The global burden of dengue: an analysis from the Global Burden of Disease Study 2013

Abstract

Background: Dengue is the most common arbovirus infection globally, but its burden is poorly quantified. We estimated dengue mortality, incidence, and burden for the Global Burden of Disease Study 2013.

Methods: We modelled mortality from vital registration, verbal autopsy, and surveillance data using the Cause of Death Ensemble Modelling tool. We modelled incidence from officially reported cases, and adjusted our raw estimates for under-reporting based on published estimates of expansion factors. In total, we had 1780 country-years of mortality data from 130 countries, 1636 country-years of dengue case reports from 76 countries, and expansion factor estimates for 14 countries.

Findings: We estimated an average of 9221 dengue deaths per year between 1990 and 2013, increasing from a low of 8277 (95% uncertainty estimate 5353-10 649) in 1992, to a peak of 11 302 (6790-13 722) in 2010. This yielded a total of 576 900 (330 000-701 200) years of life lost to premature mortality attributable to dengue in 2013. The incidence of dengue increased greatly between 1990 and 2013, with the number of cases more than doubling every decade, from 8·3 million (3·3 million-17·2 million) apparent cases in 1990, to 58·4 million (23·6 million-121·9 million) apparent cases in 2013. When accounting for disability from moderate and severe acute dengue, and post-dengue chronic fatigue, 566 000 (186 000-1 415 000) years lived with disability were attributable to dengue in 2013. Considering fatal and non-fatal outcomes together, dengue was responsible for 1·14 million (0·73 million-1·98 million) disability-adjusted life-years in 2013.

Interpretation: Although lower than other estimates, our results offer more evidence that the true symptomatic incidence of dengue probably falls within the commonly cited range of 50 million to 100 million cases per year. Our mortality estimates are lower than those presented elsewhere and should be considered in light of the totality of evidence suggesting that dengue mortality might, in fact, be substantially higher.

Funding: Bill & Melinda Gates Foundation.

Figure 1. Age-standardised mortality from dengue (per million person-years), in 2013

ATG=Antigua and Barbuda. VCT=St Vincent and Grenadines. LCA=St Lucia. TTO=Trinidad and Tobago. TLS=Timor Leste. FSM=Federated States of Micronesia.

Figure 2. Age-standardised incidence rates of dengue (per 100 000 person-years), in 2013

ATG=Antigua and Barbuda. VCT=St Vincent and Grenadines. LCA=St Lucia. TTO=Trinidad and Tobago. TLS=Timor Leste. FSM=Federated States of Micronesia.

Figure 3. Change in disability-adjusted life-years for dengue since 1990 in dengue-endemic countries

Dengue-endemic countries are those with a non-zero probability of dengue transmission based on Bhatt and colleagues.