The burden of dengue, source reduction measures, and serotype patterns in Myanmar, 2011 to 2015–R2

BACKGROUND: Myanmar is currently classified as a high burden dengue country in the Asian Pacific region. The Myanmar vector-borne diseases control (VBDC) program has collected data on dengue and source reduction measures since 1970, and there is a pressing need to collate, analyze, and interpret this information. The aim of this study was to describe the burden of hospital-based dengue disease, dengue control measures, and serotype patterns in Myanmar between 2011 and 2015. METHODS: This was a cross-sectional study using annual records from the Dengue Fever/Dengue Hemorrhagic Fever Prevention and Control Project in Myanmar. RESULTS: Between 2011 and 2015, there were a total of 89,832 cases and 393 deaths in hospitals, with 97% of cases being in children. In 2013 and 2015, there was an increased number of cases, respectively at 21,942 and 42,913, while during the other 3 years, numbers ranged from 4738 to 13,806. The distribution of dengue deaths each year mirrored the distribution of cases. Most cases (84%) occurred in the wet season and 54% occurred in the delta/lowlands. Case fatality rate (CFR) was highest in 2014 at 7 per 1000 dengue cases, while in the other years, it ranged from 3 to 5 per 1000 cases. High CFR per 1000 were also observed in infants < 1 year (CFR = 8), adults ≥ 15 years (CFR = 7), those with disease severity grade IV (CFR = 17), and those residing in hilly regions (CFR = 9). Implementation and coverage of dengue source reduction measures, including larval control, space spraying, and health education, all increased between 2012 and 2015, although there was low coverage of these interventions in households and schools and for water containers. In the 2013 outbreak, dengue virus serotype 1 predominated, while in the 2015 outbreak, serotypes 1, 2, and 4 were those mainly in circulation. CONCLUSION: Dengue is a serious public health disease burden in Myanmar. More attention is needed to improve monitoring, recording, and reporting of cases, deaths, and vector control activities, and more investment is needed for programmatic research.