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Lancet. 2007 Apr 28;369(9571):1452-1459. doi: 10.1016/S0140-6736(07)60671-0.

Burden of symptomatic dengue infection in children at primary school in Thailand: a prospective study.

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Division of Communicable Diseases and Immunology, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Ministry of Public Health, Nonthaburi, Thailand.
Department of Virology, Armed Forces Institute of Medical Research, Bangkok, Thailand.
Center For Infectious Disease and Vaccine Research, University of Massachusetts Medical School, Worcester, MA, USA.
Military Infectious Disease Research Program, Ft Detrick, MD, USA.
Division of Communicable Diseases and Immunology, Walter Reed Army Institute of Research, Silver Spring, MD, USA. Electronic address:



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.


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.


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%.


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.

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