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The global distribution and burden of dengue

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      Abstract

      Dengue is a systemic viral infection transmitted between humans by Aedes mosquitoes 1 . For some patients dengue is a life-threatening illness 2 . There are currently no licensed vaccines or specific therapeutics, and substantial vector control efforts have not stopped its rapid emergence and global spread 3 . The contemporary worldwide distribution of the risk of dengue virus infection 4 and its public health burden are poorly known 2, 5 . Here we undertake an exhaustive assembly of known records of dengue occurrence worldwide, and use a formal modelling framework to map the global distribution of dengue risk. We then pair the resulting risk map with detailed longitudinal information from dengue cohort studies and population surfaces to infer the public health burden of dengue in 2010. We predict dengue to be ubiquitous throughout the tropics, with local spatial variations in risk influenced strongly by rainfall, temperature and the degree of urbanisation. Using cartographic approaches, we estimate there to be 390 million (95 percent credible interval 284-528) dengue infections per year, of which 96 million (67-136) manifest apparently (any level of clinical or sub-clinical severity). This infection total is more than three times the dengue burden estimate of the World Health Organization 2 . Stratification of our estimates by country allows comparison with national dengue reporting, after taking into account the probability of an apparent infection being formally reported. The most notable differences are discussed. These new risk maps and infection estimates provide novel insights into the global, regional and national public health burden imposed by dengue. We anticipate that they will provide a starting point for a wider discussion about the global impact of this disease and will help guide improvements in disease control strategies using vaccine, drug and vector control methods and in their economic evaluation. [285]

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      Very high resolution interpolated climate surfaces for global land areas

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        Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.

        Measuring disease and injury burden in populations requires a composite metric that captures both premature mortality and the prevalence and severity of ill-health. The 1990 Global Burden of Disease study proposed disability-adjusted life years (DALYs) to measure disease burden. No comprehensive update of disease burden worldwide incorporating a systematic reassessment of disease and injury-specific epidemiology has been done since the 1990 study. We aimed to calculate disease burden worldwide and for 21 regions for 1990, 2005, and 2010 with methods to enable meaningful comparisons over time. We calculated DALYs as the sum of years of life lost (YLLs) and years lived with disability (YLDs). DALYs were calculated for 291 causes, 20 age groups, both sexes, and for 187 countries, and aggregated to regional and global estimates of disease burden for three points in time with strictly comparable definitions and methods. YLLs were calculated from age-sex-country-time-specific estimates of mortality by cause, with death by standardised lost life expectancy at each age. YLDs were calculated as prevalence of 1160 disabling sequelae, by age, sex, and cause, and weighted by new disability weights for each health state. Neither YLLs nor YLDs were age-weighted or discounted. Uncertainty around cause-specific DALYs was calculated incorporating uncertainty in levels of all-cause mortality, cause-specific mortality, prevalence, and disability weights. Global DALYs remained stable from 1990 (2·503 billion) to 2010 (2·490 billion). Crude DALYs per 1000 decreased by 23% (472 per 1000 to 361 per 1000). An important shift has occurred in DALY composition with the contribution of deaths and disability among children (younger than 5 years of age) declining from 41% of global DALYs in 1990 to 25% in 2010. YLLs typically account for about half of disease burden in more developed regions (high-income Asia Pacific, western Europe, high-income North America, and Australasia), rising to over 80% of DALYs in sub-Saharan Africa. In 1990, 47% of DALYs worldwide were from communicable, maternal, neonatal, and nutritional disorders, 43% from non-communicable diseases, and 10% from injuries. By 2010, this had shifted to 35%, 54%, and 11%, respectively. Ischaemic heart disease was the leading cause of DALYs worldwide in 2010 (up from fourth rank in 1990, increasing by 29%), followed by lower respiratory infections (top rank in 1990; 44% decline in DALYs), stroke (fifth in 1990; 19% increase), diarrhoeal diseases (second in 1990; 51% decrease), and HIV/AIDS (33rd in 1990; 351% increase). Major depressive disorder increased from 15th to 11th rank (37% increase) and road injury from 12th to 10th rank (34% increase). Substantial heterogeneity exists in rankings of leading causes of disease burden among regions. Global disease burden has continued to shift away from communicable to non-communicable diseases and from premature death to years lived with disability. In sub-Saharan Africa, however, many communicable, maternal, neonatal, and nutritional disorders remain the dominant causes of disease burden. The rising burden from mental and behavioural disorders, musculoskeletal disorders, and diabetes will impose new challenges on health systems. Regional heterogeneity highlights the importance of understanding local burden of disease and setting goals and targets for the post-2015 agenda taking such patterns into account. Because of improved definitions, methods, and data, these results for 1990 and 2010 supersede all previously published Global Burden of Disease results. Bill & Melinda Gates Foundation. Copyright © 2012 Elsevier Ltd. All rights reserved.
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          Novel methods improve prediction of species’ distributions from occurrence data

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            Author and article information

            Affiliations
            [1 ]Spatial Ecology and Epidemiology Group, Tinbergen Building, Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, United Kingdom.
            [2 ]Oxitec Limited, Milton Park, Abingdon OX14 4RX, United Kingdom.
            [3 ]Odum School of Ecology, University of Georgia, Athens, Georgia 30602, United States of America.
            [4 ]Department of Pediatrics, Harvard Medical School and Children’s Hospital Informatics Program, Boston Children’s Hospital, Boston, Massachusetts 02115, United States of America.
            [5 ]Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire 03755, United States of America.
            [6 ]INDEPTH Network Secretariat, East Legon, P.O. Box KD 213, Accra, Ghana.
            [7 ]School of Public Health, University of the Witwatersrand, Braamfontein 2000, Johannesburg, South Africa.
            [8 ]Institute of Public Health, Heidelberg University, Heidelberg, Germany.
            [9 ]Fogarty International Center, National Institutes of Health, Bethesda, Maryland 20892, United States of America.
            [10 ]Section Clinical Tropical Medicine, Department of Infectious Diseases, Heidelberg University Hospital, INF 324, D 69120 Heidelberg, Germany.
            [11 ]Environmental Research Group Oxford (ERGO), Tinbergen Building, Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, United Kingdom.
            [12 ]Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
            [13 ]Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, United Kingdom.
            [14 ]Department of Entomology, University of California Davis, Davis, California 95616, United States of America.
            [15 ]Department of Medicine, National University of Singapore, Singapore.
            Author notes
            Correspondence and requests for materials should be addressed to SIH ( simon.hay@ 123456zoo.ox.ac.uk ).
            Journal
            0410462
            6011
            Nature
            Nature
            Nature
            0028-0836
            1476-4687
            25 March 2013
            07 April 2013
            25 April 2013
            25 October 2013
            : 496
            : 7446
            : 504-507
            23563266
            3651993
            10.1038/nature12060
            NIHMS453763

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            Funding
            Funded by: National Institute of General Medical Sciences : NIGMS
            Award ID: R01 GM083224 || GM
            Funded by: National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID
            Award ID: R01 AI069341 || AI
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