title: Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis.
abstract: Burkholderia pseudomallei, a highly pathogenic bacterium that causes melioidosis, is commonly found in soil in Southeast Asia and Northern Australia(1,2). Melioidosis can be difficult to diagnose due to its diverse clinical manifestations and the inadequacy of conventional bacterial identification methods(3). 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 areas(6,7). The global distribution of B. pseudomallei and the burden of melioidosis, however, remain poorly understood. Here, we map documented human and animal cases and the presence of environmental B. pseudomallei and combine this in a formal modelling framework(8-10) to 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, from which 89,000 (36,000-227,000) people 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 probably endemic in a further 34 countries that have never reported the disease. The large numbers of estimated cases and fatalities emphasize that the disease warrants renewed attention from public health officials and policy makers.
authors: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK.|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: Direk
authors: D
authors: Limmathurotsakul
authors: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK.
authors: Nick
authors: N
authors: Golding
authors: 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, UK.
authors: David A B
authors: http://orcid.org/0000-0001-9189-7244
authors: DA
authors: Dance
authors: Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, UK.
authors: Jane P
authors: JP
authors: Messina
authors: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK.
authors: David M
authors: DM
authors: Pigott
authors: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK.
authors: Catherine L
authors: http://orcid.org/0000-0002-8028-4079
authors: CL
authors: Moyes
authors: Universidade de Fortaleza, Fortaleza 60811-905, Brazil.
authors: Dionne B
authors: DB
authors: Rolim
authors: Department of Pandemic and Epidemic Diseases, World Health Organization, Geneva 27, Switzerland.
authors: Eric
authors: E
authors: Bertherat
authors: 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, UK.
authors: Nicholas P J
authors: NP
authors: Day
authors: 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, UK.|London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
authors: Sharon J
authors: SJ
authors: Peacock
authors: Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK.|Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington 98121, USA.|Fogarty International Center, National Institutes of Health, Bethesda, Maryland 20892-2220, USA.
authors: Simon I
authors: http://orcid.org/0000-0002-0611-7272
authors: SI
authors: Hay
mesh_terms: D000818:Animals; D016957:Burkholderia pseudomallei / Q000145:classification / Q000302:isolation & purification*; D017281:Cost of Illness; D004783:Environmental Microbiology; D014943:Global Health; D006801:Humans; D008554:Melioidosis / Q000453:epidemiology* / Q000382:microbiology / Q000662:veterinary*; D009026:Mortality; D019371:Topography, Medical