From primary care to hospitalization: clinical warning signs of severe dengue fever in children and adolescents during an outbreak in Rio de Janeiro, Brazil

Gibson, Gerusa; Souza-Santos, Reinaldo; Brasil, Patrícia; Pacheco, Antônio Guilherme; Cruz, Oswaldo G.; Honório, Nildimar Alves; Kubelka, Claire Fernandes; Carvalho, Marília Sá

doi:10.1590/s0102-311x2013000100010

Cited by 12 publications

(19 citation statements)

References 31 publications

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“…The presence of an epidemic can also cause a change in the time of admission. In a 2007/2008 epidemic in Rio de Janiero, Dengue cases frequently received primary medical care on the third day from the onset of illness [7]. This study assessed the effect of the 2010 epidemic in Region VIII [8], Philippines on the time of admission.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with the Time of Admission among Notified Dengue Fever Cases in Region VIII Philippines from 2008 to 2014

Abello

Cuesta

Cerro³

et al. 2016

PLoS Negl Trop Dis

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In cases of Dengue fever, late hospital admission can lead to treatment delay and even death. In order to improve early disease notification and management, it is essential to investigate the factors affecting the time of admission of Dengue cases. This study determined the factors associated with the time of admission among notified Dengue cases. The study covered the period between 2008 and 2014 in Region VIII, Philippines. The factors assessed were age, sex, hospital sector, hospital level, disease severity based on the 1997 WHO Dengue classification, and period of admission (distinguishing between the 2010 Dengue epidemic and non-epidemic time). We analysed secondary data from the surveillance of notified Dengue cases. We calculated the association through chi-square test, ordinal logistic regression and linear regression at p value < 0.05. The study included 16,357 admitted Dengue cases. The reported cases included a majority of children (70.09%), mild cases of the disease (64.00%), patients from the public sector (69.82%), and non-tertiary hospitals (62.76%). Only 1.40% of cases had a laboratory confirmation. The epidemic period in 2010 comprised 48.68% of all the admitted cases during this period. Late admission was more likely among adults than children (p<0.05). The severe type of the disease was more likely to be admitted late than the mild type (p<0.05). Late admission was also more likely in public hospitals than in private hospitals (p<0.05); and within tertiary level hospitals than non-tertiary hospitals (p<0.05). Late admission was more likely during the non-epidemic period than the 2010 epidemic period (p<0.05). A case fatality rate of 1 or greater was significantly associated with children, severe diseases, tertiary hospitals and public hospitals when admitted late (p<0.05). Data suggests that early admission among child cases was common in Region VIII. This behavior is encouraging, and should be continued. However, further study is needed on the late admission among tertiary, public hospitals and non-epidemic period with reference to the quality of care, patient volume, out of pocket expense, and accessibility We recommend the consistent use of the 2009 WHO Dengue guidelines in order to standardize the admission criteria and time across hospitals.

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Section: Introductionmentioning

confidence: 99%

“…Non-severe cases were usually admitted on the third and fourth day since the onset of the disease, while severe cases were admitted later [7]. In a 2006 study by Tomaschek in Puerto Rico, Dengue cases were seen by a clinician at least once, without appropriate assessment of the severe warning signs, before being admitted [9].…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with the Time of Admission among Notified Dengue Fever Cases in Region VIII Philippines from 2008 to 2014

Abello

Cuesta

Cerro³

et al. 2016

PLoS Negl Trop Dis

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“…Brazil accounts for more than 70% of notifi ed cases in the Americas, and the City of Rio de Janeiro has become one of the most endemic cities in Brazil with a long history of dengue virus circulation [2][3][4][5] .…”

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confidence: 99%

“…Subsequently, the City of Rio de Janeiro was affected in 2008 by the largest dengue epidemic ever reported in terms of mortality. The 2008 epidemic was associated with a variant strain of the DENV-2 serotype, which was characterized by a greater proportion of severe cases in children compared with previous epidemics 2,5,10,11 .…”

