Volume 94, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



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.

[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.


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  1. 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 GRW, Simmons CP, Scott TW, Farrar JJ, Hay SI, , 2013. The global distribution and burden of dengue. Nature 496: 504507.[Crossref] [Google Scholar]
  2. Simmons CP, Farrar JJ, Nguyen VVC, Wills B, , 2012. Current concepts: dengue. N Engl J Med 366: 14231432.[Crossref] [Google Scholar]
  3. Stanaway JD, Shepard DS, Undurraga EA, Halasa YA, Coffeng LE, Brady OJ, Hay SI, Bedi N, Bensenor IM, Castañeda-Orjuela CA, Chuang T-W, Gibney KB, Memish ZA, Rafay A, Ukwaja KN, Yonemoto N, Murray CJL, , 2016. The global burden of dengue: a systematic analysis from the Global Burden of Disease Study 2013. Lancet Infect Dis Epub February 10, 2016. Available at: http://thelancet.com/journals/laninf/article/PIIS1473-3099(16)00026-8/fulltext. [Google Scholar]
  4. Lum LCS, Suaya JA, Tan LH, Sah BK, Shepard DS, , 2008. Quality of life of dengue patients. Am J Trop Med Hyg 78: 862867. [Google Scholar]
  5. Suaya JA, Shepard DS, Siqueira JB, Martelli CT, Lum LCS, 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]
  6. World Health Organization, 1997. Dengue Haemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. Available at: http://www.who.int/csr/resources/publications/dengue/Denguepublication/en/. Accessed October, 2012. [Google Scholar]
  7. Seet RCS, Quek AML, Lim ECH, , 2007. Post-infectious fatigue syndrome in dengue infection. J Clin Virol 38: 16.[Crossref] [Google Scholar]
  8. Bärnighausen T, Bloom DE, Cafiero-Fonseca ET, O'Brien JC, , 2014. Valuing vaccination. Proc Natl Acad Sci USA 111: 1231312319.[Crossref] [Google Scholar]
  9. Shepard DS, Undurraga EA, Betancourt-Cravioto M, Guzmán MG, Halstead SB, Harris E, Mudin RN, Murray KO, Tapia-Conyer R, Gubler DJ, , 2014. Approaches to refining estimates of global burden and economics of dengue. PLoS Negl Trop Dis 8: e3306.[Crossref] [Google Scholar]
  10. Undurraga EA, Betancourt-Cravioto M, Ramos-Castañeda J, Martínez-Vega R, Méndez-Galván J, Gubler DJ, Guzmán MG, Halstead SB, Harris E, Kuri-Morales P, Tapia-Conyer R, Shepard DS, , 2015. Economic and disease burden of dengue in Mexico. PLoS Negl Trop Dis 9: e3547.[Crossref] [Google Scholar]
  11. Garcia G, Gonzalez N, Perez AB, Sierra B, Aguirre E, Rizo D, Izquierdo A, Sanchez L, Diaz D, Lezcay M, Pacheco B, Hirayama K, Guzman MG, , 2011. Long-term persistence of clinical symptoms in dengue-infected persons and its association with immunological disorders. Int J Infect Dis 15: E38E43.[Crossref] [Google Scholar]
  12. Gonzalez D, Martinez R, Castro O, Serrano T, Portela D, Vazquez S, Kouri G, Guzman MG, , 2005. Evaluation of some clinical, humoral, and imagenological parameters in patients of dengue haemorrhagic fever six months after acute illness. Dengue Bull 29: 7984. [Google Scholar]
  13. Teixeira LDS, Lopes JSM, Martins AGD, Campos FAB, Miranzi SDC, Nascentes GAN, , 2010. Persistence of dengue symptoms in patients in Uberaba, Minas Gerais State, Brazil. Cad Saude Publica 26: 625630. [Google Scholar]
  14. Tristao-Sa R, Kubelka CF, Zandonade E, Zagne SMO, Rocha NDM, Zagne LO, Araujo NF, Amin B, Fazoli F, de Souza LJ, Cruz OG, da Cunha RV, do Nascimento D, Froes IB, Nogueira RMR, , 2012. Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study. Rev Soc Bras Med Trop 45: 675681.[Crossref] [Google Scholar]
  15. Halsey ES, Williams M, Laguna-Torres VA, Vilcarromero S, Ocaña V, Kochel TJ, Marks MA, , 2014. Occurrence and correlates of symptom persistence following acute dengue fever in Peru. Am J Trop Med Hyg 90: 449456.[Crossref] [Google Scholar]
  16. Dettogni RS, Tristão-Sá R, dos Santos M, da Silva FF, Louro ID, , 2015. Single nucleotide polymorphisms in immune system genes and their association with clinical symptoms persistence in dengue-infected persons. Hum Immunol 76: 717723.[Crossref] [Google Scholar]
  17. del Valle Díaz S, Piñera Martínez M, Guasch Saent-Félix F, , 2001. Hepatitis reactiva por virus del dengue hemorrágico. Rev Cubana Med Trop 53: 2831. [Google Scholar]
  18. López Barroso R, Deulofeu Betancourt I, Fayad Saeta Y, Macias Navarro MM, , 2011. Convalecencia de mujeres que sufrieron dengue serotipo 3 durante el embarazo. Rev Cubana Med Trop 63: 206210. [Google Scholar]
  19. Low JGH, Ooi EE, Tolfvenstam T, Leo YS, Hibberd ML, Ng LC, Lai YL, Yap GSL, Li CSC, Vasudevan SG, Ong A, , 2006. Early dengue infection and outcome study (EDEN)—study design and preliminary findings. Ann Acad Med Singapore 35: 783789. [Google Scholar]
  20. Reynolds KJ, Vernon SD, Bouchery E, Reeves WC, , 2004. The economic impact of chronic fatigue syndrome. Cost Eff Resour Alloc 2: 4.[Crossref] [Google Scholar]
  21. Lin J-MS, Resch SC, Brimmer DJ, Johnson A, Kennedy S, Burstein N, Simon CJ, , 2011. The economic impact of chronic fatigue syndrome in Georgia: direct and indirect costs. Cost Eff Resour Alloc 9: 1.[Crossref] [Google Scholar]
  22. Salomon JA, Haagsma JA, Davis A, de Noordhout CM, Polinder S, Havelaar AH, Cassini A, Devleesschauwer B, Kretzschmar M, Speybroeck N, , 2015. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob Health 3: e712e723.[Crossref] [Google Scholar]
  23. Guzmán MG, Kouri G, , 2002. Dengue: an update. Lancet Infect Dis 2: 3342.[Crossref] [Google Scholar]
  24. Kavelaars A, Kuis W, Knook L, Sinnema G, Heijnen CJ, , 2000. Disturbed neuroendocrine-immune interactions in chronic fatigue syndrome. J Clin Endocrinol Metab 85: 692696. [Google Scholar]
  25. Pollack A, , 2015. First dengue fever vaccine approved by Mexico. The New York Times. Business, B2. New York, NY: The New York Times Company. [Google Scholar]

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Supplementary PDF

  • Received : 12 Dec 2015
  • Accepted : 07 Feb 2016
  • Published online : 04 May 2016

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