Understanding the epidemiological trends and economic impact of dengue in Indonesia: A systematic literature review

• Dengue cases in Indonesia have increased since 2000, with periodic peaks • Bali and East Kalimantan had the highest regional incidence • Dengue cases were typically highest in 5–14-year-olds, followed by 15–44-year-olds • Underreporting of dengue in Indonesia was widespread • Severe dengue cases imposed a significant societal economic burden in the country To identify and analyze evidence on the epidemiological trends and economic impact of dengue in Indonesia. Electronic databases (PubMed, Embase, and the Cochrane Database) and gray literature were searched for publicly available data on the epidemiological (2000–2020) and economic (2010–2020) dengue burden in Indonesia. Data from the selected studies were extracted and summarized descriptively. The additional search conducted identified country-level dengue studies in Indonesia published during recent years (2021-2024). For epidemiological burden, 143 publications (94 published studies; 49 gray literature articles) were included. The number of reported dengue cases increased, ranging from 21,143 in 2000 to 204,172 in 2016. Incidence rates (IRs) peaked at 78.9 cases per 100,000 population in 2016. Between 2017 and 2020, dengue cases were generally highest among 5–14-year-olds. While the number of deaths fluctuated since 2000, case fatality rates declined. Regionally, Bali and East Kalimantan reported some of the highest IRs between 2000 and 2020. Underreporting was widespread, with expansion factors ranging from 1.66 for hospitalized cases to 34.01 for ambulatory cases. Results from eight studies showed that dengue is associated with significant economic burden, with higher costs for hospitalized/fatal cases versus ambulatory cases. The additional search identified 11 relevant articles; however, none provided country-level primary data on dengue incidence, mortality, serotype distribution, or economic outcomes in Indonesia. Dengue burden in Indonesia is high, with severe cases associated with a significant economic burden.