Dengue Epidemiology and Burden of Disease in Latin America and the Caribbean: A Systematic Review of the Literature and Meta-Analysis

MARÍA LUISA CAFFERATA,; ARIEL BARDACH,; LUCILA REY-ARES,; ANDREA ALCARAZ,; GABRIELA CORMICK,; LUZ GIBBONS,; MARINA ROMANO,; SILVANA CESARONI,; SILVINA RUVINSKY,

ELSEVIER SCIENCE B. V.

ELSEVIER

Año: 2013

Introduction: Dengue virus infection is the most common arthropodbornedisease worldwide with approximately 50 to 100 million cases ofdengue infection occurring annually. Globally, dengue incidence hasincreased in the last 40 years, especially in Latin American andCaribbean (LAC) countries where the highest incidence is found. Thissystematic review aimed to present information on dengue diseaseburden and use of health resources in the LAC region in the last 15years. Methods: We searched the main international and regionaldatabases and generic and academic Internet search engines. Grayliterature was retrieved mainly from regional health ministries and PanAmerican Health Organization. A set of inclusion criteria was defined.Results: We identified 2,041 articles of which 25 met these criteria, 13for incidence and 12 for the use of resources and related costs. Thepooled incidence of classic dengue fever was 72.1 cases per 100,000persons-years in the 44 LAC countries analyzed (95% confidence interval71.5?72.7), with an upward trend from 1995 up to 2010. Case-fatalityratio was highest in 1997 (0.12 [0.05?0.22]) and lowest in 2009, and theoverall mortality was 0.02 per 100,000 people. More than 60% of thecases in the LAC region came from Brazil. The length of hospital stayranged from 5 to 13 days. Conclusions: Activities to control denguetransmission in the region have been important but insufficient. Thesurveillance of dengue burden of disease and circulating strains helpshape and evaluate the present and future health policies.