Dengue in Endemic Countries
About Dengue• Dengue fever is a mosquito-borne viral disease that has spread
rapidly around the world.1 Global incidence rates haveincreased about ten-fold from 2000 to 2019, and more countries arereporting their first outbreaks of the disease.1• Most dengue infections are asymptomatic or lead to mild illness
with flu-like symptoms, but occasionally severe dengue can lead topotentially life-threatening complications.1° Most dengue cases are either asymptomatic or subclinical;
approximately 25% lead to clinically apparent disease, and around
5% of these may develop into severe cases.2,3• Dengue is caused by four distinct, but closely related, dengue virus
serotypes (DENV-1, 2, 3 and 4).4
• Recovery from infection with one serotype is thought to provide
long lasting protection against that serotype, but not against otherserotypes.5 Individuals who are infected for a second time with adifferent serotype are at greater risk of severe dengue.1• Dengue is found mostly in urban and semi-urban areas in tropical and sub-tropical climates whereAedes aegypti and Aedes albopictus mosquitoes are most common.6° Climate conditions, such as rainy season in endemic countries, can lead to increased
mosquito breeding.7,8

Dengue is a Top Ten Threat to Global Health9• About 50% of the world’s population lives under the threat of dengue, which is responsible
for an estimated 390 million infections globally per year and people in morethan 125 countries are at risk of infection.1,6,10• The global economic burden of dengue is substantial and has been estimated to cost

$8.9 billion per year.11• Since 1970, dengue has spread from nine countries to being endemic in more than

100 countries.1,12° The Americas, South-East Asia and Western
Pacific regions are the most seriouslyaffected, with Asia representing ~70% of
the global burden of disease.1° More than six billion people could be atrisk for dengue by 2080 due to population
growth in endemic areas based on one
projection.6• A vast majority of dengue cases are asymptomatic or mild and self-managed, resulting
in the actual numbers of dengue cases being under-reported and making it difficult toestimate the true extent of the disease and incidence rates.1,13

Dengue Can Have a Negative Impact on Endemic
Regions and Put Significant Burdens on Communities
Epidemics are unpredictable and are becoming increasinglyfrequent.
• Severe dengue is a leading cause of hospitalization anddeath in children in Southeast Asia.14• Hospitals can struggle with high numbers of cases. During anoutbreak, affected areas can see a massive spike in cases andadmitted patients.15,16° Healthcare facilities may face difficulties in finding the necessary space to care for thesignificant influx of patients, resulting in overwhelmed health care systems.15° Staff on call may not always be sufficient to meet patient demand, leading to stress, fatigue,
and unexpected lack of attendance.15

The Economic Impact of Dengue is Broad

Individuals
The average cost perhospitalized person inendemic countries canrange from $30-$2,000
and families may spend

up to a quarter ofmonthly householdincome for hospitalizations

due to dengue fever, or more,
depending on socioeconomic
factors.17,18

Local Governments
Local governments indengue endemic regions
face the expenses ofpersonnel, equipment
and supplies neededfor vector control
and surveillance;and monitoring andcommunication of
information about cases,
outbreaks and death.19

Countries
Countries experiencing
dengue outbreaks may see
loss in tourism, businesstravel and in foreign andlocal investment.19
Dengue can also significantly
impact a region’sproductivity, with somepersisting dengue symptoms
including long-term fatigue
affecting educational levels
and labor supply.19

Controlling Dengue• Current efforts for dengue control are directed at reducing the infection rate throughvector control methods, such as personal protection, biological control, chemical control
and environmental management of mosquitoes 1,20,21 :° Preventing breeding: Removing or applying insecticide to
outdoor water storage containers;° Personal protection measures: Use of window screens,
repellents, or wearing clothing that minimizes skin
exposure;° Community engagement: Educate the community on
mosquito-borne diseases and mobilize together for vector
control;° Active mosquito and virus surveillance: Build
surveillance measures to monitor mosquito population.
• An integrated dengue prevention and control strategy is important to combating dengue, asrecommended by international organizations such as the World Health Organization (WHO)and Pan American Health Organization (PAHO). 20, 21

References
1World Health Organization. Dengue and Severe Dengue. https://www.who.int/en/news-room/fact-sheets/detail/dengue-andsevere-dengue. Published April 23, 2024.