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confidence: 99%

“…No consensus is currently available on the determinants of a poor clinical prognosis in dengue patients; however, the excessive number of severe cases in Rio de Janeiro in 2008 may be explained by a combination of factors that range from proximal determinants, such as the genetic variant of the DENV-2 serotype, the immune status of the population, the supply and quality of health services, and the socioeconomic context from which the severe cases emerged 2,4,5,11 . Therefore, this ecological study aimed to analyze the association between the occurrence of severe cases of dengue in the 2008 epidemic and socioeconomic indicators, as well as indicators of health service availability and previous circulation of the DENV-3 serotype.…”

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confidence: 99%

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Occurrence of severe dengue in Rio de Janeiro: an ecological study

Gibson

Souza-Santos

Siqueira

et al. 2014

Rev. Soc. Bras. Med. Trop.

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Introduction:This study aimed to analyze the relationship between the incidence of severe dengue during the 2008 epidemic in Rio de Janeiro, Brazil, and socioeconomic indicators, as well as indicators of health service availability and previous circulation of the dengue virus serotype-3 (DENV-3). Methods: In this ecological study, the units of analysis were the districts of Rio de Janeiro. The data were incorporated into generalized linear models, and the incidence of severe dengue in each district was the outcome variable. Results: The districts with more cases of dengue fever in the 2001 epidemic and a higher percentage of residents who declared their skin color or race as black had higher incidence rates of severe dengue in the 2008 epidemic [incidence rate ratio (IRR)= 1.21; 95% confi dence interval ( 95% CI)= 1.05-1.40 and IRR= 1.34; 95% CI= 1.16-1.54, respectively]. In contrast, the districts with Family Health Strategy (FHS) clinics were more likely to have lower incidence rates of severe dengue in the 2008 epidemic (IRR= 0.81; 95% CI= 0.70-0.93). Conclusions: At the ecological level, our fi ndings suggest the persistence of health inequalities in this region of Brazil that are possibly due to greater social vulnerability among the selfdeclared black population. Additionally, the protective effect of FHS clinics may be due to the ease of access to other levels of care in the health system or to a reduced vulnerability to dengue transmission that is afforded by local practices to promote health.

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Dengue severity associated with age and a new lineage of dengue virus‐type 2 during an outbreak in Rio De Janeiro, Brazil

Nunes

Sampaio

Costa

et al. 2016

Journal of Medical Virology

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Dengue virus-type 2 (DENV-2) caused three outbreaks, in the years 1990, 1998, and 2008, in Rio de Janeiro, Brazil. The 2008 outbreak was the most severe in reported cases, hospitalizations, and deaths. To investigate virological and epidemiological factors that may have contributed to the pathogenic profile of 2008 epidemic, 102 patients sera obtained during the epidemic and inter-epidemic periods of three outbreaks were analysed by qRT-PCR to estimate viremia levels and their correlation with the clinical, immunological, and demographic patient characteristics. DENV-2 isolates from the outbreaks were sequenced. Two DENV-2 lineages (I and II) of the American/Asian genotype were confirmed, each exclusive for 1990-2002 and 2007-2011, respectively. The mean viremia level in the 2008 samples was two orders of magnitude higher than that of the 1990-2002 samples. Severe dengue cases increased from 31% in 1990-2002 to 69% in 2007-2011; in patients aged ≤15 years, from 3% in 1990-2002 to 37% in 2007-2011. The DENV-2 lineage II and younger age significantly contributed to the pathogenic profile of 2008 epidemic in Rio de Janeiro.

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From primary care to hospitalization: clinical warning signs of severe dengue fever in children and adolescents during an outbreak in Rio de Janeiro, Brazil

Cited by 12 publications

References 31 publications

Factors Associated with the Time of Admission among Notified Dengue Fever Cases in Region VIII Philippines from 2008 to 2014

Factors Associated with the Time of Admission among Notified Dengue Fever Cases in Region VIII Philippines from 2008 to 2014

Occurrence of severe dengue in Rio de Janeiro: an ecological study

Dengue severity associated with age and a new lineage of dengue virus‐type 2 during an outbreak in Rio De Janeiro, Brazil

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