The ten original papers in this special issue present a series of approaches and findings to contribute to measuring the cost and burden of dengue and chikungunya from the Americas to Asia.
The papers are arranged geographically from west to east to reflect the longitudinal scope of these mosquito-borne diseases in the tropical regions of the world.
The first paper, Dengue in Brazil: 1999� by Luiz Tadeu Moraes Figueiredo, is based on the paper with the highest western longitude (60o west) in this special issue. Figueiredo's paper focuses on the epidemiology of dengue over an 11-year period. The data show the remarkable year-to-year variation in incidence of the disease. The number of reported cases in the year of highest incidence (718 000 cases) is seven times the number reported for in the lowest year (113 000). In addition to the fluctuation, the author's trend lines confirm disconcerting general upward trends corresponding to an annual rise of 6.2% in dengue cases and 12.0% in dengue deaths in the country.
The second paper, Cost of dengue vector control in Puerto Rico, 2002 through 2007 by Carmen Perez and colleagues, does not examine the disease itself, but the prevention and control activities, primarily through vector control. Perez and co-authors report that surveillance and vector control are implemented and funded through a combination of two levels of local government: the affected municipalities and the state (corresponding to provinces in some other countries). Across the study years, overall annual spending in the island totals US$ 1.97 per capita, of which 83% comes from the 12 municipalities with their own programmes and 17% from the state. Clean-up campaigns had the highest share of average expenditure, followed by fumigation, surveillance and inspection. Puerto Rico's experience highlights the importance of the role of multiple levels of governm
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