Age and regional differences in clinical presentation and risk of hospitalization for dengue in Brazil, 2000-2014

Abstract

OBJECTIVES:Dengue cases range from asymptomatic to severe, eventually leading to hospitalization and death. Timely and appropriate management is critical to reduce morbidity. Since 1980, dengue has spread throughout Brazil, affecting an increasing number of individuals. This paper describes age and regional differences in dengue’s clinical presentation and associated risk of hospitalization based on more than 5 million cases reported to the Brazilian Ministry of Health from 2000-2014.METHODS:We performed a retrospective analysis of ∼5,450,000 dengue cases, relating clinical manifestations and the risk of hospitalization to age, gender, previous infection by dengue, dengue virus serotype, years of formal education, delay to first attendance and the occurrence of dengue during outbreaks and in different Brazilian regions.RESULTS:Complicated forms of dengue occurred more frequently among those younger than 10 years (3.12% vs 1.92%) and those with dengue virus 2 infection (7.65% vs 2.42%), with a delay to first attendance >2 days (3.18% vs 0.82%) and with ≤4 years of formal education (2.02% vs 1.46%). The risk of hospitalization was higher among those aged 6-10 years old (OR 4.57; 95% CI 1.43-29.96) and those who were infected by dengue virus 2 (OR 6.36; 95% CI 2.52-16.06), who lived in the Northeast region (OR 1.38; 95% CI 1.11-2.10) and who delayed first attendance by >5 days (composite OR 3.15; 95% CI 1.33-8.9).CONCLUSIONS:In Brazil, the occurrence of severe dengue and related hospitalization is associated with being younger than 10 years old, being infected by dengue virus 2 or 3, living in the Northeast region (the poorest and the second most populated) and delaying first attendance for more than 2 days.

Peer Review #2 of "Characterization of dengue cases among patients with an acute illness, Central Department, Paraguay (v0.1)"

“…Clinical findings in our patients appear more consistent with dengue in adults rather than dengue caused specifically by DENV-1, which is often associated with lower rates of arthralgia and myalgia (Burattini et al 2016;Martins Vdo et al 2014;Suppiah et al 2018;Yung et al 2015).…”

Analysis of the optimal vaccination age for dengue in Brazil with a tetravalent dengue vaccine

“…One theory is that a first infection provides some immunity, but that if immunity fails resulting in a secondary infection, the risk is higher. Burattini et al [47] claim that hospitalisation risk is almost the same for those who have A C C E P T E D M A N U S C R I P T Table 6: Vaccination ages A 1 in months for the initial of three doses optimal under the age-constraints of the current Dengvaxia license and the percentage increase δ % E of the lifetime expected risk E compared to its minimum. Only results for constant efficacy are shown in the case of the risk of Dengue being hospitalisation since all optimal vaccination ages for the age-dependent efficacy cases adhere to the license restriction, Table 4 shows the optimal ages in this case.…”

“…Burattini et al [47] used data provided by SINAN to evaluate the cases of hospitalisation by age. We used their data to find the risk function R(a) describing the undesirability of Dengue in terms of hospitalisation by fitting a piecewise function and assuming the risk to remain constant for ages above the highest age of the recorded data.…”

The Optimal Age of Vaccination Against Dengue with an Age-Dependent Biting Rate with Application to Brazil

“…The most likely scenario in the majority of endemic areas in Brazil, and in fact in the world, is that all four dengue serotypes coexist. Based on the evaluation of nearly 7 million cases leading to hospitalisation in Brazil (Burattini et al 2016) our conclusion is that primary infections are in fact risky. This does not mean that ADE does not play an important role in the risk of dengue, but there is a trade-off between the probability that secondary infections are more risky than primary ones and reducing the risk of getting a secondary infection.…”

“…We will consider the risk of being admitted to hospital due to an infection. In this case the pre-vaccine risk of hospitalisation can be derived from data provided by SINAN that was reviewed by Burattini et al (2016) to evaluate age differences in hospital admissions due to dengue. The data show that the highest risk is associated with young ages, with a peak at approximately 5.5 years.…”