title: The global burden of dengue: an analysis from the Global Burden of Disease Study 2013.
abstract: Dengue is the most common arbovirus infection globally, but its burden is poorly quantified. We estimated dengue mortality, incidence, and burden for the Global Burden of Disease Study 2013.
  
  
  
  We modelled mortality from vital registration, verbal autopsy, and surveillance data using the Cause of Death Ensemble Modelling tool. We modelled incidence from officially reported cases, and adjusted our raw estimates for under-reporting based on published estimates of expansion factors. In total, we had 1780 country-years of mortality data from 130 countries, 1636 country-years of dengue case reports from 76 countries, and expansion factor estimates for 14 countries.
  
  
  
  We estimated an average of 9221 dengue deaths per year between 1990 and 2013, increasing from a low of 8277 (95% uncertainty estimate 5353-10 649) in 1992, to a peak of 11 302 (6790-13 722) in 2010. This yielded a total of 576 900 (330 000-701 200) years of life lost to premature mortality attributable to dengue in 2013. The incidence of dengue increased greatly between 1990 and 2013, with the number of cases more than doubling every decade, from 8·3 million (3·3 million-17·2 million) apparent cases in 1990, to 58·4 million (23·6 million-121·9 million) apparent cases in 2013. When accounting for disability from moderate and severe acute dengue, and post-dengue chronic fatigue, 566 000 (186 000-1 415 000) years lived with disability were attributable to dengue in 2013. Considering fatal and non-fatal outcomes together, dengue was responsible for 1·14 million (0·73 million-1·98 million) disability-adjusted life-years in 2013.
  
  
  
  Although lower than other estimates, our results offer more evidence that the true symptomatic incidence of dengue probably falls within the commonly cited range of 50 million to 100 million cases per year. Our mortality estimates are lower than those presented elsewhere and should be considered in light of the totality of evidence suggesting that dengue mortality might, in fact, be substantially higher.
  
  
  
  Bill & Melinda Gates Foundation.
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: stanaway@uw.edu.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Stanaway
authors.affiliation: Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Shepard
authors.affiliation: Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Undurraga
authors.affiliation: Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
authors.forename: Yara A
authors.initials: YA
authors.lastname: Halasa
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands.
authors.forename: Luc E
authors.initials: LE
authors.lastname: Coffeng
authors.affiliation: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Brady
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Simon I
authors.initials: SI
authors.lastname: Hay
authors.affiliation: College of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Bedi
authors.affiliation: University of São Paulo, Hospital Universitário, São Paulo, Brazil.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Bensenor
authors.affiliation: Colombian National Health Observatory, Bogotá, DC, Colombia; Epidemiology and Public Health Evaluation Group, Public Health Department, Universidades Nacional de Colombia, Ciudad Universitaria, Facultad de Medicina, Bogotá, Colombia.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Castañeda-Orjuela
authors.affiliation: Taipei Medical University, Taipei City, Taiwan.
authors.forename: Ting-Wu
authors.initials: TW
authors.lastname: Chuang
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Melbourne Health, Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, VIC, Australia.
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Gibney
authors.affiliation: College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Saudi Ministry of Health, Prince Riyadh, Saudi Arabia.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
authors.affiliation: Contech International Health Consultants, Lahore, Pakistan; Contech School of Public Health, Lahore, Pakistan.
authors.forename: Anwar
authors.initials: A
authors.lastname: Rafay
authors.affiliation: Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
authors.forename: Kingsley N
authors.initials: KN
authors.lastname: Ukwaja
authors.affiliation: National Center of Neurology and Psychiatry, Tokyo, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Yonemoto
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Christopher J L
authors.initials: CJL
authors.lastname: Murray
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000453:epidemiology* / Q000401:mortality; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D000071219:Global Burden of Disease / Q000706:statistics & numerical data*; D014943:Global Health; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012737:Sex Factors