Dengue fever, a mosquito-borne illness causing flu-like symptoms, is a recurring public health challenge in Puerto Rico. Every three to five years, the territory experiences epidemic levels of the disease, straining healthcare resources and impacting the lives of residents. Now, a new study reveals the economic toll of dengue extends far beyond direct medical costs, exceeding $1 billion annually in some years. The findings underscore the urgent need for sustained investment in prevention and control measures to protect both public health and the island’s fragile economy.
Researchers from Northeastern University and the Centers for Disease Control and Prevention (CDC) published the study, which details the comprehensive economic burden of dengue in Puerto Rico from 2010 to 2023. The analysis considers not only hospitalizations and medical care, but as well lost productivity due to illness, transportation costs for treatment, and other related expenses. The scale of the impact—potentially representing nearly 1% of Puerto Rico’s gross domestic product in peak years—highlights the critical need for a more thorough understanding of the disease’s true cost.
The Hidden Costs of Dengue
A significant component of the economic burden stems from the large number of dengue cases that move unreported. Michael Johansson, a research professor of public health and health sciences at Northeastern University and a contributor to the study, explained that conventional reporting systems capture only a fraction of the actual infections. “We estimated there are about 15 cases that are actually occurring for every one that’s getting reported,” Johansson said. This underreporting is due to several factors, including mild cases that don’t require medical attention and the difficulty in distinguishing dengue from other similar illnesses like the flu.
To address this underreporting, the researchers leveraged data from two fever monitoring systems established across the island. These systems allow patients with a fever to opt-in for additional testing, helping to identify cases that might otherwise be missed. The data revealed that for every conventionally reported case, there were an estimated 6-9 outpatient cases and another 5-8 hospitalized cases that had previously gone unrecorded, according to the study published in PLOS Neglected Tropical Diseases.
Economic Impact Across the Years
The economic burden of dengue fluctuates significantly depending on the severity of outbreaks. In 2010, a particularly severe epidemic year with over 144,000 estimated cases, the total economic impact exceeded $1 billion, representing just under 1% of Puerto Rico’s annual gross domestic product. By contrast, 2014, considered a median year in the study, saw approximately 8,400 cases and an economic burden of just under $63 million. These figures demonstrate the substantial economic vulnerability Puerto Rico faces during dengue outbreaks.
The costs associated with dengue extend beyond immediate medical expenses. Treatment for mild cases typically involves over-the-counter medications like acetaminophen and hydration, while severe cases may require hospitalization, intravenous fluids, and even blood transfusions, according to the Cleveland Clinic. Individuals unable to perform due to illness contribute to lost productivity, impacting businesses and the overall economy.
Challenges in Prevention and Treatment
While vaccines for dengue have been developed, the only one previously available for commercial use in the U.S. Has been discontinued, leaving limited options for preventative measures. Currently, control efforts primarily focus on mosquito control strategies, such as eliminating breeding sites and using insecticides. Though, these methods can be costly and may have environmental consequences.
Maile Thayer, a CDC epidemiologist involved in the study, emphasized the importance of the surveillance system in accurately assessing the burden of dengue. “Without the surveillance system, it would not be possible to reliably estimate the true burden of dengue, as passive systems alone,” such as relying solely on physician reports, “can lead to significant undercounts,” she said.
Looking Ahead
The study’s findings are intended to inform policymakers and public health officials in Puerto Rico, guiding decisions related to hospital planning, resource allocation, and the evaluation of different intervention strategies. Johansson hopes that demonstrating the substantial economic impact of dengue will encourage increased investment in research and development of effective control measures. “We should invest more in figuring out what the solutions are” to control the spread of the disease and mitigate its impact, he stated.
While dengue is not typically fatal, Johansson cautioned that significant transmission rates can still lead to deaths. The economic consequences, coupled with the potential for severe illness, underscore the urgency of addressing this ongoing public health threat.
The CDC provides updated information on dengue fever, including prevention tips and travel advisories, on its website: https://www.cdc.gov/dengue/. The Puerto Rico Department of Health also offers resources and guidance on dengue prevention and control.
Disclaimer: This article provides information for general knowledge and informational purposes only, and does not constitute medical advice. It’s essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
What steps do you think Puerto Rico should prioritize to combat the economic and health impacts of dengue fever? Share your thoughts in the comments below.
