Epidemic Dengue Fever in Puerto Rico, 1977: a Cost Analysis

Allmen, S. D. Von; López-Correa, Raúl H.; Woodall, John; Morens, David M.; Chiriboga, J.; Casta-velez, A.

doi:10.4269/ajtmh.1979.28.1040

Cited by 41 publications

(39 citation statements)

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“…38 In Puerto Rico as well, dengue has been shown to have a large economic impact, in terms of direct costs associated with medical care, hospitalization, and epidemic control measures, as well as indirect costs (lost production of ill workers and parents of ill children). 39 A recent study found that disability-adjusted life year (DALY) losses due to dengue in Puerto Rico were on the order of those due to malaria, tuberculosis, or hepatitis in the Latin American/Caribbean region. 40 The importance of laboratory confirmation of clinical diagnosis was reaffirmed, as a number of dengue cases were misdiagnosed based solely on clinical suspicion (ranging from 47% in DF cases to 17% in DSS cases and 10% in DSAS cases).…”

Section: Discussionmentioning

confidence: 99%

Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in Nicaragua.

Harris¹,

Videa²,

Pérez³

et al. 2000

Am J Trop Med Hyg

261

206

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Abstract. From July to December 1998, a hospital-and health center-based surveillance system for dengue was established at selected sites in Nicaragua to better define the epidemiology of this disease. Demographic and clinical information as well as clinical laboratory results were obtained, and virus isolation, reverse transcriptase-polymerase chain reaction, and serologic assays were performed. World Health Organization criteria were used to classify disease severity; however, a number of patients presented with signs of shock in the absence of thrombocytopenia or hemoconcentration. Therefore, a new category was designated as ''dengue with signs associated with shock'' (DSAS). Of 1,027 patients enrolled in the study, 614 (60%) were laboratory-confirmed as positive cases; of these, 268 (44%) were classified as dengue fever (DF); 267 (43%) as DF with hemorrhagic manifestations (DFHem); 40 (7%) as dengue hemorrhagic fever (DHF); 20 (3%) as dengue shock syndrome (DSS); and 17 (3%) as DSAS. Interestingly, secondary infection was not significantly correlated with DHF/DSS, in contrast to previous studies in Southeast Asia. DEN-3 was responsible for the majority of cases, with a minority due to DEN-2; both serotypes contributed to severe disease. As evidenced by the analysis of this epidemic, the epidemiology of dengue can differ according to geographic region and viral serotype.

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Section: Discussionmentioning

confidence: 99%

Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in Nicaragua.

Harris¹,

Videa²,

Pérez³

et al. 2000

Am J Trop Med Hyg

261

206

View full text Add to dashboard Cite

show abstract

“…Around 10 4 to 10 5 persons are commonly affected during epidemics in Puerto Rico, often resulting in substantive economic impacts. During the 1977 epidemic when an estimated 335,000 Puerto Ricans were affected (Morens et al 1986), the economic impact associated with medical costs, lost work and control measures alone fell between US $6 and $16 × 10 6 (Von Allmen et al 1979). The economic damage is substantially magnified for multi-epidemic decades.…”

Section: Introductionmentioning

confidence: 98%

An investigation of relationships between climate and dengue using a water budgeting technique

Kv¹

2001

Int J Biometeorol

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Climatic water budget indicators were used to assess intra- and interannual variations in dengue incidence for San Juan, Puerto Rico. Multivariate stochastic relationships between dengue and the water budget were developed to (1) determine and quantify the particular climatic measures and their associated lag periods related to dengue variations, and (2) assess their use for dengue prediction and initiation of emergency response procedures. Such a predictive model would be advantageous because it is based on reliable, easily obtained, and low-cost weather observations. Daily running averages of water budget variables over an 8-week period were related to daily running averages of unconfirmed dengue totals (1988-1993). Resultant models show that a variety of water budget and traditional climate measures over the full 8-week period are associated with dengue. The mean seasonal variation in dengue is highly related (R2=88.1%) to the mean seasonal climate variation, with those thermal and energy variables immediately preceding the dengue response showing the strongest relationships. However, moisture variables, predominantly in the form of surplus, are more influential many weeks in advance. For the interannual model (R2=44.1%), energy change, thermal change, and moisture variables are significant across the 8-week period, with moisture variables playing a stronger role than in the intraannual model. Standardisation substantially changes the importance and timing of the variables, and suggests that dengue during this period is more associated with the mean annual variation of climate than deviations from mean conditions. A dengue early-warning model (based on 5 weeks of climate data) was also developed to predict dengue incidence 3 weeks later. While this predictive model is not reliable as a sole predictor of dengue in San Juan, it may be useful as part of a multifaceted watch/warning system.

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“…Although other efforts have included out-of-pocket payments covered by the population, as a result of transportation, food, indebtedness, or other costs, these were not included here because of the variability in costs and the lack of reliable data for determining these contributions to the total costs. 40,41 Our definition of total costs, therefore, necessarily excludes these; future in-depth analyses could include these other costs that we have not included.…”

Section: Economics Of Dengue Illness In Nicaraguamentioning

confidence: 99%

Total Economic Cost and Burden of Dengue in Nicaragua: 1996–2010

Wettstein¹,

Fleming²,

Chang³

et al. 2012

The American Society of Tropical Medicine and Hygiene

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Abstract. The burden of dengue in Nicaragua has been steadily rising during the last three decades; however, there have been few efforts to quantify the burden (measured in disability-adjusted life years [DALYs]) and cost to society. Using primary data from the Nicaraguan Ministry of Health (MINSA), the total cost and burden of dengue were calculated from 1996 to 2010. Total costs included both direct costs from medical expenditures and prevention activities and indirect costs from lost productivity. The annual disease burden ranged from 99 to 805 DALYs per million, with a majority associated with classic dengue fever. The total cost was estimated to be US$13.5 million/year (range: US$5.1-27.6 million). This analysis can help improve allocation of dengue control resources in Nicaragua and the region. As one of the most comprehensive analyses of its type to date in Nicaragua and Latin America, this study can serve as a model to determine the burden and cost of dengue.

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Epidemic Dengue Fever in Puerto Rico, 1977: a Cost Analysis

Cited by 41 publications

References 1 publication

Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in Nicaragua.

Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in Nicaragua.

An investigation of relationships between climate and dengue using a water budgeting technique

Total Economic Cost and Burden of Dengue in Nicaragua: 1996–2010

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