Volume 91, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Between 2006 and 2012 India reported an annual average of 20,474 dengue cases. Although dengue has been notifiable since 1996, regional comparisons suggest that reported numbers substantially underrepresent the full impact of the disease. Adjustment for underreporting from a case study in Madurai district and an expert Delphi panel yielded an annual average of 5,778,406 clinically diagnosed dengue cases between 2006 and 2012, or 282 times the reported number per year. The total direct annual medical cost was US$548 million. Ambulatory settings treated 67% of cases representing 18% of costs, whereas 33% of cases were hospitalized, comprising 82% of costs. Eighty percent of expenditures went to private facilities. Including non-medical and indirect costs based on other dengue-endemic countries raises the economic cost to $1.11 billion, or $0.88 per capita. The economic and disease burden of dengue in India is substantially more than captured by officially reported cases, and increased control measures merit serious consideration.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Beatty ME, Beutels P, Meltzer MI, Shepard DS, Hombach J, Hutubessy R, Dessis D, Coudeville L, Dervaux B, Wichmann O, Margolis HS, Kuritsky JN, , 2011. Health economics of dengue: a systematic literature review and expert panel's assessment. Am J Trop Med Hyg 84: 473488.[Crossref] [Google Scholar]
  2. Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, Drake JM, Brownstein JS, Hoen AG, Sankoh O, Myers MF, George DB, Jaenisch T, Wint GR, Simmons CP, Scott TW, Farrar JJ, Hay SI, , 2013. The global distribution and burden of dengue. Nature 496: 504507.[Crossref] [Google Scholar]
  3. Gubler DJ, , 2002. Epidemic dengue/dengue hemorrhagic fever as a public health, social and economic problem in the 21st century. Trends Microbiol 10: 100103.[Crossref] [Google Scholar]
  4. Murray NE, Quam MB, Wilder-Smith A, , 2013. Epidemiology of dengue: past, present and future prospects. Clin Epidemiol 5: 299309. [Google Scholar]
  5. World Health Organization, 2009. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Geneva: World Health Organization. [Google Scholar]
  6. Gupta N, Srivastava S, Jain A, Chaturvedi UC, , 2012. Dengue in India. Indian J Med Res 136: 373390. [Google Scholar]
  7. Rochlin I, Ninivaggi DV, Hutchinson ML, Farajollahi A, , 2013. Climate change and range expansion of the Asian tiger mosquito (Aedes albopictus) in northeastern USA: implications for public health practitioners. PLoS ONE 8: e60874.[Crossref] [Google Scholar]
  8. Schwartz E, Weld LH, Wilder-Smith A, von Sonnenburg F, Keystone JS, Kain KC, Torresi J, Freedman DO, GeoSentinel Surveillance Network; , 2008. Seasonality, annual trends, and characteristics of dengue among ill returned travelers, 1997–2006. Emerg Infect Dis 14: 10811088.[Crossref] [Google Scholar]
  9. Wilder-Smith A, Gubler DJ, , 2008. Geographic expansion of dengue: the impact of international travel. Med Clin North Am 92: 13771390.[Crossref] [Google Scholar]
  10. Adalja AA, Sell TK, Bouri N, Franco C, , 2012. Lessons learned during dengue outbreaks in the United States, 2001–2011. Emerg Infect Dis 18: 608614.[Crossref] [Google Scholar]
  11. Effler PV, Pang L, Kitsutani P, Vorndam V, Nakata M, Ayers T, Elm J, Tom T, Reiter P, Rigau-Perez JG, Hayes JM, Mills K, Napier M, Clark GG, Gubler DJ, Hawaii Dengue Outbreak Investigation Team; , 2005. Dengue fever, Hawaii, 2001–2002. Emerg Infect Dis 11: 742749.[Crossref] [Google Scholar]
  12. Gould EA, Gallian P, De Lamballerie X, Charrel RN, , 2010. First cases of autochthonous dengue fever and chikungunya fever in France: from bad dream to reality! Clin Microbiol Infect 16: 17021704.[Crossref] [Google Scholar]
  13. Gjenero-Margan I, Aleraj B, Krajcar D, Lesnikar V, Klobucar A, Pem-Novosel I, Kurecic-Filipovic S, Komparak S, Martic R, Duricic S, Betica-Radic L, Okmadzic J, Vilibic-Cavlek T, Babic-Erceg A, Turkovic B, Avsic-Zupanc T, Radic I, Ljubic M, Sarac K, Benic N, Mlinaric-Galinovic G, , 2011. Autochthonous dengue fever in Croatia, August–September 2010. Euro Surveill 16: e19805. [Google Scholar]
  14. Sessions OM, Khan K, Hou Y, Meltzer E, Quam M, Schwartz E, Gubler DJ, Wilder-Smith A, , 2013. Exploring the origin and potential for spread of the 2013 dengue outbreak in Luanda, Angola. Glob Health Action 6: 21822.[Crossref] [Google Scholar]
  15. Ministry of Tourism, 2013. Indian Tourism Statistics. Available at: http://www.tourism.gov.in/writereaddata/CMSPagePicture/file/marketresearch/Ministry%20of%20tourism%20English%202013.pdf. Accessed December 11, 2013. [Google Scholar]
  16. World Bank, 2013. India Overview. Available at: http://www.worldbank.org/en/country/india/overview. Accessed December 11, 2013. [Google Scholar]
