{"doi":"10.1016/j.ijid.2023.08.026","title":"Bangladesh's 2023 Dengue outbreak – age/gender-related disparity in morbidity and mortality and geographic variability of epidemic burdens","abstract":"Bangladesh is currently grappling to control its most devastating dengue fever outbreak recorded since the dengue virus (DENV) reappeared in the country in 2000 [1–3]. Although dengue is endemic in Bangladesh, the current dengue surge is unusual in terms of case burden and mortality, seasonality, and the early sharp increase [1]. Between 1 January and 25 August 2023, a total of 110,224 DENV infections including 528 deaths (case fatality ratio [CFR]: 0.48%) were recorded [2]. The reported number of dengue cases and deaths this year so far is already the highest ever recorded in the country, while the numbers are continuing to rise [1–3]. The Bangladesh Ministry of Health and Family Welfare's Management Information System (MIS) provides daily reports on cases, deaths, and the district-wise distribution of DENV infections [2]. Analyses of data from inpatient records and geographic coordinates of residence locations between 1 January and 17 August 2023 highlight four important findings that require further epidemic investigation: First, approximately half of the cases (n=52,656) were recorded in the capital city Dhaka, and 86% of them were located within a 2-km radius of hospitals, raising concern about the high density of DENV patients in the proximity of the hospitals (Fig 1). Second, although 62% of the cases are males, 58% of the deaths are females indicating a higher risk of mortality among females. Third, we identified a possible age-specific disparity in morbidity and mortality indicating more severe infections in the older age group. People ≥30 years old accounted for 38% of cases and 64% of deaths in 2023. Fourth, out of 528 deaths, 391 (74%) were recorded among the patients hospitalized in the capital city, Dhaka (Fig 2).Figure 2Comparison of proportion of Dengue cases and deaths reported from Dhaka and from outside Dhaka on 28th June (Eid-Al-Adha festival) and on 25th August 2023. Although the percentage of cases changes over time (76% vs. 48%. P<0.05) in Dhaka city, the percentage of deaths remains similar over time (78% vs. 74%). (Data source: Management Information System, Ministry of Health and Family Welfare [2])View Large Image Figure ViewerDownload Hi-res image Download (PPT) Currently, Dhaka accounts for approximately 48% (n=52,656) of reported dengue cases and 74% (n=391) of deaths (Fig 2), showing a higher CFR of 0.74% compared to that of 0.24% in the rest of the country, while the percentage distribution of cases had changed over time. Initially, 76% (n=6,014) of cases were reported from Dhaka up until 28 June when Eid-al-Adha was celebrated by the Muslims in the country. To celebrate the festival, people left the capital city for rural family homes. This probably allowed the spread of DENV from Dhaka to the rest of the country. The reason for more fatal outcomes of dengue in female patients needs further study. The median age of infected males and females are similar, at 25 years and 26 years respectively. Compared to females, males spend more time outdoors, especially during the dawn and dusk, when Aedes mosquitoes remain active [3]. Furthermore, males are often earners and decision-makers of the families in Bangladesh, and are more likely to get admitted to the hospital than their female counterparts. It may be that only a small fraction of females who have severe dengue are hospitalized rendering a lower denominator for the gender among admitted patients. Vitamin D deficiency is more frequent in females than males in Bangladesh [4] due to less exposure to sunlight, which might be associated with susceptibility to severe disease. People living in dengue-endemic countries experience a higher cumulative lifetime exposure to DENV and thus older people have a higher likelihood of secondary (when infected with 2nd serotype) or tertiary dengue infection (when infected with a third serotype) which can lead to more fatal outcomes. The prevention and control of dengue depends on effective mosquito control measures ","journal":"International Journal of Infectious Diseases","year":2023,"id":323101,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":38,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9306,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1037737,"name":"Md Asaduzzaman","orcid":"0000-0002-8885-6721","position":1,"is_corresponding":false},{"id":263035,"name":"Mohammad Nayeem Hasan","orcid":"0000-0002-2383-0459","position":2,"is_corresponding":false},{"id":898624,"name":"Mahbubur Rahman","orcid":"0000-0001-8577-8281","position":3,"is_corresponding":false},{"id":1037738,"name":"Ahmed Raihan Sharif","orcid":"0000-0003-3271-5134","position":4,"is_corresponding":false},{"id":1037739,"name":"Shah Ali Akbar Ashrafi","orcid":"0000-0002-2334-4039","position":5,"is_corresponding":false},{"id":600732,"name":"Shui Shan Lee","orcid":"0000-0003-1448-765X","position":6,"is_corresponding":false},{"id":85550,"name":"Alimuddin Zumla","orcid":"0000-0002-5111-5735","position":7,"is_corresponding":false},{"id":259403,"name":"Najmul Haider","orcid":"0000-0002-5980-3460","position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":null,"created_at":"2026-07-19T01:07:52.377944Z","pmid":"37660728","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}