted cases according to RMSE and SRMSE, as well as AIC. An optimal combination of meteorology and autoregressive lag terms of dengue counts in the past were identified best in predicting dengue incidence and the occurrence of dengue epidemics. Past data on disease surveillance, as predictor alone, visually gave reasonably accurate results for outbreak periods, but not for non-outbreaks periods. A combination of surveillance and meteorological data including lag patterns up to a few years in the past showed most predictive of dengue incidence and occurrence in Yogyakarta, Indonesia. The external validation showed poorer results than the internal validation, but still showed skill in detecting outbreaks up to two months ahead. Prior studies support the fact that past meteorology and surveillance data can be predictive of dengue. However, to a less extent has prior research shown how the longer-term past disease incidence data, up to years, can play a role in predicting outbreaks in the coming years, possibly indicating cross-immunity status of the population.
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Affiliation(s)
- Aditya Lia Ramadona
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Center for Environmental Studies, Universitas Gadjah Mada, Yogyakarta, Indonesia
- * E-mail:
| | - Lutfan Lazuardi
- Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yien Ling Hii
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Åsa Holmner
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Hari Kusnanto
- Center for Environmental Studies, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Joacim Rocklöv
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Thalagala N, Tissera H, Palihawadana P, Amarasinghe A, Ambagahawita A, Wilder-Smith A, Shepard DS, Tozan Y. Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka. PLoS Negl Trop Dis 2016; 10:e0004466. [PMID: 26910907 PMCID: PMC4766086 DOI: 10.1371/journal.pntd.0004466] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/26/2016] [Indexed: 12/29/2022] Open
Abstract
Background Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector. Methods We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health’s perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches. Results The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216–609 for pediatric cases and between US$196–866 for adult cases according to disease severity and treatment setting. Conclusions This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka. Dengue is a major public health problem affecting more than half of the world’s population living in tropical and subtropical regions of the world. The disease is estimated to place a heavy socio-economic burden on households, health care systems, and governments, particularly during outbreaks; however, country-specific reliable estimates of burden of disease and cost data are limited. This study estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo district—the most heavily populated and urbanized district in Sri Lanka—during the epidemic year of 2012 from the Ministry of Health’s perspective. Results revealed that the Ministry’s cost of dengue control and hospitalizations totaled US$3.45 million (US$1.50 per capita), of which US$971,360 (US$0.42 per capita) was for dengue control activities. Personnel costs accounted for the largest shares of the costs of dengue control activities (79%) and of hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs of hospitalization ranged between US$216–609 for pediatric cases and between US$196–866 for adult cases according to disease severity and treatment setting. These results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka.
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Affiliation(s)
- Neil Thalagala
- National Child Health Programme, Family Health Bureau, Ministry of Health, Colombo, Sri Lanka
| | - Hasitha Tissera
- Epidemiology Unit, Ministry of Health, Colombo, Sri Lanka
- National Dengue Control Unit, Colombo, Sri Lanka
| | | | | | | | - Annelies Wilder-Smith
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Donald S. Shepard
- Brandeis University, The Heller School for Social Policy and Management, Waltham, Massachusetts, United States of America
| | - Yeşim Tozan
- Institute of Public Health, Heidelberg University Medical School, Heidelberg, Germany
- College of Global Public Health, New York University, New York, New York, United States of America
- * E-mail:
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Tangena JAA, Thammavong P, Wilson AL, Brey PT, Lindsay SW. Risk and Control of Mosquito-Borne Diseases in Southeast Asian Rubber Plantations. Trends Parasitol 2016; 32:402-415. [PMID: 26907494 DOI: 10.1016/j.pt.2016.01.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/04/2016] [Accepted: 01/19/2016] [Indexed: 11/18/2022]
Abstract
Unprecedented economic growth in Southeast Asia (SEA) has encouraged the expansion of rubber plantations. This land-use transformation is changing the risk of mosquito-borne diseases. Mature plantations provide ideal habitats for the mosquito vectors of malaria, dengue, and chikungunya. Migrant workers may introduce pathogens into plantation areas, most worryingly artemisinin-resistant malaria parasites. The close proximity of rubber plantations to natural forest also increases the threat from zoonoses, where new vector-borne pathogens spill over from wild animals into humans. There is therefore an urgent need to scale up vector control and access to health care for rubber workers. This requires an intersectoral approach with strong collaboration between the health sector, rubber industry, and local communities.
