Disability adjusted life years lost to dengue in Brazil

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Abstract
To assess the dengue burden in Brazil, and to compare it over three spatial scales: in the city of Rio de Janeiro, the state of Rio de Janeiro, and in Brazil overall. We calculated disability adjusted life years (DALYs) lost to dengue per million individuals annually from 1986 through 2006. To calculate DALYs, we compiled data on the number of dengue cases by age, clinical syndrome and outcome. We evaluated the sensitivity of our results to multiplication factors used to adjust for inaccuracies in reporting using a Monte Carlo method. From 1986 through 2006, a mean of 56, 47 and 22 DALYs per million individuals annually were lost to dengue in the city of Rio de Janeiro, in the state of Rio de Janeiro and in Brazil, respectively. Over 80% of the dengue burden derived from dengue fever cases. The dengue burden was highest at the city-level with a maximum single-year estimate of 560 DALYs per million individuals for 2002. Assessment of dengue burden requires consideration of all clinical syndromes over multiple years. Our results indicate that the dengue burden is as high as the burden of other major infectious diseases that afflict the Brazilian population, including malaria. These results may prompt policy makers to elevate the prioritization of dengue control, and allocate resources needed to curtail the increasing dengue burden.