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Economic Burden of Dengue Virus Infection at the Household Level Among Residents of Puerto Maldonado, Peru
Gabriela Salmon-Mulanovich
Gabriela Salmon-Mulanovich
Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
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David L. Blazes
David L. Blazes
Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
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Andres G. Lescano
Andres G. Lescano
Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
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Daniel G. Bausch
Daniel G. Bausch
Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
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Joel M. Montgomery
Joel M. Montgomery
Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
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William K. Pan
William K. Pan
Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru; Department of International Health,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Military Tropical Medicine Course, Navy Medicine Professional Development Center, Bethesda, Maryland; Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru; School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana; Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya; Nicholas School of the Environment, Duke University, Durham, North Carolina
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Dengue virus (DENV) was reintroduced to Peru in the 1990s and has been reported in Puerto Maldonado (population ∼65,000) in the Peruvian southern Amazon basin since 2000. This region also has the highest human migration rate in the country, mainly from areas not endemic for DENV. The objective of this study was to assess the proportion of household income that is diverted to costs incurred because of dengue illness and to compare these expenses between recent migrants (RMs) and long-term residents (LTRs). We administered a standardized questionnaire to persons diagnosed with dengue illness at Hospital Santa Rosa in Puerto Maldonado from December 2012 to March 2013. We compared direct and indirect medical costs between RMs and LTRs. A total of 80 participants completed the survey, of whom 28 (35%) were RMs and 52 (65%) were LTRs. Each dengue illness episode cost the household an average of US$105 (standard deviation [SD] = 107), representing 24% of their monthly income. Indirect costs were the greatest expense (US$56, SD = 87), especially lost wages. The proportion of household income diverted to dengue illness did not differ significantly between RM and LTR households. The study highlights the significant financial burden incurred by households when a family member suffers dengue illness.
Author Notes
Financial support: The study was funded by the National Institute of Health–Fogarty International Center training grant no. D43-TW007393 and the U.S. DoD Global Emerging Infections Surveillance and Response System under work unit 847705 82000 25GB B0016.
Authors' addresses: Gabriela Salmon-Mulanovich, Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru, and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: gsalmonm.veid@gmail.com. David L. Blazes, Navy Medicine Professional Development Center, Bethesda, MD, E-mail: david.l.blazes.mil@mail.mil. Andres G. Lescano, Department of Parasitology, Naval Medical Research Unit No. 6, Callao, Peru, and School of Public Health and Management, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mail: andres.lescano.g@upch.pe. Daniel G. Bausch, Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, and Department of Virology and Emerging Infections, Naval Medical Research Unit No. 6, Callao, Peru, E-mail: dbausch@tulane.edu. Joel M. Montgomery, Division of Global Health Protection, Centers for Disease Control and Prevention Kenya, Nairobi, Kenya, E-mail: ztq9@cdc.gov. William K. Pan, Nicholas School of the Environment, Duke University, Durham, NC, and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: william.pan@duke.edu.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Gubler DJ, 2002. Epidemic dengue/dengue hemorrhagic fever as a public health, social and economic problem in the 21st century. Trends Microbiol 10: 100–103.
-
2.
Morrison AC, Minnick SL, Rocha C, Forshey BM, Stoddard ST, Getis A, Focks DA, Russel KL, Olson JG, Blair PJ, Watts DM, Sihuincha M, Scott TW, Kochel TJ, 2010. Epidemiology of dengue virus in Iquitos, Peru 1999 to 2005: interepidemic and epidemic patterns of transmission. PLoS Negl Trop Dis 4: e670.
-
3.
Teixeira M da G, Barreto ML, Costa M da C, Ferreira LD, Vasconcelos PF, Cairncross S, 2002. Dynamics of dengue virus circulation: a silent epidemic in a complex urban area. Trop Med Int Health 7: 757–762.
-
4.
Endy TP, Chunsuttiwat S, Nisalak A, Librati DH, Green S, Rothmann AL, Vaughn DW, Ennis FA, 2002. Epidemiology of inapparent and symptomatic acute dengue virus infection: a prospective study of primary school children in Kamphaeng Phet, Thailand. Am J Epidemiol 156: 40–51.
-
5.
Hammond SN, Balmaseda A, Perez L, Tellez Y, Saborio SI, Mercado JC, Videa E, Rodriguez Y, Perez MA, Cuadra R, Solano S, Rocha J, Idiaquez W, Gonzales A, Harris E, 2005. Differences in dengue severity in infants, children, and adults in a 3-year hospital-based study in Nicaragua. Am J Trop Med Hyg 73: 1063–1070.
-
6.
Braks MAH, Honorio NA, Lourenco-De-Oliveira R, Juliano SA, Lounibos LP, 2003. Convergent habitat segregation of Aedes aegypti and Aedes albopictus (Diptera: Culicidae) in southeastern Brazil and Florida. J Med Entomol 40: 785–794.
-
7.
Tsuda Y, Suwonkerd W, Chawprom S, Prajakwong S, Takagi M, 2006. Different spatial distribution of Aedes aegypti and Aedes albopictus along an urban–rural gradient and the relating environmental factors examined in three villages in northern Thailand. J Am Mosq Control Assoc 22: 222–228.
-
8.
