Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil

Abstract

Introduction:The dengue classifi cation proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classifi cation proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classifi cation to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classifi cation to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. Methods: This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confi rmed to have dengue based on the fi ndings of laboratory examinations. Results: The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classifi cation, 9.1% (11/121) of the cases were classifi ed as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classifi ed as dengue with complications. According to the 2009 classifi cation, 100% (121/121) of the cases were classifi ed as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm 3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF. Conclusions: The WHO 2009 classifi cation is more sensitive than the WHO 1997 classifi cation for identifying dengue deaths among autopsied individuals suspected of having dengue.

Molecular and clinical epidemiological surveillance of dengue virus in Paraíba, Northeast Brazil

“…However, data on comorbidities are not included in the SINAN, and can only be obtained through investigation of fatal dengue cases [33][34][35][36] .…”

Use of minimally invasive autopsy during the COVID-19 pandemic and its possibilities in the context of developing countries

“…The value of the autopsy has been shown in recent epidemics such as dengue, influenza A/H1N1, Zika, HIV, and yellow fever [ 5 – 9 ]. The autopsy findings helped to clarify not only the basic cause of death, but also the pathophysiology of the disease.…”