The WHO dengue classification and case definitions: time for a reassessment

JL Deen, E Harris, B Wills, A Balmaseda… - The Lancet, 2006 - thelancet.com
JL Deen, E Harris, B Wills, A Balmaseda, SN Hammond, C Rocha, NM Dung, NT Hung…
The Lancet, 2006thelancet.com
Viewpoint www. thelancet. com Vol 368 July 8, 2006 171 past two decades along with an
increase in the number of concurrent circulating dengue virus serotypes. The burden of
dengue in the region also varies by country. For example, from 1996 to 1997 (two non-
epidemic years) the laboratory-based surveillance system in Puerto Rico detected 0· 71
cases per 1000 children aged 2–18 years. 20 By contrast, prospective cohort studies in
Managua, Nicaragua, recorded 60–180 infections per 1000 children from 2001 to 2003, and …
Viewpoint www. thelancet. com Vol 368 July 8, 2006 171 past two decades along with an increase in the number of concurrent circulating dengue virus serotypes. The burden of dengue in the region also varies by country. For example, from 1996 to 1997 (two non-epidemic years) the laboratory-based surveillance system in Puerto Rico detected 0· 71 cases per 1000 children aged 2–18 years. 20 By contrast, prospective cohort studies in Managua, Nicaragua, recorded 60–180 infections per 1000 children from 2001 to 2003, and 4· 6 confirmed cases per 1000 children aged 2–9 years during a non-epidemic dengue year from 2004 to 2005 (Hammond SN, Balmaseda A, Kuan G, and Harris E, unpublished). Children with severe dengue are particularly susceptible to shock, with the highest mortality in infants. In children admitted to hospital, case-fatality rates can be as high as 4% depending on the age of the population and disease severity (table 2). 2, 20–28 True case-fatality rates are probably higher because hospitals that confirm the diagnosis and publish their findings are more likely to practise better case management than hospitals without basic diagnostic tools. A review of case-fatality rates that included clinically diagnosed cases showed variation in mortality figures between regions and between hospitals, from less than 1% to 13%. 29
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