“…However in the past decade, a trend toward infections in younger age groups (De Rivera et al, 2008; Hammond et al, 2005) and a downward shift in the age of severe dengue disease cases (Nunes-Araujo et al, 2003; Rodriguez-Barraquer et al, 2011; Teixeira et al, 2008; Teixeira et al, 2009) has been reported for the Americas. The overall burden of dengue disease in the Americas is currently estimated to be 99 – 1,300 disability adjusted life years (DALYs) per million, depending on the spatiotemporal attributes of epidemics (Guzman et al, 2010; Luz et al, 2009; Mathers et al, 2007; Torres and Castro, 2007; Wettstein et al, 2012), imposing enormous economic burdens on national economies and on patients for whom the costs associated with DENV infection significantly exceed average monthly income [(Anez et al, 2006; Armien et al, 2008; Luz et al, 2011; Shepard et al, 2011; Suaya et al, 2009; Wettstein et al, 2012) and reviewed in (Beatty et al, 2011; Gubler, 2012b)].…”