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Evaluation of the Traditional and Revised WHO Classifications of Dengue Disease Severity

DOI: 10.1371/journal.pntd.0001397

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Abstract:

Dengue is a major public health problem worldwide and continues to increase in incidence. Dengue virus (DENV) infection leads to a range of outcomes, including subclinical infection, undifferentiated febrile illness, Dengue Fever (DF), life-threatening syndromes with fluid loss and hypotensive shock, or other severe manifestations such as bleeding and organ failure. The long-standing World Health Organization (WHO) dengue classification and management scheme was recently revised, replacing DF, Dengue Hemorrhagic Fever (DHF), and Dengue Shock Syndrome (DSS) with Dengue without Warning Signs, Dengue with Warning Signs (abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, increasing hematocrit with decreasing platelets) and Severe Dengue (SD; dengue with severe plasma leakage, severe bleeding, or organ failure). We evaluated the traditional and revised classification schemes against clinical intervention levels to determine how each captures disease severity using data from five years (2005–2010) of a hospital-based study of pediatric dengue in Managua, Nicaragua. Laboratory-confirmed dengue cases (n = 544) were categorized using both classification schemes and by level of care (I–III). Category I was out-patient care, Category II was in-patient care that did not meet criteria for Category III, which included ICU admission, ventilation, administration of inotropic drugs, or organ failure. Sensitivity and specificity to capture Category III care for DHF/DSS were 39.0% and 75.5%, respectively; sensitivity and specificity for SD were 92.1% and 78.5%, respectively. In this data set, DENV-2 was found to be significantly associated with DHF/DSS; however, this association was not observed with the revised classification. Among dengue-confirmed cases, the revised WHO classification for severe dengue appears to have higher sensitivity and specificity to identify cases in need of heightened care, although it is no longer as specific for a particular pathogenic entity as was the traditional schema.

References

[1]  WHO (1975) Technical Guide for Diagnosis, Surveillance, Prevention and Control of Dengue Haemorrhagic Fever. Geneva: World Health Organization.
[2]  WHO (1997) Dengue haemorrhagic fever: Diagnosis, treatment, prevention, and control. Geneva: World Health Organization.
[3]  Deen JL, Harris E, Wills B, Balmaseda A, Hammond SN, et al. (2006) The WHO dengue classification and case definitions: Time for a reassessment? The Lancet 368: 170–173. doi: 10.1016/s0140-6736(06)69006-5
[4]  Phuong CXT, Nhan NT, Kneen R, Thuy PT, van Thien C, et al. (2004) Clinical diagnosis and assessment of severity of confirmed dengue infections in Vietnamese children: is the World Health Organization classification system helpful? Am J Trop Med Hyg 70: 172–179.
[5]  Balmaseda A, Hammond SN, Perez MA, Cuadra R, Solano S, et al. (2005) Assessment of the World Health Organization scheme for classification of dengue severity in Nicaragua. Am J Trop Med Hyg 73: 1059–1062.
[6]  Bandyopadhyay S, Lum LC, Kroeger A (2006) Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever. Trop Med Int Health 11: 1238–1255. doi: 10.1111/j.1365-3156.2006.01678.x
[7]  Rigau-Perez JG (2006) Severe dengue: the need for new case definitions. Lancet Infect Dis 6: 297–302. doi: 10.1016/S1473-3099(06)70465-0
[8]  Kabra SK, Jain Y, Pandey RM, Madhulika , Singhal T, et al. (1999) Dengue haemorrhagic fever in children in the 1996 Delhi epidemic. Trans Royal Soc Trop Med Hyg 93: 294–298. doi: 10.1016/s0035-9203(99)90027-5
[9]  Alexander N, Balmaseda A, Coelho IC, Dimaano E, Hien TT, et al. (2011) Multicentre prospective study on dengue classification in four South-east Asian and three Latin American countries. Trop Med Int Health. May 30, 2011 [Epub ahead of print].
[10]  WHO (2009) Dengue guidelines for diagnosis, treatment, prevention and control. Third edition. Geneva: World Health Organization.
[11]  Fernandez R, Vasquez S (1990) Serological diagnosis of dengue by an ELISA Inhibition method. Mem Inst Oswaldo Cruz 85: 347–351. doi: 10.1590/S0074-02761990000300012
[12]  Balmaseda A, Hammond SN, Tellez Y, Imhoff L, Rodriguez Y, et al. (2006) High seroprevalence of antibodies against dengue virus in a prospective study of schoolchildren in Managua, Nicaragua. Trop Med Intl Health 11: 935–942. doi: 10.1111/j.1365-3156.2006.01641.x
[13]  Harris E, Videa E, Perez L, Sandoval E, Tellez Y, et al. (2000) Clinical, epidemiologic, and virologic features of dengue in the 1998 epidemic in Nicaragua. Am J Trop Med Hyg 63: 5–11.
[14]  Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33: 159–174. doi: 10.2307/2529310
[15]  Guzman MG, Kouri G, Martinez E, Bravo J, Riveron R, et al. (1987) Clinical and serologic study of Cuban children with dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). Bull Pan Am Health Organ 21: 270–279.
[16]  Samsi TK, Wulur H, Sugianto D, Bartz CR, Tan R, et al. (1990) Some clinical and epidemiological observations on virologically confirmed dengue hemorrhagic fever. Paediatr Indones 30: 293–303.
[17]  Lucas GN, Amerasinghe A, Sriranganathan S (2000) Dengue haemorrhagic fever in Sri Lanka. Indian J Pediatr 67: 503–504. doi: 10.1007/BF02760477
[18]  Ahmed FU, Mahmood CB, Sharma JD, Hoque SM, Zaman R, et al. (2001) Dengue and Dengue Haemorrhagic Fever in children during the 2000 outbreak in Chittagong, Bangladesh. WHO Dengue Bull 25: 33–39.
[19]  Srivastava VK, Suri S, Bhasin A, Srivastava L, Bharadwaj M (1990) An epidemic of dengue haemorrhagic fever and dengue shock syndrome in Delhi: a clinical study. Ann Trop Pediatr 10: 329–334.
[20]  Chumdermpadetsuk S (1978) Early recognition of severe dengue hemorrhagic fever. J Med Assoc Thai 61: 42–47.
[21]  Nimmannitya S (1996) Clinical management of DHF/DSS. WHO Dengue Bull 20: 13–19.
[22]  Rigau-Perez JG, Bonilla GL (1999) An evaluation of modified case definitions for the detection of dengue hemorrhagic fever. Puerto Rico Association of Epidemiologists. P R Health Sci J 18: 347–352.
[23]  Balmaseda A, Hammond S, Pérez L, Tellez Y, Saboria S, et al. (2006) Serotype-specific differences in clinical manifestations of dengue. Am J Trop Med Hyg 74: 449–456.
[24]  Vaughn DW, Green S, Kalayanarooj S, Innis BL, Nimmannitya S, et al. (2000) Dengue viremia titer, antibody response pattern, and virus serotype correlate with disease severity. J Infect Dis 181: 2–9. doi: 10.1086/315215
[25]  Nisalak A, Endy TP, Nimmanniya S, Kalayanarooj S, Thisayakorn U, et al. (2003) Serotype-specific dengue virus circulation and dengue disease in Bangkok, Thailand from 1973 to 1999. Am J Trop Med Hyg 68: 191–202.

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