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Affiliation(s)
- Julie-Anne A Tangena
- Laboratory of Vector-Borne Diseases, Institut Pasteur du Laos, Vientiane, Laos; School of Biological and Biomedical Sciences, Durham University, Durham, UK.
| | | | - Anne L Wilson
- School of Biological and Biomedical Sciences, Durham University, Durham, UK
| | - Paul T Brey
- Laboratory of Vector-Borne Diseases, Institut Pasteur du Laos, Vientiane, Laos
| | - Steve W Lindsay
- School of Biological and Biomedical Sciences, Durham University, Durham, UK
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Constenla D, Clark S. Financing dengue vaccine introduction in the Americas: challenges and opportunities. Expert Rev Vaccines 2016; 15:547-59. [DOI: 10.1586/14760584.2016.1134329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Dengue is a major public health concern in tropical and subtropical areas of the world. The prospects for dengue prevention have recently improved with the results of efficacy trials of a tetravalent dengue vaccine. Although partially effective, once licensed, its introduction can be a public health priority in heavily affected countries because of the perceived public health importance of dengue. This review explores the most immediate economic considerations of introducing a new dengue vaccine and evaluates the published economic analyses of dengue vaccination. Findings indicate that the current economic evidence base is of limited utility to support country-level decisions on dengue vaccine introduction. There are a handful of published cost-effectiveness studies and no country-specific costing studies to project the full resource requirements of dengue vaccine introduction. Country-level analytical expertise in economic analyses, another gap identified, needs to be strengthened to facilitate evidence-based decision-making on dengue vaccine introduction in endemic countries.
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Affiliation(s)
- Yesim Tozan
- a College of Global Public Health , New York University , New York , NY , USA
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Constenla D, Garcia C, Lefcourt N. Assessing the Economics of Dengue: Results from a Systematic Review of the Literature and Expert Survey. PHARMACOECONOMICS 2015; 33:1107-1135. [PMID: 26048354 DOI: 10.1007/s40273-015-0294-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The economics of dengue is complex and multifaceted. OBJECTIVES We performed a systematic review of the literature to provide a critical overview of the issues related to dengue economics research and to form a background with which to address the question of cost. METHODS Three literature databases were searched [PubMed, Embase and Latin American and Caribbean Health Sciences Literature (LILACS)], covering a period from 1980 to 2013, to identify papers meeting preset inclusion criteria. Studies were reviewed for methodological quality on the basis of a quality checklist developed for this purpose. An expert survey was designed to identify priority areas in dengue economics research and to identify gaps between the methodology and actual practice. Survey responses were combined with the literature review findings to determine stakeholder priorities in dengue economics research. RESULTS The review identified over 700 papers. Forty-two of these papers met the selection criteria. The studies that were reviewed presented results from 32 dengue-endemic countries, underscoring the importance of dengue as a global public health problem. Cost analyses were the most common, with 21 papers, followed by nine cost-effectiveness analyses and seven cost-of-illness studies, indicating a relatively strong mix of methodologies. Dengue annual overall costs (in 2010 values) ranged from US$13.5 million (in Nicaragua) to $56 million (in Malaysia), showing cost variations across countries. Little consistency exists in the way costs were estimated and dengue interventions evaluated, making generalizations around costs difficult. CONCLUSIONS The current evidence suggests that dengue costs are substantial because of the cost of hospital care and lost earnings. Further research in this area will broaden our understanding of the true economic impact of dengue.
