Dengue in the Middle East

Resource Economics: Dengue in the Middle East

Dengue in the Middle East

Over the past several years the dengue virus has become the most rapidly spreading mosquito-borne disease in the tropical and sub-tropical regions of the world (reviewed by Nathan, Dayal-Drager, and Guzman, 2009). Recent estimates suggest that about 50-100 million people are infected each year, resulting in approximately 20,000 deaths (WHO, 2012). While most of these infections occur in heavily urbanized regions of Asia and South America, all countries have discovered their vulnerability to dengue. This includes countries in the mostly arid regions of the Middle East where historically the mosquito vector had problems surviving (Nathan, Dayal-Drager, and Guzman, 2009). This essay will examine the financial and human resource needs of Middle Eastern countries for managing dengue risk. The Middle East is defined here as the countries between North Africa to the west and Pakistan/Afghanistan to the East (CIA, 2013).

Significance

The virus that causes dengue fever and dengue hemorrhagic fever is transmitted by mosquitoes and the primary vector is Aedes aegypti, although there are confirmed reports that other Aedes species are capable of transmitting the disease (Nathan, Dayal-Drager, and Guzman, 2009). a. aegypti requires small pools of water to lay their eggs, which in tropical regions are in plentiful supply in the natural environment (CDC, 2012). By comparison, a. aegypti in an arid environment would have little opportunity for breeding if not for the encroachment of urban environments. These opportunities have increased due to the rapid population growth of the Middle East between 1950 and 2000, which went from 92 to 349 million residents (Clawson, 2009). The rapid urbanization of the Middle East has therefore rendered it susceptible to the spread of dengue, which depends on the availability of a plentiful supply of human hosts.

Although the rate of population growth has slowed recently (Clawson, 2009), international air travel has emerged as a significant means for spreading the disease (Nathan, Dayal-Drager, and Guzman, 2009). For example, most of the 796 dengue cases reported in the United States between 2001 and 2007 were imported.

Patients who manifest symptoms typically transition through three phases, febrile, critical, and recovery, and the disease course lasts about 10 days (Nathan, Dayal-Drager, and Guzman, 2009). The symptom variety is quite large and determining an accurate prognosis early in the infection is impossible. Despite these difficulties, treatment for most patients is effective, inexpensive, and straightforward. As a result, most patients will not require hospitalization, but the few that develop severe disease, which tend to be children and the elderly, will require intensive and more costly interventions to prevent death.

Economic Impact

The direct medical costs of dengue were estimated by several studies conducted in Asia and the Americas in 2005 to 2006 (reviewed by Nathan, Dayal-Drager, and Guzman, 2009). Treating an average case of dengue during that time period cost about $828 dollars, with ambulatory and hospital costs averaging $514 and $1,491 dollars, respectively. The estimated total direct medical cost for the countries conducting these studies was $400 million dollars, which had 532,000 confirmed dengue cases during the study period.

Determining an accurate estimate of the economic burden of dengue in the Middle East is next to impossible, because reporting practices are inconsistent or nonexistent (Nathan, Dayal-Drager, and Guzman, 2009). However, Yemen and Saudi Arabia have been reporting dengue cases to the World Health Organization (WHO) for many years. Between 1994 and 2005, Saudi Arabia reported 694 suspected and 347 confirmed cases of dengue. In 2000, 2004, and 2005, Yemen reported a combined 1101 suspected cases of dengue. The direct medical costs would be an estimated $1.8 million dollars for these cases. However, dengue underreporting and misdiagnosis is probably common to this region, so this probably represents an extreme underestimate.

Dengue is now considered endemic to Western and Southern Saudi Arabia and outbreaks have been occurring in Yemen (Hotez, Savioli, and Fenwick, 2012), so vector control measures should be concentrated in these areas. Relatively recent estimates of the per capita costs for vector control have been estimated to be between $0.02 and $3.56 dollars (Beatty et al., 2011), which would translate into $1.1 to $200 million for these three countries (IMF, 2012); however, vector control costs would probably be towards the low end because the climate is naturally hostile towards a. aegypti and dengue is endemic only to limited regions of Saudi Arabia and Yemen. In terms of percent gross domestic product (GDP), a $1 million dollar annual vector control program would represent 1.7x10?6 and 3.0x10?5 of the GDP in Saudi Arabia and Yemen, respectively.

Global Health Policies for Dengue Control

The WHO has identified three goals to be achieved by 2020 for global dengue prevention and control and these are: (1) 50% reduction in mortality, (2) 25% reduction in morbidity, and (3) determine the true burden of the disease (WHO, 2012). The technical elements cited as critical for achieving these goals are improved disease management, partnerships, surveillance, vector control, and communications. The partnerships that the WHO has identified as essential are broad, from national health ministries, private providers, non-governmental organizations, and community leaders. Essentially, controlling and preventing dengue in the Middle East will require the creation of a dengue health and vector control infrastructure.