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

Abstract

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 modeled mortality from vital registration, verbal autopsy, and surveillance data using the Cause of Death Ensemble Modeling tool. We modeled incidence from officially reported cases, and adjusted our raw estimates for underreporting based on published estimates of expansion factors. In total, we had 1,780 country-years of mortality data from 130 countries, 1,636 country-years of dengue case reports from 76 countries, and expansion factor estimates for 14 countries.

Findings

We estimated an average of 9,221 dengue deaths per year between 1990 and 2013, increasing from a low of 8,277 (95% uncertainty estimate 5,353–10,649) in 1992, to a peak of 11,302 (6,790–13,722) 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 nonfatal 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.