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Affiliation(s)
- Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, 21205, USA.
- Dengue Vaccine Initiative (DVI), Baltimore, USA.
| | - Cristina Garcia
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, 21205, USA
| | - Noah Lefcourt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 855 N. Wolfe Street, Suite 600, Baltimore, 21205, USA
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Affiliation(s)
- Stephen J Thomas
- From the Walter Reed Army Institute of Research, Silver Spring, MD
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The human CD8+ T cell responses induced by a live attenuated tetravalent dengue vaccine are directed against highly conserved epitopes. J Virol 2014; 89:120-8. [PMID: 25320311 DOI: 10.1128/jvi.02129-14] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
UNLABELLED The incidence of infection with any of the four dengue virus serotypes (DENV1 to -4) has increased dramatically in the last few decades, and the lack of a treatment or vaccine has contributed to significant morbidity and mortality worldwide. A recent comprehensive analysis of the human T cell response against wild-type DENV suggested an human lymphocyte antigen (HLA)-linked protective role for CD8(+) T cells. We have collected one-unit blood donations from study participants receiving the monovalent or tetravalent live attenuated DENV vaccine (DLAV), developed by the U.S. National Institutes of Health. Peripheral blood mononuclear cells from these donors were screened in gamma interferon enzyme-linked immunosorbent spot assays with pools of predicted, HLA-matched, class I binding peptides covering the entire DENV proteome. Here, we characterize for the first time CD8(+) T cell responses after live attenuated dengue vaccination and show that CD8(+) T cell responses in vaccinees were readily detectable and comparable to natural dengue infection. Interestingly, whereas broad responses to structural and nonstructural (NS) proteins were observed after monovalent vaccination, T cell responses following tetravalent vaccination were, dramatically, focused toward the highly conserved NS proteins. Epitopes were highly conserved in a vast variety of field isolates and able to elicit multifunctional T cell responses. Detailed knowledge of the T cell response will contribute to the identification of robust correlates of protection in natural immunity and following vaccination against DENV. IMPORTANCE The development of effective vaccination strategies against dengue virus (DENV) infection and clinically significant disease is a task of high global public health value and significance, while also being a challenge of significant complexity. A recent efficacy trial of the most advanced dengue vaccine candidate, demonstrated only partial protection against all four DENV serotypes, despite three subsequent immunizations and detection of measurable neutralizing antibodies to each serotype in most subjects. These results challenge the hypothesis that seroconversion is the only reliable correlate of protection. Here, we show that CD8(+) T cell responses in vaccinees were readily detectable and comparable to natural dengue virus infection. Detailed knowledge of the T cell response may further contribute to the identification of robust correlates of protection in natural immunity and vaccination against DENV.
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Tozan Y, Ratanawong P, Louis VR, Kittayapong P, Wilder-Smith A. Use of insecticide-treated school uniforms for prevention of dengue in schoolchildren: a cost-effectiveness analysis. PLoS One 2014; 9:e108017. [PMID: 25247556 PMCID: PMC4172602 DOI: 10.1371/journal.pone.0108017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dengue-related illness is a leading cause of hospitalization and death, particularly among children. Practical, acceptable and affordable measures are urgently needed to protect this age group. Schools where children spend most of their day is proposed as an ideal setting to implement preventive strategies against day-biting Aedes mosquitoes. The use of insecticide-treated school uniforms is a promising strategy currently under investigation. METHODS Using a decision-analytic model, we evaluated the cost-effectiveness of the use of insecticide-treated school uniforms for prevention of dengue, compared with a "do-nothing" alternative, in schoolchildren from the societal perspective. We explored how the potential economic value of the intervention varied under various scenarios of intervention effectiveness and cost, as well as dengue infection risk in school-aged children, using data specific to Thailand. RESULTS At an average dengue incidence rate of 5.8% per year in school-aged children, the intervention was cost-effective (ICER≤$16,440) in a variety of scenarios when the intervention cost per child was $5.3 or less and the intervention effectiveness was 50% or higher. In fact, the intervention was cost saving (ICER<0) in all scenarios in which the intervention cost per child was $2.9 or less per year and the intervention effectiveness was 50% or higher. The results suggested that this intervention would be of no interest to Thai policy makers when the intervention cost per child was $10.6 or higher per year regardless of intervention effectiveness (ICER>$16,440). CONCLUSIONS Our results present the potential economic value of the use of insecticide-treated uniforms for prevention of dengue in schoolchildren in a typical dengue endemic setting and highlight the urgent need for additional research on this intervention.
