Mosquito-borne disease costs India $1.1 billion per year.
By The American Bazaar Staff
WASHINGTON, DC: The annual average of 20,000 laboratory confirmed cases of dengue in India may be just the tip of the iceberg as far as the mosquito-borne fever disease is concerned: the actual number may be actually a startling six million cases, says a new study.
The new study published online on Tuesday in the American Journal of Tropical Medicine & Hygiene estimates that the 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 $1.11 billion each year in medical and other expenses.
The study, led by researchers at Brandeis University’s Schneider Institute for Health Policy in Waltham, Massachusetts, the INCLEN Trust International in New Delhi, and the Indian Council of Medical Research’s Centre 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.
“We found that India had nearly 6 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 Donald Shepard, PhD, lead author of the study and a health economics professor at Brandeis University, in a statement. “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.”
Dengue, a viral disease transmitted by Aedes mosquitoes, is a serious global public health problem, infecting 50 to 390 million people each year in more than 100 countries and 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. India had a major dengue outbreak in 2013, with more than 55,000 reported cases, triggered largely by the heaviest rains in two decades.
The researchers conducted a three-part national retrospective study. They 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). They then used that data, along with less complete disease surveillance data from 18 other states and information from a panel of dengue experts, to calculate a national estimate for annual dengue cases, including ambulatory cases (ones in which the patient was treated but not hospitalized).
To estimate the cost of each dengue case, the researchers analyzed the medical records of 1,541 dengue patients who had been treated in 10 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.
The Economist reported that prime minister Narendra Modi’s drive to ‘clean up’ India, could go a long way in tackling the disease. It also pointed out to methods used in Singapore, to remove breeding spots for the mosquitoes by draining even small pools of water in urban areas—or to attack the vector by other means, such as insecticides.
“Elsewhere, as in Australia and Brazil, new technology is being used to disrupt the ability of mosquitoes to pass on dengue. One of their methods has been to spread about mosquitoes which have inserted into them a bacterium taken from fruit flies. And there is work under way towards a vaccine for dengue—the study released this week was funded by a vaccine-maker, Sanofi Pasteur, though the researchers say the firm had no role in preparing or influencing their work,†pointed out the Economist report.