Gubler DJ, 2004. The changing epidemiology of yellow fever and dengue, 1900 to 2003: full circle? Comp Immunol Microbiol Infect Dis 27: 319–330.
-
9.
WHO/TDR, 2009. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland: WHO Press.
-
10.
Torres JR, Castro J, 2007. The health and economic impact of dengue in Latin America. Cad Saude Publica 23: 23–31.
-
11.
Lagrotta MT, Silva W da C, Souza-Santos R, 2008. Identification of key areas for Aedes aegypti control through geoprocessing in Nova Iguacu, Rio de Janeiro State, Brazil. Cad Saude Publica 24: 70–80.
-
12.
Lloyd LS, Winch P, Ortega-Canto J, Kendall C, 1992. Results of a community-based Aedes aegypti control program in Merida, Yucatan, Mexico. Am J Trop Med Hyg 46: 635–642.
-
13.
Paz-Soldan VA, Plasai V, Morrison AC, Rios-Lopez EJ, Guedez-Gonzales S, Grieco JP, Mundal K, Chareonviriyaphap T, Achee NL, 2011. Initial assessment of the acceptability of a push-pull Aedes aegypti control strategy in Iquitos, Peru and Kanchanaburi, Thailand. Am J Trop Med Hyg 84: 208.
-
14.
Vanlerberghe V, Toledo ME, Rodriguez M, Gomez D, Baly A, Benitez JR, Van der Stuyft P, 2009. Community involvement in dengue vector control: cluster randomised trial. BMJ 338: b1959.
-
15.
Durbin A, Karron RA, Sun W, Vaughn DW, Reynolds MJ, Perreault JR, Thumar B, Men R, Lai CJ, Elkins WR, Chanock RM, Murphy BR, Whitehead SS, 2001. Attenuation and immunogenicity in humans of a live dengue virus type-4 vaccine candidate with a 30 nucleotide deletion in its 3′-untranslated region. Am J Trop Med Hyg 65: 405.
-
16.
Whitehead S, Falgout B, Hanley KA, Blaney JE Jr, Markoff L, Murphy BR, 2003. A live, attenuated dengue virus type 1 vaccine candidate with a 30-nucleotide deletion in the 3′untranslated region is highly attenuated and immunogenic in monkeys. J Virol 77: 1653.
-
17.
Murray CJL, Lopez AD, 1997. Mortality by cause for eight regions of the world: global burden of disease study. Lancet 349: 1269.
-
18.
Garg P, Nagpal J, Khairnar P, Seneviratne SL, 2008. Economic burden of dengue infections in India. Trans R Soc Trop Med Hyg 102: 570–577.
-
19.
Shepard DS, Coudeville L, Halasa YA, Zambrano B, Dayan GH, 2011. Economic impact of dengue illness in the Americas. Am J Trop Med Hyg 84: 200–207.
-
20.
Segel JE, 2006. Cost-of-Illness Studies—A Primer. RTI-UNC Center of Excellence in Health Promotion Economics, RTI International, North Carolina, 1–39.
-
21.
Phillips I, Need J, Escamilla J, Colan E, Sanches A, Rodriguez M, Vasquez L, Seminario J, Betz T, da Rosa AT, 1992. First documented outbreak of dengue in the Peruvian Amazon region. Bull Pan Am Health Organ 26: 201–207.
-
22.
Cáceres-Rey OA, León-Cueto W, 2007. Variantes genéticas de Aedes aegypti y su asociación con el serotipo del virus dengue en un área endémica del Perú. Lima, Peru: Centro de Información y Documentación Científica. Instituto Nacional de Salud, 14.
-
23.
DGE, 2011. Indicadores de Morbilidad: Ucayali, in Vigilancia Epidemiologica. MINSA. Available at: http://www.dge.gob.pe/portal/index.php?option=com_content&view=article&id=347&Itemid=249.
-
24.
DGE, 2011. Indicadores de Morbilidad: Loreto, in Vigilancia Epidemiologica. MINSA. Available at: http://www.dge.gob.pe/portal/index.php?option=com_content&view=article&id=347&Itemid=249.
-
25.
DGE, 2011. Indicadores de Morbilidad: Madre de Dios, in Vigilancia Epidemiologica. MINSA. Available at: http://www.dge.gob.pe/portal/index.php?option=com_content&view=article&id=347&Itemid=249.
-
26.
MINSA, 2010. Análisis de la situación de salud en el Perú. Lima, Peru: DGE.
-
27.
INEI, 2007. Censos Nacionales 2007: XI de Población y VI de Vivienda, in Sistema de Consulta de Datos. Available at: http://www.inei.gob.pe/.
-
28.
Yamada G, 2010. Migración interna en el Perú. Banco Mundial.
-
29.
Borjas GJ, Bronars SG, Trejo SJ, 1992. Assimilation and the earnings of young internal migrants. Rev Econ Stat 74: 170–175.
-
30.
Balan J, 1969. Migrant-native socioeconomic differences in Latin American cities: a structural analysis. Lat Am Res Rev 4: 3–29.
-
31.
Alcalde-Rabanal JE, Lazo-González O, Nigenda G, 2011. Sistema de salud de Perú Salud Pública Méx 53: 243–254.
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