  17. Bagchi S, , 2009. Dengue bites India. CMAJ 180: E7.[Crossref] [Google Scholar]
  18. Kakkar M, , 2012. Dengue fever is massively under-reported in India, hampering our response. BMJ 345: e8574.[Crossref] [Google Scholar]
  19. Halasa YA, Dogra V, Arora N, Tyagi BK, Nanda D, Shepard DS, , 2011. Overcoming data limitations: design of a multi-component study for estimating the economic burden of dengue in India. Dengue Bull 35: 114. [Google Scholar]
  20. National Vector Borne Disease Control Programme, 2013. Dengue Cases and Deaths in the Country since 2007. Ministry of Health and Family Welfare, Directorate General of Health Services. Available at: http://www.nvbdcp.gov.in/den-cd.html. Accessed May 30, 2013. [Google Scholar]
  21. Shepard DS, Undurraga EA, Halasa YA, , 2013. Economic and disease burden of dengue in Southeast Asia. PLoS Negl Trop Dis 7: e2055.[Crossref] [Google Scholar]
  22. Undurraga EA, Halasa YA, Shepard DS, , 2013. Use of expansion factors to estimate the burden of dengue in Southeast Asia: a systematic analysis. PLoS Negl Trop Dis 7: e2056.[Crossref] [Google Scholar]
  23. Chakravarti A, Arora R, Luxemburger C, , 2012. Fifty years of dengue in India. Trans R Soc Trop Med Hyg 106: 273282.[Crossref] [Google Scholar]
  24. Gupta B, Reddy BP, , 2013. Fight against dengue in India: progresses and challenges. Parasitol Res 112: 13671378.[Crossref] [Google Scholar]
  25. Garg P, Nagpal J, Khairnar P, Seneviratne SL, , 2008. Economic burden of dengue infections in India. Trans R Soc Trop Med Hyg 102: 570577.[Crossref] [Google Scholar]
  26. Murtola T, Vasan S, Puwar T, Govil D, Field R, Gong H, Bhavsar-Vyas A, Suaya J, Howard M, Shepard D, Kohli V, Prajapati P, Singh A, Mavalankar D, , 2010. Preliminary estimate of immediate cost of chikungunya and dengue to Gujarat, India. Dengue Bull 34: 3238. [Google Scholar]
  27. Chatterjee S, Laxminarayan R, , 2013. Costs of surgical procedures in Indian hospitals. BMJ Open 3: e002844.[Crossref] [Google Scholar]
  28. Shepard DS, Hodgkin D, Anthony YE, , 2000. Analysis of Hospital Costs: A Manual for Managers. Geneva: World Health Organization. [Google Scholar]
  29. Tyagi BK, Karthiga S, Vidya C, Arora NK, Nandan D, Halasa YA, Charles J, Mohan N, Varadarajan P, Mariappan T, Samuel PP, Paramasivan R, Adhish SV, Gaba M, Porkaipandianh RT, Shepard DS, , 2014. Estimation of the adjustment factor for hospitalized clinical cases diagnosed and tested for dengue in Madurai Tamil Nadu (India). Dengue Bull 38: (in press). [Google Scholar]
  30. Sudarshan MK, Madhusudana SN, Mahendra BJ, Rao NS, Ashwath Narayana DH, Abdul Rahman S, Meslin F, Lobo D, Ravikumar K, Gangaboraiah, 2007. Assessing the burden of human rabies in India: results of a national multi-center epidemiological survey. Int J Infect Dis 11: 2935.[Crossref] [Google Scholar]
  31. Dhingra N, Jha P, Sharma VP, Cohen AA, Jotkar RM, Rodriguez PS, Bassani DG, Suraweera W, Laxminarayan R, Peto R, Million Death Study C; , 2010. Adult and child malaria mortality in India: a nationally representative mortality survey. Lancet 376: 17681774.[Crossref] [Google Scholar]
  32. Krishnamoorthy K, Harichandrakumar KT, Krishna Kumari A, Das LK, , 2009. Burden of chikungunya in India: estimates of disability adjusted life years (DALY) lost in 2006 epidemic. J Vector Borne Dis 46: 2635. [Google Scholar]
  33. Sinha K, , 2012. India to Raise Malaria Toll Figure 40-Fold. New Delhi, India: Times News Network. Available at: http://timesofindia.indiatimes.com/india/India-to-raise-malaria-toll-figure-40-fold/articleshow/11747962.cms. [Google Scholar]
  34. Pantoja A, Floyd K, Unnikrishnan KP, Jitendra R, Padma MR, Lal SS, Uplekar M, Chauhan LS, Kumar P, Sahu S, Wares F, Lonnroth K, , 2009. Economic evaluation of public-private mix for tuberculosis care and control, India. Part I. Socio-economic profile and costs among tuberculosis patients. Int J Tuberc Lung Dis 13: 698704. [Google Scholar]
  35. Pantoja A, Lonnroth K, Lal SS, Chauhan LS, Uplekar M, Padma MR, Unnikrishnan KP, Rajesh J, Kumar P, Sahu S, Wares F, Floyd K, , 2009. Economic evaluation of public-private mix for tuberculosis care and control, India. Part II. Cost and cost-effectiveness. Int J Tuberc Lung Dis 13: 705712. [Google Scholar]
  36. Halasa YA, Shepard DS, Zeng W, , 2012. Economic cost of dengue in Puerto Rico. Am J Trop Med Hyg 86: 745752.[Crossref] [Google Scholar]
  37. Suaya JA, Shepard DS, Siqueira JB, Martelli CT, Lum LC, Tan LH, Kongsin S, Jiamton S, Garrido F, Montoya R, Armien B, Huy R, Castillo L, Caram M, Sah BK, Sughayyar R, Tyo KR, Halstead SB, , 2009. Cost of dengue cases in eight countries in the Americas and Asia: a prospective study. Am J Trop Med Hyg 80: 846855. [Google Scholar]

Data & Media loading...

  • Received : 01 Jan 2014
  • Accepted : 18 Aug 2014
  • Published online : 03 Dec 2014

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error