Dengue in India: Recent Advances, Prognostic Concerns and Future Considerations - A Review

Abstract

The last semi centennial has witnessed Dengue’s expansion and escalation into all WHO regions, through the progressive build-up of hyperendemicity, to become the most important mosquito-borne disease in the world. India reports the fourth highest incidence of Dengue in the world, 14 cases per 100,000 population, after Brazil, Malaysia and Mexico. However, in 2014, a complexly designed study showed that India’s Dengue case rate is severely under-reported and estimated it to be probably higher than Brazil’s 291/100,000. India will, in all probability, experience many more outbreaks of Dengue as hyperendemicity gets established in our 4000-odd smaller cities and towns in the years to come.
We have characterized the available weapons against Dengue as 3Is – Insecticides, Immunologicals and Innovations. We have reviewed India’s budgetary allocations for Dengue control and surveillance in the past five years. We compare this with expenditures in other Asian countries. While India’s central allocation on all vector-borne diseases as part of 12th five-year plan was 0.36 USD per capita, Mexico, Malaysia , Brazil and Singapore spent 0.76, 3, 5 and 10 USDs per capita for Dengue surveillance and vector control in the same period. Even if we double this estimate of India’s central allocation on all vector-borne diseases (0.72 USD per capita), accounting for an equal contribution from states, it is lower than the total cost of illness per capita for Dengue in the country (0.88 USDs per capita).
Eradication of Dengue virus is theoretically possible before it establishes itself completely in the mosquito-vector and human populations. We have argued for improved surveillance as a necessary backdrop for dengue control strategies. With good infrastructure and manpower, these strategies could be up scaled in the future for eradication of the Dengue virus. We conclude with recommendations for a future systemic strategy that synthesizes surveillance and control measures to achieve zero-infestation of humans and mosquitoes by the Dengue virus.,