title: Economic Burden of Dengue Virus Infection at the Household Level Among Residents of Puerto Maldonado, Peru.
abstract: 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.
authors.affiliation: 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 gabriela.salmon@med.navy.mil.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Salmon-Mulanovich
authors.affiliation: 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.
authors.forename: David L
authors.initials: DL
authors.lastname: Blazes
authors.affiliation: 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.
authors.forename: Andres G
authors.initials: AG
authors.lastname: Lescano
authors.affiliation: 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.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Bausch
authors.affiliation: 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.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Montgomery
authors.affiliation: 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.
authors.forename: William K
authors.initials: WK
authors.lastname: Pan
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003715:Dengue / Q000191:economics* / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D005382:Financing, Personal / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D010568:Peru / Q000453:epidemiology