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BMC Med. 2019 Sep 9;17(1):172. doi: 10.1186/s12916-019-1396-4.

Estimating the burden of dengue and the impact of release of wMel Wolbachia-infected mosquitoes in Indonesia: a modelling study.

Author information

1
Department of Disease Control, Faculty of Infectious Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
2
Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK.
3
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK.
4
Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA.
5
Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
6
Oxford University Clinical Research Unit, Wellcome Trust Asia-Africa Programme, Ho Chi Minh City, Vietnam.
7
Nuffield Department of Medicine, University of Oxford, Oxford, UK.
8
Eijkman Oxford Clinical Research Unit, Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
9
Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
10
Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK. oliver.brady@lshtm.ac.uk.
11
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK. oliver.brady@lshtm.ac.uk.

Abstract

BACKGROUND:

Wolbachia-infected mosquitoes reduce dengue virus transmission, and city-wide releases in Yogyakarta city, Indonesia, are showing promising entomological results. Accurate estimates of the burden of dengue, its spatial distribution and the potential impact of Wolbachia are critical in guiding funder and government decisions on its future wider use.

METHODS:

Here, we combine multiple modelling methods for burden estimation to predict national case burden disaggregated by severity and map the distribution of burden across the country using three separate data sources. An ensemble of transmission models then predicts the estimated reduction in dengue transmission following a nationwide roll-out of wMel Wolbachia.

RESULTS:

We estimate that 7.8 million (95% uncertainty interval [UI] 1.8-17.7 million) symptomatic dengue cases occurred in Indonesia in 2015 and were associated with 332,865 (UI 94,175-754,203) lost disability-adjusted life years (DALYs). The majority of dengue's burden was due to non-severe cases that did not seek treatment or were challenging to diagnose in outpatient settings leading to substantial underreporting. Estimated burden was highly concentrated in a small number of large cities with 90% of dengue cases occurring in 15.3% of land area. Implementing a nationwide Wolbachia population replacement programme was estimated to avert 86.2% (UI 36.2-99.9%) of cases over a long-term average.

CONCLUSIONS:

These results suggest interventions targeted to the highest burden cities can have a disproportionate impact on dengue burden. Area-wide interventions, such as Wolbachia, that are deployed based on the area covered could protect people more efficiently than individual-based interventions, such as vaccines, in such dense environments.

KEYWORDS:

Burden; Dengue; Elimination; Indonesia; Maps; Model; Wolbachia

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