Dengue fever is massively under-reported in India, hampering our response

An estimated 20 000 people in India die each year from rabies,1 but in 2011 only 253 deaths were reported as having this cause.2 An estimated 100 000-200 000 people in India die annually from malaria,3 but in 2011 only 753 such deaths were reported.4 A recent spate of cases of dengue fever and a media outcry have brought the focus back to the widespread problem of under-reporting of cases of disease in India, linked to the ineffectiveness of our public health efforts.5 As of 26 November 37 070 cases of dengue fever had been reported this year in India.6 But a substantially bigger population is at risk, and India reported only an average of 4.2% of the total number of cases reported in the World Health Organization South East Asia region between 2000 and 2010.7 A study estimated that Thailand (population 70 million) had an annual incidence of more than 231 000 cases of symptomatic dengue in 2003-7.8 Given India’s population (1.2 billion) and environment, which is conducive to dengue, we should expect an incidence in India many times that of the Thai estimate. …