Global estimation of dengue disability weights based on clinical manifestations data

Abstract

Background: Dengue is a major global health threat with varied clinical manifestations across age groups, countries, and regions. This study aims to estimate global dengue disability weights (DWs) based on clinical manifestations data and examine variations across different demographics and geographical areas. These findings will inform public health strategies and interventions to reduce the global burden of dengue.

Methods: We conducted a systematic search across six databases (Scopus, Web of Science, PubMed, China National Knowledge Infrastructure, Wanfang Data, and Database of Chinese sci-tech periodicals) for studies on human dengue clinical manifestations or infection from the establishment of each database through December 31, 2023. DWs were estimated by combining clinical manifestations frequencies with corresponding DW values derived from the Global Burden of Disease (GBD) study, using Monte Carlo simulations to generate uncertainty intervals. Odds ratios (ORs) with 95% confidence intervals (CI) and Chi-square tests were performed to compare clinical manifestations between adults and children.

Results: A total of 35 adult studies (7109 cases) and 17 pediatric studies (2996 cases) were analysed. Adults had higher rates of muscle pain (OR = 9.18; 95% CI: 8.17-10.33) and weak (OR = 4.95; 95% CI 4.12-5.98). Children showed higher frequencies of decreased appetite (OR = 0.12; 95% CI: 0.11-0.14) and lymphadenectasis (OR = 0.04; 95% CI: 0.03-0.06). Severe dengue was more prevalent in children (8.2%) than adults (4.6%). The global DW for universal dengue was 0.3258 in adults and 0.4022 in children, with Indian children showing the highest DW for severe dengue (0.6991) and Chinese adult showing the highest DW for severe dengue (0.7214). Regionally, most studies were from South and Southeast Asia, with India contributing the largest number of publications (80 articles). Additionally, India had the highest dengue disease burden in 2021 (352,468.54 person-years).

Conclusions: These findings reveal important age and regional differences in dengue disease burden. There is a relative lack of research on dengue clinical manifestations in several high-burden countries in the Americas, and these gaps may affect the comprehensiveness and accuracy of global dengue disability weight estimates. These highlight the urgent need for targeted interventions and optimized resource allocation to mitigate its global impact.

Keywords: Clinical manifestation; Dengue; Disability weight; Meta-analysis; Region-specific.

Fig. 1

Study selection process flowchart. The flowchart shows the systematic selection and screening of research articles, divided into two paths: articles focusing on dengue (both mild and severe) on the left, and articles focusing only on severe dengue on the right

Fig. 2

Comparison of clinical manifestations and incidence rates of dengue in adults and children. The bar chart compares the incidence of various clinical manifestations of dengue fever in adults and children, ranked from highest to lowest in the adult group. The Y-axis shows the different clinical manifestations, and the X-axis shows the incidence (%) in both adults and children

Fig. 3

Subgroup analysis of severe dengue combined incidence rate in adults and children. The studies are categorized into adult (A) and pediatric (B) groups, further divided into before 2009 and after 2009 periods, with a combined incidence rate calculated for each to observe changes between the two time periods