It may be beneficial to select a discrete dengue outbreak, such as the recent outbreak in Martinique, and examine all the associated costs. This could then be more broadly applied to better understand the total costs of dengue. The indirect costs find more that are typically unaccounted for include the cost of disruption to health care services (caused by the influx of dengue cases), and the cost of decreased tourism, shipping, transport, and commerce due to fears of the disease spreading. The impact of dengue on patients and their families is significant, both

economically and in terms of quality of life. The economic cost disproportionately falls on the poor, particularly in countries where most costs are covered by the patient. A study in Cambodia showed that patients with dengue cover, on average, 78% of the total cost and 63% of the direct medical cost [28]. In a study in Thailand, 47% of patients with dengue could not afford to visit a reputable medical provider, 14% could not afford treatment, and 17% had to borrow money to cover the cost of illness [29]. Other studies in Cambodia show how these costs are a continuing burden to the

poor [30], with the majority (62%) GW3965 purchase still unable to repay their debts up to one year later [31]. There is also a significant drop (>50%) in the quality of life of both children and adults with dengue, which does not return to baseline until 12–16 days after onset of illness which is almost twice the duration of fever [32]. To raise the profile of dengue among governments and global decision-makers, which will be essential to secure funding for vaccine CYTH4 introduction, it will be necessary to publicise the full

extent of the human burden of dengue. The morbidity caused by dengue should be highlighted and attempts made to move the global focus away from simply considering mortality statistics. While the mortality statistics for dengue are lower than for some other diseases considered a global health priority, the human impact of dengue morbidity is profound and, if better conveyed, persuasive. In particular, the impact of dengue on communities and its psychological impact on patients and families are often ignored. Computational modelling is an additional tool to support the decision-making process. It has proven to be highly advantageous in dengue research, for example in mapping the movement of the dengue virus from urban centres [33] and identifying the causes of the upwards shift in the average age of patients with dengue in some countries [34]. Each dengue-endemic country should have the opportunity to run its own modelling programs, however both human (skilled technicians/programmers) and material (sufficient computational power) resources are currently lacking.