The third paper, Increase in dengue fever imported from Cte d'Ivoire and West Africa to France, by Guy LaRuche, provides a creative window on a disturbing trend the increase in dengue in Africa. Reports to WHO document dengue transmission in Africa in recent history since 1948, with recent major outbreaks in Cape Verde (peaking in November 2009) and the Red Sea state of Sudan (peaking in March 2010). Yet the limited dengue diagnostic and surveillance systems provide few statistics. Using surveillance from international travelers for the years immediately preceding these outbreaks, LaRuche confirms a significant increase in dengue in Cte d'Ivoire from only one case in the 18-month study period in 2006-07 to six cases in 2008. This trend and the 148 imported cases to metropolitan France from 2006 to 2008 highlight the value of international cooperation in studying and controlling the disease.
The fourth paper, A preliminary estimate of the immediate cost of chikungunya and dengue to Gujarat, India, by Tiina Murtola and co-authors, is one of two papers in this special issue to use Monte Carlo simulations with existing data to extrapolate the annual burden of dengue or chikungunya to a state or national level. To address the fact that existing surveillance systems capture only a fraction of the actual cases, this paper develops the "RUHA" matrix by estimating shares of reported (R) and unreported (U) hospitalized (H) and ambulatory (A) dengue cases. The paper calculates that the immediate cost to households of chikungunya and dengue in the state of Gujarat was estimated to be 3.8 (range 1.6-9.1) billion Indian rupees (INR) per annum.
The fifth paper, Prevalence of chikungunya in the city of Ahmedabad, India, during the 2006 outbreak: A community-based study, by Tapasvi Puwar and co-authors, describes an extensive household survey of 1301 households across 43 clusters. It ascertained the magnitude and characteristics
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