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Affiliation(s)
- Yesim Tozan
- Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
- Steinhardt School of Culture, Education and Human Development, New York University, New York, New York, United States of America
- * E-mail:
| | - Pitcha Ratanawong
- Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - Valérie R. Louis
- Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - Pattamaporn Kittayapong
- Center of Excellence for Vectors and Vector-Borne Diseases, Faculty of Science, Mahidol University at Salaya, Nakhon Phatom, Thailand
| | - Annelies Wilder-Smith
- Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- University of Umea, Umea, Sweden
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Stoler J, Al Dashti R, Anto F, Fobil JN, Awandare GA. Deconstructing "malaria": West Africa as the next front for dengue fever surveillance and control. Acta Trop 2014; 134:58-65. [PMID: 24613157 DOI: 10.1016/j.actatropica.2014.02.017] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/19/2014] [Accepted: 02/23/2014] [Indexed: 11/15/2022]
Abstract
Presumptive treatment of febrile illness patients for malaria remains the norm in endemic areas of West Africa, and "malaria" remains the top source of health facility outpatient visits in many West African nations. Many other febrile illnesses, including bacterial, viral, and fungal infections, share a similar symptomatology as malaria and are routinely misdiagnosed as such; yet growing evidence suggests that much of the burden of febrile illness is often not attributable to malaria. Dengue fever is one of several viral diseases with symptoms similar to malaria, and the combination of rapid globalization, the long-standing presence of Aedes mosquitoes, case reports from travelers, and recent seroprevalence surveys all implicate West Africa as an emerging front for dengue surveillance and control. This paper integrates recent vector ecology, public health, and clinical medicine literature about dengue in West Africa across community, regional, and global geographic scales. We present a holistic argument for greater attention to dengue fever surveillance in West Africa and renew the call for improving differential diagnosis of febrile illness patients in the region.
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Affiliation(s)
- Justin Stoler
- Department of Geography and Regional Studies, University of Miami, 1300 Campo Sano Avenue, Coral Gables, FL, USA; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Rawan Al Dashti
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - Francis Anto
- Department of Epidemiology and Disease Control, University of Ghana, Legon, Ghana.
| | - Julius N Fobil
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana, Legon, Ghana.
| | - Gordon A Awandare
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon, Ghana.
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Weiskopf D, Sette A. T-cell immunity to infection with dengue virus in humans. Front Immunol 2014; 5:93. [PMID: 24639680 PMCID: PMC3945531 DOI: 10.3389/fimmu.2014.00093] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/21/2014] [Indexed: 11/21/2022] Open
Abstract
Dengue virus (DENV) is the etiologic agent of dengue fever, the most significant mosquito-borne viral disease in humans. Up to 400 million DENV infections occur every year, and severity can range from asymptomatic to an acute self-limiting febrile illness. In a small proportion of patients, the disease can exacerbate and progress to dengue hemorrhagic fever and/or dengue shock syndrome, characterized by severe vascular leakage, thrombocytopenia, and hemorrhagic manifestations. A unique challenge in vaccine development against DENV is the high degree of sequence variation, characteristically associated with RNA viruses. This is of particular relevance in the case of DENV since infection with one DENV serotype (primary infection) presumably affords life-long serotype-specific immunity but only partial and temporary immunity to other serotypes in secondary infection settings. The role of T cells in DENV infection and subsequent disease manifestations is not fully understood. According to the original antigenic sin theory, skewing of T-cell responses induced by primary infection with one serotype causes less effective response upon secondary infection with a different serotype, predisposing to severe disease. Our recent study has suggested an HLA-linked protective role for T cells. Herein, we will discuss the role of T cells in protection and pathogenesis from severe disease as well as the implications for vaccine design.
