Dengue In India 300 Times Under-Reported

Researchers estimate that the dengue infection rates in India are 282 times higher than officially reported, costing the country US$1.11 billion each year.

AsianScientist (Oct. 10, 2014) – The annual number of dengue fever cases in India is 282 times higher than officially reported, and the disease inflicts an economic burden on the country of at least US$1.11 billion each year in medical and other expenses, according to a study published in the American Journal of Tropical Medicine & Hygiene.

The study, led by researchers at Brandeis University’s Schneider Institute for Health Policy in Waltham, Massachusetts, the International Clinical Epidemiology Network (INCLEN) Trust International in New Delhi and the Indian Council of Medical Research’s Center for Research in Medical Entomology (CRME) in Madurai, Tamil Nadu, is the first to use systematic empirical data to estimate both the disease burden and the direct and indirect costs of dengue in India. Until now, the reported data indicated that there was an annual average of 20,000 laboratory confirmed cases.

“We found that India had nearly six million annual clinically diagnosed dengue cases between 2006 and 2012—almost 300 times greater than the number of cases that had been officially reported,” said Dr. Donald Shepard, lead author of the study and a health economics professor at Brandeis University.

“Yet we believe even that number may be low because dengue reporting is better in the area we studied in the state of Tamil Nadu than in most other Indian states due to its well-established medical surveillance system.”

In recent decades, dengue outbreaks in India have become larger and more frequent, with a greater number of severe cases and deaths.

“Good data on the incidence and cost of the illness have been lacking due to gaps in how information on individual cases is collected and reported,” said Dr. Narendra Arora, executive director of INCLEN.

Dengue infects 50 to 390 million people each year in more than 100 countries, resulting in at least 20,000 deaths annually. Symptoms of the disease range from mild fever and joint pain to potentially fatal hemorrhaging and circulatory shock. No effective anti-viral drugs yet exist to treat the illness, and large mosquito-control efforts have thus far failed to stem the increasing incidence and spread of dengue epidemics.

India is believed to have more cases of dengue than any other country in the world, and except for a slight dip in 2011, the incidence rate has grown steadily there in recent years. In 2013, India’s National Vector Borne Diseases Control Program reported that the country had experienced an annual average of 20,474 dengue cases and 132 dengue-related deaths since 2007, but infectious disease experts believe those official numbers likely reflect only a small fraction of actual cases.

To reach a more accurate assessment of both the incidence and economic burden of dengue in India, Shepard and his colleagues conducted a three-part national retrospective study.

To determine the annual number of dengue patients in India, the researchers collected data on patients who had been hospitalized with the disease in the Madurai district of the state of Tamil Nadu during a three-year period (2009-2011). To estimate the cost of each dengue case, the researchers analyzed the medical records of 1,541 dengue patients who had been treated in ten public and private medical college hospitals across India from 2006 through 2011. Gaps in those data were then filled in through a survey of 151 patients who had received care at a medical college hospital in Mumbai in 2012 and 2013.

In the final part of the study, the researchers used those cost findings, along with the results of the Madurai analysis, to estimate the total annual economic burden of dengue in India. They found that the total direct medical cost to India was US$548 million per year, or about US$94.85 per patient. Given that the average dengue case lasts about two weeks, that figure breaks down to US$6.77 per patient per day. Dengue is therefore more expensive to treat in India than tuberculosis. The overall annual economic cost of dengue in India was estimated to be about US$1.11 billion annually.

While this study indicates that the economic and disease burdens of dengue in India are hundreds of times greater than estimates based entirely on official reports, further studies are needed to garner additional detail. Most notably, the incidence estimate relies heavily on data from only one district: Madurai.

“Understanding the full extent of the economic and disease burden of dengue in India is necessary to help policymakers and public health officials prepare for and control future outbreaks of the disease,” said Dr. Brij Kishore Tyagi, senior investigator from CRME.

The article can be found at: Shepard et al. (2014) Economic and Disease Burden of Dengue Illness in India.

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Source: Brandeis University; Photo: Curtis Palmer/Flickr/CC.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

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