Disease Burden of 32 Infectious Diseases in the Netherlands, 2007-2011

Abstract

Background: Infectious disease burden estimates provided by a composite health measure give a balanced view of the true impact of a disease on a population, allowing the relative impact of diseases that differ in severity and mortality to be monitored over time. This article presents the first national disease burden estimates for a comprehensive set of 32 infectious diseases in the Netherlands.

Methods and findings: The average annual disease burden was computed for the period 2007-2011 for selected infectious diseases in the Netherlands using the disability-adjusted life years (DALY) measure. The pathogen- and incidence-based approach was adopted to quantify the burden due to both morbidity and premature mortality associated with all short and long-term consequences of infection. Natural history models, disease progression probabilities, disability weights, and other parameters were adapted from previous research. Annual incidence was obtained from statutory notification and other surveillance systems, which was corrected for under-ascertainment and under-reporting. The highest average annual disease burden was estimated for invasive pneumococcal disease (9444 DALYs/year; 95% uncertainty interval [UI]: 8911-9961) and influenza (8670 DALYs/year; 95% UI: 8468-8874), which represents 16% and 15% of the total burden of all 32 diseases, respectively. The remaining 30 diseases ranked by number of DALYs/year from high to low were: HIV infection, legionellosis, toxoplasmosis, chlamydia, campylobacteriosis, pertussis, tuberculosis, hepatitis C infection, Q fever, norovirus infection, salmonellosis, gonorrhoea, invasive meningococcal disease, hepatitis B infection, invasive Haemophilus influenzae infection, shigellosis, listeriosis, giardiasis, hepatitis A infection, infection with STEC O157, measles, cryptosporidiosis, syphilis, rabies, variant Creutzfeldt-Jakob disease, tetanus, mumps, rubella, diphtheria, and poliomyelitis. The very low burden for the latter five diseases can be attributed to the National Immunisation Programme. The average disease burden per individual varied from 0.2 (95% UI: 0.1-0.4) DALYs per 100 infections for giardiasis, to 5081 and 3581 (95% UI: 3540-3611) DALYs per 100 infections for rabies and variant Creutzfeldt-Jakob disease, respectively.

Conclusions: For guiding and supporting public health policy decisions regarding the prioritisation of interventions and preventive measures, estimates of disease burden and the comparison of burden between diseases can be informative. Although the collection of disease-specific parameters and estimation of incidence is a process subject to continuous improvement, the current study established a baseline for assessing the impact of future public health initiatives.

Fig 1. Average annual disease burden in the Netherlands in 2007–2011 for new cases of sexually-transmitted infections.

YLD and YLL components are shown separately. Red lines indicate 95% uncertainty intervals.(DALY = Disability-Adjusted Life Year, YLD = Years Lived with Disability, YLL = Years of Life Lost).

Fig 2. Ranking of sexually-transmitted infections by disease burden at population/individual level in the Netherlands in 2007–2011.

The area of each bubble is proportional to the average number of estimated annual cases. Both axes are on a logarithmic scale.(DALY = Disability-Adjusted Life Years, population level = number of DALYs/year, individual level = number of DALYs/100 infections).

Fig 3. Average annual disease burden in the Netherlands in 2007–2011 for new cases of vaccine-preventable diseases.

YLD and YLL components are shown separately. Red lines indicate 95% uncertainty intervals. (DALY = Disability-Adjusted Life Year, YLD = Years Lived with Disability, YLL = Years of Life Lost, I. = invasive).

Fig 4. Ranking of vaccine-preventable diseases by disease burden at population/individual level in the Netherlands in 2007–2011.

Diphtheria and poliomyelitis could not be included because there were no cases reported in this period. The area of each bubble is proportional to the average number of estimated annual cases (50 cases were added to each bubble for visibility reasons). Both axes are on a logarithmic scale. (DALY = Disability-Adjusted Life Years, population level = number of DALYs/year, individual level = number of DALYs/100 infections, I. = invasive).

Fig 5. Average annual disease burden in the Netherlands in 2007–2011 for new cases of food-related diseases.

YLD and YLL components are shown separately. Red lines indicate 95% uncertainty intervals. (DALY = Disability-Adjusted Life Year, YLD = Years Lived with Disability, YLL = Years of Life Lost).

Fig 6. Ranking of food-related diseases by disease burden at population/individual level in the Netherlands in 2007–2011.

The area of each bubble is proportional to the average number of estimated annual cases (200 cases were added to each bubble for visibility reasons). Both axes are on a logarithmic scale. (DALY = Disability-Adjusted Life Years, population level = number of DALYs/year, individual level = number of DALYs/100 infections).

Fig 7. Average annual disease burden in the Netherlands in 2007–2011 for new cases of respiratory diseases.

YLD and YLL components are shown separately. Red lines indicate 95% uncertainty intervals. (DALY = Disability-Adjusted Life Year, YLD = Years Lived with Disability, YLL = Years of Life Lost).

Fig 8. Ranking of respiratory diseases by disease burden at population/individual level in the Netherlands in 2007–2011.

The area of each bubble is proportional to the average number of estimated annual cases. Both axes are on a logarithmic scale. (DALY = Disability-Adjusted Life Years, population level = number of DALYs/year, individual level = number of DALYs/100 infections).