Ebola highlights developing world shares more disease burden

Ebola, measles, syphilis and other diseases with skin manifestations have rates that are hundreds of times higher in developing than in developed countries, according to a new study.
"Our goal is to provide information about trends and patterns to bring to light what's going on around the world so that funds can be allocated and policy developed as needed," said Lindsay Boyers, a medical student at the Georgetown University.
The research used data from the Global Burden of Disease Study, an ongoing project funded by the Bill and Melinda Gates Foundation to collect a billion data points describing the distribution of the world's diseases.

Of the 269 diseases in the GBD database, the study compared rates in developed versus developing countries of Ebola, malignant melanoma, basal and squamous cell carcinoma, decubitus ulcer, bacterial skin diseases, cellulitis, varicella (including chickenpox, congenital varicella infection, and herpes zoster), syphilis, measles, and dengue.
Specifically, findings show that in 2010 the measles death rate was 197 times greater in developing countries than in developed countries, but this ratio was down from 345-to-1 in 1990.
Syphilis death rates were 33 and then 45 times greater in developing countries in the years 1990 and 2010. And so far 4,447 people have died of Ebola in developing countries compared with two in developed countries, researchers said.

Of the diseases studied, only melanoma was higher in developed countries, at about 5 times the age-adjusted mortality as in developing countries.

"We have light-skinned populations in areas with tropical sun including Australia and New Zealand, and Asian populations don't tend to embrace tanning the way we do in the US and many developed countries in Europe," said Robert Dellavalle, investigator at the University of Colorado Cancer Centre, and the research paper's senior author.
Interestingly, dengue fever and dengue hemorrhagic fever had no higher age-adjusted mortality in developing countries than they did in the developed world.
The researchers suggest that in addition to the necessity of disease monitoring to help ensure containment of outbreaks such as Ebola, findings suggest that campaigns to eradicate measles in sub-Saharan Africa are effective but significant work is still to be done, and treatment of (and potentially a vaccine for) syphilis remains a major health challenge in developing countries.

The authors suggests that the skin manifestations of Ebola have been under-reported, and that recognition of "non-proritic morbilliform eruptions" that may occur within 2-7 days of symptom onset could help early detection of the disease.
The study was published in the Journal of the American Academy of Dermatology.