2

CDC. Travelers’ Health- Yellow book. New York: Oxford University Press; 2020.

3

Wilder-Smith A. Current Infectious Disease Reports. 2018;20:50.

4CDC. About Dengue: What You Need to Know. https://www.cdc.gov/dengue/about/index.html. Published April 13, 2023.

5

Reich, et al. Interactions between serotypes of dengue highlight epidemiological impact of cross-immunity. J R Soc Interface 10:20130414. http://dx.doi.org/10.1098/rsif.2013.0414.

6

Messina, J.P., Brady, O.J., Golding, N. et al. The current and future global distribution and population at risk of dengue. Nat
Microbiol 4, 1508–1515 (2019). https://doi.org/10.1038/s41564-019-0476-8.

7World Health Organization (WHO). Dengue increase likely during rainy season: WHO warns. https://www.who.int/
westernpacific/news/item/11-06-2019-dengue-increase-likely-during-rainy-season-who-warns. Published June 11, 2019

8Guo, et al. Global Epidemiology of Dengue Outbreaks in 1990-2015: A Systematic Review and Meta-Analysis. Front Cell InfectMicrobiol. 2017 Jul 12;7:317. doi: 10.3389/fcimb.2017.00317.

9World Health Organization (WHO). Top ten threats to global health in 2019. https://www.who.int/newsroom/spotlight/
tenthreats-to-global-health-in-2019.

10

Guzman MG, Halstead SB, Artsob H, et al. Dengue: a continuing global threat. Nat Rev Microbiol. 2010;8(12 Suppl):S7-S16.
doi:10.1038/nrmicro2460.

11The Lancet Infectious Diseases. The Global Economic Burden of Dengue: A Systematic Analysis. Retrieved February 2024.

12

Guo, et al. Global Epidemiology of Dengue Outbreaks in 1990-2015: A Systematic Review and Meta-Analysis. Front Cell InfectMicrobiol. 2017 Jul 12;7:317. doi: 10.3389/fcimb.2017.00317.

13

Shepard, et al. The global economic burden of dengue: a systematic analysis. Lancet Infect Dis 2016;16:935–41.

14

Murray, et al. Epidemiology of dengue: past, present and future prospects. Clin Epidemiol. 2013 Aug 20;5:299-309. doi:
10.2147/CLEP.S34440.

15

PLOS. Neglected Tropical Disease. Societal impact of dengue outbreaks: Stakeholder perceptions and related implications. A
qualitative study in Brazil, 2015.

16

World Health Organization (WHO). WHO Scales Up Response to Worldwide Surge in Dengue. https://www.who.int/news-room/feature-stories/detail/who-scales-up-response-to-worldwide-surge-in-dengue. Published November 14, 2019.

17

Tozan Y, Ratanawong P, Sewe MO, Wilder-Smith A, Kittayapong P. Household costs of hospitalized dengue illness in semi-ruralThailand. PLoS Negl Trop Dis. 2017;11(9):e0005961.

18

Sri Lanka Journal of Child Health, 2014; 43(4): 205-207 . Economic cost of hospitalized non-fatal paediatric dengue at the Lady
Ridgeway Hospital for Children in Sri Lanka.

19

Castro MC, Wilson ME, Bloom DE. Disease and economic burdens of dengue. Lancet Infect Dis. (2017) 17:e70–8. doi: 10.1016/
S1473-3099(16)30545-X.

20

Pan American Health Organization (PAHO/WHO). Integrated management strategy for dengue prevention and control. https://www.paho.org/en/topics/dengue/integrated-management-strategy-dengue-prevention-and-control. Accessed March 11, 2024.

21

Wilder-Smith A, et al. Dengue. Lancet. 2019 Jan 26;393(10169):350-363. doi: 10.1016/S0140-6736(18)32560-1. PMID: 30696575.‌

C-ANPROM/INT/DENV/0023 May 2024. ©2024. Takeda Pharmaceutical Company Limited. All rights reserved.