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Lue AM, Richards-Dawson MAEH, Gordon-Strachan GM, Kodilinye SM, Dunkley-Thompson JAT, James-Powell TD, Pryce CA, Mears CD, Anzinger JJ, Webster-Kerr K, Christie CDC. Severity and Outcomes of Dengue in Hospitalized Jamaican Children in 2018-2019 During an Epidemic Surge in the Americas. Front Med (Lausanne) 2022; 9:889998. [PMID: 35801209 PMCID: PMC9254731 DOI: 10.3389/fmed.2022.889998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022] Open
Abstract
Objective In 2019, dengue was among the "top-ten threats to global health," with 3.1 million cases reported from the Americas, the highest ever. Simultaneously, Jamaica reported its largest dengue outbreak in 40 years, following Chikungunya and Zika virus epidemics, in 2014 and 2016-2017, respectively. We describe dengue in children admitted to five hospitals in Jamaica during August 2018 through September 2019. Methods Hospitalized children and adolescents aged 0 to 15 years with dengue were managed using PAHO/WHO criteria. Data were extracted from questionnaires, entered into a dataset on Microsoft Excel version 2016, exported to SPSS version 20 and analyzed. Groups were compared using Student's t-test for normally distributed parametric data. Chi-square analysis, or Fisher's exact test was used for categorical variables. A p-value < 0.05 was considered statistically significant. Results There were 339 children, 245 (72.3%) aged 1-10 years, males:females 1:1. Classification was "dengue without warning signs" 53 (15.3%), "dengue with warning signs" 218 (64.3%) and "severe dengue" 68 (20%). Co-morbidities were reported in 88 (26%). Hemoglobin SC disease was associated with severe dengue with hemorrhage (p = 0.005). Organ-system involvement occurred in 334 (98.5%) including gastrointestinal 317 (93.5%), hematologic 311 (91.7%) and musculoskeletal 180 (53.1%). Thirty-nine (11.5%) had 5-7 organ-systems involved. Metabolomics emphasized increased hepatic transaminases 245 (72.3%), lactate dehydrogenase 164 (48.4%) and creatine phosphokinase 84 (24.8%) approaching the high thousands (121,560 u/L), both were markers for severe disease (p < 0.002). Thirteen (3.8%) received intensive care. Dengue was laboratory-confirmed in 220 (78.9%): NS1 antigen-positive (218); RT-PCR-positive (23), with an overlap of NS1 antigen and RT-PCR positive (21); DENV-3 serotype (20). Seventeen (5%) died, 16 (94.1%) had severe dengue and 11 (64.7%) succumbed within 24 to 48 h of admission despite resuscitation and transfusion of blood products. Conclusion Severe dengue with increased attributable mortality occurred in hospitalized children after Jamaica's maiden Zika epidemic.
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Affiliation(s)
- Aileen May Lue
- Bustamante Hospital for Children, Kingston, Jamaica
- Pediatric Residency Program, University of the West Indies, Kingston, Jamaica
| | | | - Georgiana Marie Gordon-Strachan
- Caribbean Institute of Health Research, University of the West Indies, Kingston, Jamaica
- ZIKAction Research Consortium, Fondazione Penta, University of Padova, Padova, Italy
| | - Syed Matthew Kodilinye
- Department of Child and Adolescent Health, University Hospital of the West Indies, Kingston, Jamaica
| | | | | | | | | | - Joshua James Anzinger
- ZIKAction Research Consortium, Fondazione Penta, University of Padova, Padova, Italy
- Department of Microbiology, University of the West Indies, Kingston, Jamaica
- Global Virus Network, Baltimore, MD, United States
| | - Karen Webster-Kerr
- ZIKAction Research Consortium, Fondazione Penta, University of Padova, Padova, Italy
- National Epidemiology Unit, Ministry of Health and Wellness, Kingston, Jamaica
| | - Celia Dana Claire Christie
- ZIKAction Research Consortium, Fondazione Penta, University of Padova, Padova, Italy
- Department of Child and Adolescent Health, University Hospital of the West Indies, Kingston, Jamaica
- Department of Child and Adolescent Health, University of the West Indies, Kingston, Jamaica
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Rodrigo C, Sigera C, Fernando D, Rajapakse S. Plasma leakage in dengue: a systematic review of prospective observational studies. BMC Infect Dis 2021; 21:1082. [PMID: 34670495 PMCID: PMC8527656 DOI: 10.1186/s12879-021-06793-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Plasma leakage is a precursor to life-threatening complications of dengue, but this group is poorly defined and not often reported in literature. Patients with Dengue haemorrhagic fever (DHF) as defined in the 1997 World Health Organization classification are often reported, and they all have plasma leakage, but some patients with plasma leakage do not meet the definition of DHF. The study aims to estimate the frequency of plasma leakage and DHF (as a surrogate of plasma leakage) in dengue and its variations based on virus serotype, geography, patient gender and pre-existing immunity to dengue. PUBMED, Scopus, EMBASE, CINAHL and Web of Science were searched for prospective observational studies reporting on plasma leakage or DHF. Quality of data was assessed using the NIH quality assessment tool for cohort studies. Forty-three studies that recruited 15,794 confirmed dengue patients were eligible. Cumulative frequency of plasma leakage was 36.8% (15 studies, 1642/4462, 95% CI 35.4-38.2%), but surprisingly the estimated cumulative frequency of DHF was higher (45.7%, 32 studies, 4758/10417, 95% CI 44.7-46.6%), indicating that current medical literature over-reports DHF or under-reports plasma leakage. Therefore, a reliable estimate for the proportion of dengue patients developing plasma leakage cannot be derived from existing medical literature even after applying rigorous inclusion criteria to select homogenous studies. Plasma leakage is an important marker of "at-risk" dengue patients and standardizing its definition, diagnosis and reporting should be a priority in research and global policy.