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Affiliation(s)
- Daniela Weiskopf
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology , La Jolla, CA , USA
| | - Alessandro Sette
- Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology , La Jolla, CA , USA
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Nazareth T, Teodósio R, Porto G, Gonçalves L, Seixas G, Silva AC, Sousa CA. Strengthening the perception-assessment tools for dengue prevention: a cross-sectional survey in a temperate region (Madeira, Portugal). BMC Public Health 2014; 14:39. [PMID: 24428823 PMCID: PMC3905660 DOI: 10.1186/1471-2458-14-39] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 12/17/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Community participation is mandatory in the prevention of Dengue outbreaks. Taking public views into account is crucial to guide more effective planning and quicker community participation in preventing campaigns. This study aims to assess community perceptions of Madeira population in order to explore their involvement in the A. aegypti's control and reinforce health-educational planning. Due to the lack of accurate methodologies for measuring perception, a new tool to assess the community's perceptions was built. METHODS A cross-sectional survey was performed in the Island's aegypti-infested area, exploring residents' perceptions regarding most critical community behaviour: aegypti-source reduction and their domestic aegypti-breeding sites. A novel tool defining five essential topics which underlie the source reduction's awareness and accession was built, herein called Essential-Perception (EP) analysis. RESULTS Of 1276 individuals, 1182 completed the questionnaire (92 · 6%). EP-Score analysis revealed that community's perceptions were scarce, inconsistent and possibly incorrect. Most of the population (99 · 6%) did not completely understood the five essential topics explored. An average of 54 · 2% of residents only partially understood each essential topic, revealing inconsistencies in their understanding. Each resident apparently believed in an average of four false assumptions/myths. Significant association (p<0.001) was found between both the EP-Score level and the domestic presence of breeding sites, supporting the validity of this EP-analysis. Aedes aegypti's breeding sites, consisting of décor/leisure containers, presented an atypical pattern of infestation comparing with dengue prone regions. CONCLUSIONS The studied population was not prepared for being fully engaged in dengue prevention. Evidences suggest that EP-methodology was efficient and accurate in assessing the community perception and its compliance to practices. Moreover, it suggested a list of myths that could persist in the community. This is the first study reporting an aegypti-entomological pattern and community's perception in a developed dengue-prone region. Tailored messages considering findings of this study are recommended to be used in future campaigns in order to more effectively impact the community perception and behaviour.
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Affiliation(s)
- Teresa Nazareth
- GABBA Doctoral Program, ICBAS, Abel Salazar Institute for the Biomedical Sciences, University of Porto, Porto, Portugal
- Unidade Clínica Tropical, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Unidade de Parasitologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Rosa Teodósio
- Unidade Clínica Tropical, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro de Malária e Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Graça Porto
- GABBA Doctoral Program, ICBAS, Abel Salazar Institute for the Biomedical Sciences, University of Porto, Porto, Portugal
- IBMC, Institute for Molecular and Cellular Biology, Porto, Portugal
| | - Luzia Gonçalves
- Unidade de Saúde Pública e Internacional e Bioestatística, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa (CEAUL), Universidade de Lisboa, Lisboa, Portugal
| | - Gonçalo Seixas
- Unidade de Parasitologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana Clara Silva
- Departamento de Saúde, Planeamento e Administração Geral, Instituto de Administração da Saúde e Assuntos Sociais, IP-RAM, Funchal, Portugal
| | - Carla Alexandra Sousa
- Unidade de Parasitologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Unidade de Parasitologia e Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
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