title: Predicted global distribution ofBurkholderia pseudomalleiand burden of melioidosis.
abstract: Burkholderia pseudomallei,a highly pathogenic bacterium that causes melioidosis, is commonly found in soil in Southeast Asia and Northern Australia1,2. Melioidosis can be difficult to diagnose due to its diverse clinical manifestations and the inadequacy of conventional bacterial identification methods3. The bacterium is intrinsically resistant to a wide range of antimicrobials, and treatment with ineffective antimicrobials may result in case fatality rates (CFRs) exceeding 70%4,5. The importation of infected animals has, in the past, spread melioidosis to non-endemic areas6,7. The global distribution ofB. pseudomalleiand burden of melioidosis, however, remain poorly understood. Here, we map documented human and animal cases, and the presence of environmentalB. pseudomallei, and combine this in a formal modelling framework8-10to estimate the global burden of melioidosis. We estimate there to be 165,000 (95% credible interval 68,000-412,000) human melioidosis cases per year worldwide, of which 89,000 (36,000-227,000) die. Our estimates suggest that melioidosis is severely underreported in the 45 countries in which it is known to be endemic and that melioidosis is likely endemic in a further 34 countries which have never reported the disease. The large numbers of estimated cases and fatalities emphasise that the disease warrants renewed attention from public health officials and policy makers.
authors.affiliation: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, United Kingdom ; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand ; Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.
authors.forename: Direk
authors.initials: D
authors.lastname: Limmathurotsakul
authors.affiliation: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Golding
authors.affiliation: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao PDR ; Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, Oxford, OX3 7FZ, United Kingdom.
authors.forename: David Ab
authors.initials: DA
authors.lastname: Dance
authors.affiliation: Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, United Kingdom.
authors.forename: Jane P
authors.initials: JP
authors.lastname: Messina
authors.affiliation: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, United Kingdom.
authors.forename: David M
authors.initials: DM
authors.lastname: Pigott
authors.affiliation: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, United Kingdom.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Moyes
authors.affiliation: Universidade de Fortaleza, Fortaleza, 60811-905, Brazil.
authors.forename: Dionne B
authors.initials: DB
authors.lastname: Rolim
authors.affiliation: Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva, 27, Switzerland.
authors.forename: Eric
authors.initials: E
authors.lastname: Bertherat
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand ; Centre for Tropical Medicine and Global Health, University of Oxford, Old Road Campus, Oxford, OX3 7FZ, United Kingdom.
authors.forename: Nicholas Pj
authors.initials: NP
authors.lastname: Day
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand ; Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom ; London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Peacock
authors.affiliation: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, OX3 7BN, United Kingdom ; Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA ; Fogarty International Center, National Institutes of Health, Bethesda, MD 20892-2220, USA.
authors.forename: Simon I
authors.initials: SI
authors.lastname: Hay