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Affiliation(s)
- Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, UNSW Sydney, Sydney, NSW, 2052, Australia.
- Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | - Chathurani Sigera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, 00800, Sri Lanka
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Agrupis KA, Ylade M, Aldaba J, Lopez AL, Deen J. Trends in dengue research in the Philippines: A systematic review. PLoS Negl Trop Dis 2019; 13:e0007280. [PMID: 31022175 PMCID: PMC6483330 DOI: 10.1371/journal.pntd.0007280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 03/04/2019] [Indexed: 01/26/2023] Open
Abstract
Dengue is an important public health problem in the Philippines. We sought to describe the trends in dengue research in the country. We searched four databases and identified published studies on dengue research in the Philippines during the past 60 years. We reviewed 135 eligible studies, of which 33% were descriptive epidemiologic studies or case series, 16% were entomologic or vector control studies, 12% were studies on dengue virology and serologic response, 10% were socio-behavioral and economics studies, 8% were clinical trials, 7% were on burden of disease, 7% were investigations on markers of disease severity, 5% were on dengue diagnostics, and 2% were modeling studies. During the last decade, dengue research in the Philippines has increased and evolved from simple descriptive studies to those with more complex and diverse designs. We identified several key topics where more research would be useful.
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Affiliation(s)
- Kristal An Agrupis
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Michelle Ylade
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Josephine Aldaba
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Anna Lena Lopez
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Jacqueline Deen
- Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
- * E-mail:
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Low GKK, Ogston SA, Yong MH, Gan SC, Chee HY. Global dengue death before and after the new World Health Organization 2009 case classification: A systematic review and meta-regression analysis. Acta Trop 2018; 182:237-245. [PMID: 29545158 DOI: 10.1016/j.actatropica.2018.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/22/2018] [Accepted: 03/10/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Since the introduction of 2009 WHO dengue case classification, no literature was found regarding its effect on dengue death. This study was to evaluate the effect of 2009 WHO dengue case classification towards dengue case fatality rate. METHODS Various databases were used to search relevant articles since 1995. Studies included were cohort and cross-sectional studies, all patients with dengue infection and must report the number of death or case fatality rate. The Joanna Briggs Institute appraisal checklist was used to evaluate the risk of bias of the full-texts. The studies were grouped according to the classification adopted: WHO 1997 and WHO 2009. Meta-regression was employed using a logistic transformation (log-odds) of the case fatality rate. The result of the meta-regression was the adjusted case fatality rate and odds ratio on the explanatory variables. RESULTS A total of 77 studies were included in the meta-regression analysis. The case fatality rate for all studies combined was 1.14% with 95% confidence interval (CI) of 0.82-1.58%. The combined (unadjusted) case fatality rate for 69 studies which adopted WHO 1997 dengue case classification was 1.09% with 95% CI of 0.77-1.55%; and for eight studies with WHO 2009 was 1.62% with 95% CI of 0.64-4.02%. The unadjusted and adjusted odds ratio of case fatality using WHO 2009 dengue case classification was 1.49 (95% CI: 0.52, 4.24) and 0.83 (95% CI: 0.26, 2.63) respectively, compared to WHO 1997 dengue case classification. There was an apparent increase in trend of case fatality rate from the year 1992-2016. Neither was statistically significant. CONCLUSIONS The WHO 2009 dengue case classification might have no effect towards the case fatality rate although the adjusted results indicated a lower case fatality rate. Future studies are required for an update in the meta-regression analysis to confirm the findings.
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Iguchi JA, Seposo XT, Honda Y. Meteorological factors affecting dengue incidence in Davao, Philippines. BMC Public Health 2018; 18:629. [PMID: 29764403 PMCID: PMC5952851 DOI: 10.1186/s12889-018-5532-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/01/2018] [Indexed: 01/11/2023] Open
Abstract
Background Dengue fever is a major public health concern in the Philippines, and has been a significant cause of hospitalizations and deaths among young children. Previous literature links climate change to dengue, and with increasingly unpredictable changing climate patterns, there is a need to understand how these meteorological variables affect dengue incidence in a highly endemic area. Methods Weekly dengue incidences (2011–2015) in Davao Region, Philippines were obtained from the Department of Health. Same period of weekly local meteorological variables were obtained from the National Climatic Data Center (NCDC) and the National Oceanic and Atmospheric Administration (NOAA). Wavelet coherence analysis was used to determine the presence of non-stationary relationships, while a quasi-Poisson regression combined with distributed lag nonlinear model (DLNM) was used to analyze the association between meteorological variables and dengue incidences. Results Significant periodicity was detected in the 7 to 14-week band between the year 2011–2012 and a 26-week periodicity from the year 2013–2014. Overall cumulative risks were particularly high for rainfall at 32 mm (RR: 1.67, 95% CI: 1.07–2.62), while risks were observed to increase with increasing dew point. On the other hand, lower average temperature of 26 °C has resulted to an increased RR of dengue (RR: 1.96, 95% CI: 0.47–8.15) while higher temperature from 27 °C to 31 °C has lower RR. Conclusions The observed possible threshold levels of these meteorological variables can be integrated into an early warning system to enhance dengue prediction for better vector control and management in the future. Electronic supplementary material The online version of this article (10.1186/s12889-018-5532-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jesavel A Iguchi
- Department of Health Care Policy and Health Economics, Graduate School of Comprehensive Human Sciences, Ibaraki, 305-8577, Japan
| | - Xerxes T Seposo
- Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, 615-8530, Japan.
| | - Yasushi Honda
- Faculty of Health and Sports Sciences, University of Tsukuba, Ibaraki, 305-8577, Japan
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