Dengue is a mosquito-borne viral disease. Female mosquito species known as “Aedes aeqypti” are the vectors that cause Dengue fever. On a smaller scale, species with the name “Ae. Albopictus” also spread dengue fever. Dengue is widespread in tropical and subtropical regions, causing severe illness or death in some Asian and Latin American countries. 390 million dengue infections are estimated each year in more than 100 countries, which puts a strain on the healthcare systems of the affected countries. Asia is the worst-hit region, bearing 70% of the affliction from dengue and increasing incidences in the Americas, Africa, and Thailand. Because there is no specific treatment for dengue fever, its impact on the health care system and global or national economies is significant.
[REFERENCE: “Aedes Aegypti – Factsheet for Experts.” European Centre for Disease Prevention and Control, 9 June 2017, www.ecdc.europa.eu/en/disease-vectors/facts/mosquito-factsheets/aedes-aegypti.]
Dengue Fever Patterns: Global Outbreaks and Risks
The world has experienced an exponential surge of Dengue in the last couple of decades. Though a proportion of Dengue cases are asymptomatic, mild, and self-managed, the World Health Organization has recorded an eight-fold increase in Dengue cases reported in the last two decades. A total of 96 million cases of Dengue manifest clinically out of 390 million each year. Unreported and self-managed cases result in inaccurate estimates and consequent uncertainty over the cost of health care when implementing preventive and control strategies.
Dengue fever is prevalent in over 100 countries spanning Africa, the Americas, the Eastern Mediterranean, Southeast Asia, and the western Pacific. Europe also faces the looming threat of Dengue outbreaks. In 2019, there was a significant surge in Dengue cases, including the first-ever transmission in Afghanistan. The American region alone witnessed 3.1 million cases, while Bangladesh, Malaysia, the Philippines, and Vietnam reported 101,000, 131,000, 420,000, and 320,000 cases, respectively. Brazil, India, Vietnam, the Philippines, the Cook Islands, Columbia, Fiji, Kenya, Paraguay, Peru, and the Reunion Islands are among the countries most heavily affected by Dengue.
[REFERENCE: Arora, Anshana. “Innovative Methods for Predicting Dengue Cases in Brazil – UNICEF Data for Action Blog.” UNICEF DATA, 26 Sept. 2022, data.unicef.org/data-for-action/innovative-methods-for-predicting-dengue-cases-in-brazil.]
Dengue Fever Causes And Symptoms
There are four closely related stereotypes about the dengue virus (DENV-1, DENV-2, DENV-3, and DENV-4). Dengue is divided into two categories by the World Health Organization: mild Dengue and severe Dengue. Symptoms of Dengue are fever, nausea, vomiting, aches, and excruciating pain in muscles or joints, whereas severe Dengue symptoms are internal bleeding, organ failure, shock, and a substantial risk of death. Recovery from Dengue is likely to provide lifelong immunity from the stereotype that affected the individual; however, cross-immunity from other stereotypes is only partial, and a second-time infection from a different stereotype can develop severe Dengue.
Unplanned Urbanization
Unplanned urbanization is a driving factor that amplifies various social and environmental aspects contributing to the transmission of Dengue. Population density, human mobility, water source, lack of sanitization, and poor living conditions in urban centers complement the breeding of Dengue vectors, Aedes aegyptus and Ae. Albopictus. Climate change has created conducive conditions for vector habitats through changing rainfall patterns, humidity, and temperature. Rising temperatures attributed to climate change will increase mosquitoes’ survival, reproduction, and biting rates. Rapid urbanization, climate change, and population growth are the major factors that threaten the food and health security of the world. The same factor enhances the endemic characteristics of Dengue and is estimated to affect 60% of the world’s population by 2080.
The Strain on Health Care System by Dengue Fever
The cost of Dengue, like any other disease, has various direct and indirect impacts. Direct costs encompass the expenditures incurred on Dengue Fever diagnosis, Dengue fever treatment, and prevention. The indirect cost amounts to economic value lost by households and society due to illness, morbidity, and mortality. Dengue is dangerous, endemic, thrives in urban centers, transmits exponentially, and has no specific treatment. Albeit, governments have to mainly focus on preventive and control strategies, which boost the direct cost and burden the health care system. The global economic burden of Dengue is estimated to be more than $9 billion per year, exceeding several other infectious diseases. Dengue fever is a resource-heavy outbreak due to increasing cases vis-à-vis inadequate space to accommodate all arriving patients in hospitals. In Pakistan, the average direct cost per patient is estimated to be 358 US dollars, much higher than the average monthly income per household.
Economic Burden of Dengue
One of the peculiar aspects of Dengue is its unparalleled productivity cost, which amounts to 40% of the total economic burden of Dengue. Dengue outbreaks render a sizeable portion of affected individuals ineffective or unproductive due to illness, which complements the productivity cost of Dengue. Around 18% of symptomatic patients are hospitalized, 43% are treated in ambulatory settings, and 48% are treated in non-medical settings all over the world. 11% of $9 billion is attributed to fatal cases, 46% to hospitalized nonfatal, 33% to ambulatory nonfatal, and 8% to non-medical cases.
Vaccination is a proactive preventive and control strategy that curbs the direct, indirect, and productivity costs in terms of reduced hospitalization, minimal impact on the efficiency of the population, and less expenditure on community control to avoid the spread of an outbreak. In the absence of specific Dengue treatments and vaccines, the direct cost tends to multiply manifolds.
Common Strategies for the World to Fight Dengue
Personal preventive measures rely on avoiding mosquito bites, which are ensured through distance from the breeding habitat, wearing full clothes to minimize the skin’s exposure, using repellants, etc. However, it is high time that the world acts decisively to hold the bull by the horn. The first and foremost thing that is instrumental in the outbreaks of Dengue is unplanned urbanization. It leads to population density, poor sanitization, and stagnant water, creating an ideal environment for the habitat and reproduction of Dengue vectors. Dengue is dangerous, and the World Health Organization must put its weight behind it and force the Dengue-affected countries to have well-planned urbanization to reduce Dengue fever causes, the direct cost, and the productivity cost associated with Dengue.
The second most important factor that impacts transmission, breeding, and Dengue fever pattern is climate change, which requires the collective resolve of the world. The rising temperature, population growth, and ill-planned urbanization facilitate the reproduction and survival of Dengue vectors. Though Dengue may not be the leading concern, world leaders have to come together to avoid the devastating and ruinous cataclysm of climate change.
Conclusion
Dengue fever poses significant challenges to healthcare systems globally, particularly in tropical and subtropical regions. The disease is transmitted by mosquito vectors and has no specific treatment, leading to severe illness and even death in some cases. The increasing incidence of Dengue, coupled with unplanned urbanization, climate change, and population growth, exacerbates its impact on health care and economies. The direct and indirect costs of Dengue are substantial, with the disease burden estimated to exceed $9 billion annually. Productivity costs also contribute significantly to the economic burden, as affected individuals are rendered unproductive due to illness. Vaccination is a crucial strategy to mitigate the costs and effects of Dengue, but currently, there are no specific treatments or vaccines available. Urgent action is needed to address unplanned urbanization and climate change to reduce Dengue transmission and its detrimental effects on health care systems worldwide.
