title: Burden of symptomatic dengue infection in children at primary school in Thailand: a prospective study.
abstract: BACKGROUND
  Dengue viruses are a major cause of morbidity and mortality in tropical and subtropical areas. Our aim was to assess prospectively the burden of dengue-related illness in children in Thailand.
  
  
  METHODS
  We did a prospective study in a cohort of children at primary school in northern Thailand from 1998 to 2002. We assessed the burden of dengue illness as disability-adjusted life years (DALYs) and patient costs per illness.
  
  
  RESULTS
  Dengue accounted for 328 (11%) of the 3056 febrile cases identified in 2114 children during the study period. The mean burden of dengue was 465.3 (SD 358.0; range 76.5-954.0) DALYs per million population per year, accounting for about 15% of DALYs lost to all febrile illnesses (3213.1 [SD 2624.2] DALYs per million per year). Non-hospitalised patients with dengue illnesses represented a substantial proportion of the overall burden of disease, with 44-73% of the total DALYs lost to dengue each year due to such illness. The infecting dengue serotype was an important determinant of DALYs lost: DEN4 was responsible for 1% of total DALYs lost, DEN1 for 9%, DEN2 for 30%, and DEN3 for 29%.
  
  
  CONCLUSIONS
  Use of prospective data to estimate the burden of disease shows that most DALYs lost to dengue illness were the result of non-hospitalised illnesses of long duration. Thus, inclusion of non-hospitalised cases is critical to accurately assess the total burden of dengue illness.
authors.affiliation: Division of Communicable Diseases and Immunology, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
authors.forename: Katie B
authors.initials: KB
authors.lastname: Anderson
authors.affiliation: Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Supamit
authors.initials: S
authors.lastname: Chunsuttiwat
authors.affiliation: Department of Virology, Armed Forces Institute of Medical Research, Bangkok, Thailand.
authors.forename: Ananda
authors.initials: A
authors.lastname: Nisalak
authors.affiliation: Department of Virology, Armed Forces Institute of Medical Research, Bangkok, Thailand.
authors.forename: Mammen P
authors.initials: MP
authors.lastname: Mammen
authors.affiliation: Center For Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Libraty
authors.affiliation: Center For Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Rothman
authors.affiliation: Center For Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Sharone
authors.initials: S
authors.lastname: Green
authors.affiliation: Military Infectious Disease Research Program, Ft Detrick, MD, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Vaughn
authors.affiliation: Center For Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Francis A
authors.initials: FA
authors.lastname: Ennis
authors.affiliation: Division of Communicable Diseases and Immunology, Walter Reed Army Institute of Research, Silver Spring, MD, USA. Electronic address: endyt@upstate.edu.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Endy
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000150:complications / Q000453:epidemiology; D017281:Cost of Illness; D003715:Dengue / Q000145:classification / Q000191:economics / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D019595:Severe Dengue / Q000145:classification / Q000191:economics / Q000453:epidemiology*; D012720:Severity of Illness Index; D013785:Thailand / Q000453:epidemiology