Assessing health burden risk and control effect on dengue fever infection in the southern region of Taiwan

Cheng, Yi-Hsien; Lin, Yi-Jun; Chen, Szu-Chieh; You, Shu-Han; Chen, Wei-Yu; Hsieh, Nan-Hung; Yang, Ying-Fei; Liao, Chung-Min

Recently, the parameter of disability-adjusted life years (DALYs) estimates the amount of time, ability, or activity of an individual lost because of disease-induced disability or death. 19 These composite measures incorporate several estimates, including the incidence, prevalence, duration of a particular condition, as well as the outcome of a specific disease, either disability or premature death. Hence, a DALY represents 1 year lost of healthy life. 19 Nowadays, several studies have used DALYs to estimate the disease burden of dengue in various regions, including Mexico, 20 USA, 21 Southeast Asia, 22 and globally. 23 It is estimated, on average, 115.3 (range 6.3-934.3) DALYs per million population annually were lost to dengue for the period 1998-2014 in Taiwan. 24 In epidemic years, direct costs associated with dengue result mostly from hospitalization (86.09%), followed by emergency (7.77%), outpatient (6.10%), and drug costs (0.03%). 24 For indirect costs, lost productivity due to death (70.76%) was the dominant contributor. Overall, the costs were 12.3 times higher in epidemic years than those in nonepidemic years (Wilcoxon rank sum test, P<0.05). 24 Taken together, the relationship among temperature, vectorial capacity, R 0 , and disease burden in terms of DALYs lost is still poorly understood in Taiwan. A better understanding of the complex relationship is helpful for designing more effective public control programs. Therefore, this study aims 1) to explore the temperature-R 0 -DALYs relationship; 2) to examine the impacts of temperature on the risk of dengue health burden in terms of DALYs lost; and 3) to evaluate the effectiveness of various control interventions to design more effective control strategies for achieving the optimal containment of dengue epidemics. To achieve these goals, we developed an integrated framework with a combination of a dengue-mosquito-human transmission model, probabilistic risk assessment, and multi-efficacy control model.