Persistent Symptoms of Dengue: Estimates of the Incremental Disease and Economic Burden in Mexico

Abstract

Dengue is mostly considered an acute illness with three phases: febrile, critical with possible hemorrhagic manifestations, and recovery. But some patients present persistent symptoms, including fatigue and depression, as acknowledged by the World Health Organization. If persistent symptoms affect a non-negligible share of patients, the burden of dengue will be underestimated. On the basis of a systematic literature review and econometric modeling, we found a significant relationship between the share of patients reporting persisting symptoms and time. We updated estimates of the economic burden of dengue in Mexico, addressing uncertainty in productivity loss and incremental expenses using Monte Carlo simulations. Persistent symptoms represent annually about US$22.6 (95% certainty level [CL]: US$13–US$29) million in incremental costs and 28.2 (95% CL: 21.6–36.2) additional disability-adjusted life years per million population, or 13% and 43% increases over previous estimates, respectively. Although our estimates have uncertainty from limited data, they show a substantial, unmeasured burden. Similar patterns likely extend to other dengue-endemic countries.

Disease Burden of Dengue in the Philippines: Adjusting for Underreporting by Comparing Active and Passive Dengue Surveillance in Punta Princesa, Cebu City

“…Another limitation includes the reliance on expert opinion to allocate dengue cases by treatment setting 10. Finally, our estimates of disease burden did not include persistent symptoms, such as fatigue, asthenia, depression, and weight loss, that have been associated with DENV infection,8,78 as acknowledged by the WHO since 1997 57. Persistent symptoms may represent about a 40% increase in disease burden estimates over those from acute impacts 78…”

The Uncertainty Surrounding the Burden of Post-acute Consequences of Dengue Infection

“…A range of post-acute consequences of dengue have been reported across different studies [3]. The most consistently reported included myalgia, weakness, headache, fever, and fatigue [3][4][5][6][7]. However, some of these symptoms, such as fever or headache, are quite common and are prevalent during an acute dengue episode.…”

“…Both hospitalized patients and outpatients can experience these post-acute consequences and they have not been shown to associate with the severity of the acute episode [4,8]. Furthermore, postacute consequences were usually associated with female gender and older age [3,4,9].…”

“…The estimated proportion of patients experiencing post-acute consequences varies significantly across studies and tends to decrease over time after the acute illness [3,6]. Figure 2 illustrates the percentage of patients reporting dengue symptoms that may result in productivity losses (fatigue, asthenia, or trouble working) by elapsed follow-up time.…”

“…A recent study estimated that accounting for the post-acute consequences would increase the economic burden of dengue in Mexico by an additional 13%. Specifically, the post-acute consequences were estimated to contribute an incremental economic cost of US$1.95 million in direct costs and US$20.68 million in productivity costs (indirect costs) (2012 prices) [3]. The productivity costs were calculated based on the assumption that adult patients experiencing post-acute consequences had a 45% reduction in productivity.…”