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82 THIRD WHO REPORT ON NEGLECTED TROPICAL DISEASES *** 4.3 Dengue Introduction Dengue is a mosquito-borne viral disease of public-health significance that has affected all regions of WHO since 2010. The flavivirus is transmitted by female mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Ae. albopictus. Investment case Dengue, a rapidly spreading vector-borne disease, is endemic in more than 100 countries and affects travellers and local communities worldwide. Today, hundreds of thousands of severe dengue cases arise every year, including about 3000 deaths. The cost of ambulatory care and hospitalization is unaffordable for poor people. In Cambodia and Viet Nam, between half and two-thirds of affected households have incurred debt as a result of treatment. 1,2 The economic burden of the disease is already measured in the billions of dollars annually. 3,4,5 Environmental change and urbanization are conspiring to elevate the cost even further beyond the reach of health systems and households. Fortunately, outbreaks are preventable if detected and managed early. In 2006, the second edition of the Disease Control Priorities Project put the cost per DALY averted by sustained vector control at less than US$ 3500 using environmental management and less than US$ 2000 using insecticides. More recent evidence suggests the number might be even lower. 6 (See the Technical Appendix for further references on cost and cost−effectiveness of vector control interventions.) The investment target for sustained vector control is US$ 510 million (US$ 440–580 million) per year during 2015–2030. This range does not fully reflect uncertainty about the size and distribution of the population at risk, especially in Africa. It probably underestimates the cost of sustained vector control for all populations at risk. Nonetheless, these conservative estimates indicate that vector control will be of increasing importance within the NTD portfolio. The investments are significant, but less than the costs of the alternatives. A review of the literature suggests that the cost of sustained vector control is lower than that of outbreak response. 7 The introduction of a highly effective vaccine against dengue may re-programme some of the investments in vector control towards immunization but is unlikely to obviate the need for it. The available models suggests that vector control will remain cost−effective in the presence of a vaccine. 8,9,10 Vector control may enhance the cost−effectiveness of a mediumefficacy vaccine, or a vaccine that is highly effective but only against one of the four dengue
*** THE DISEASES − CHAPTER 4 83 Investment targets for vector control against dengue, 2015–2030 600 Constant US$ millions 400 200 0 2015 2020 Year 2025 2030 Notes: Shaded areas reflect the range determined by low and high values of the unit cost benchmarks; they do not reflect uncertainty about future rates of scale-up and scale-down of interventions. All numbers expressed in US$ are constant (real) US$, adjusted to reflect purchasing power in the United States of America in 2015. serotypes. It may allow for lower levels of coverage by immunization programmes, especially when and where vaccine production is constrained. Investments in vector control should therefore be seen as complementary to the development and implementation of a future dengue prevention and control strategy. As the disease continues to expand to newer areas, vector control alone can prevent and reduce outbreaks. _____________________ 1 Huy R, Wichmann O, Beatty M, Ngan C, Duong S, Margolis HS, et al. Cost of dengue and other febrile illnesses to households in rural Cambodia: a prospective community-based case-control study. BMC Public Health. 2009;9:155. doi:10.1186/1471-2458-9-155. 2 Tam PT, Dat NT, Huu LM, Thi XCP, Duc HM, Tu TC et al. High household economic burden caused by hospitalization of patients with severe dengue fever cases in Can Tho province, Vietnam. Am J Trop Med Hyg. 2012;87:554–8. doi:10.4269/ajtmh.2012.120101. 3 Shepard DS, Coudeville L, Halasa YA, Zambrano B, Dayan GH. Economic impact of dengue illness in the Americas. Am J Trop Med Hyg. 2011;84:200–7. doi:10.4269/ajtmh.2011.10-0503. 4 Shepard DS, Undurraga EA, Halasa YA. Economic and disease burden of dengue in Southeast Asia. PLoS Negl Trop Dis. 2013;7:e2055. doi:10.1371/journal.pntd.0002055. 5 Shepard DS, Halasa YA, Tyagi BK, Adhish V, Nandan D, Karthiga KS et al. Economic and disease burden of dengue illness in India. Am J Trop Med Hyg. 2014;14–0002. doi:10.4269/ajtmh.14-0002. 6 Luz PM, Vanni T, Medlock J, Paltiel AD, Galvani AP. Dengue vector control strategies in an urban setting: an economic modelling assessment. Lancet. 2011;377:1673–80. doi:10.1016/S0140-6736(11)60246-8. 7 Stahl H-C, Butenschoen VM, Tran HT, Gozzer E, Skewes R, Mahendradhata Y et al. Cost of dengue outbreaks: literature review and country case studies. BMC Public Health. 2013;13:1048. doi:10.1186/1471-2458-13-1048. 8 Durham DP, Ndeffo Mbah ML, Medlock J, Luz PM, Meyers LA, Paltiel AD et al. Dengue dynamics and vaccine costeffectiveness in Brazil. Vaccine. 2013;31:3957–61. doi:10.1016/j.vaccine.2013.06.036. 9 Carrasco LR, Lee LK, Lee VJ, Ooi EE, Shepard DS, Thein TL et al. Economic impact of dengue illness and the cost-effectiveness of future vaccination programs in Singapore. PLoS Negl Trop Dis. 2011;5:e1426. doi:10.1371/journal.pntd.0001426. 10 Lee BY, Connor DL, Kitchen SB, Bacon KM, Shah M, Brown ST et al. Economic value of dengue vaccine in Thailand. Am J Trop Med Hyg. 2011;84:764–72. doi:10.4269/ajtmh.2011.10-0624.
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*** ANNEXES 179 ANNEXES
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*** ANNEXES 181 Annex 1a (cont’d)
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*** ANNEXES 183 WHA66.12 Recognizin
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*** ANNEXES 185 WHA66.12 3. REQUEST
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*** ANNEXES 187 Annex 3. Classifica
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*** ANNEXES 189 Annex 5. Medicines
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*** ANNEXES 191 WHO REGIONAL OFFICE
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