Dengue and COVID-19: Managing Undifferentiated Febrile Illness during a “Twindemic”

Abstract

Background: During the COVID-19 pandemic, distinguishing dengue from COVID-19 in endemic areas can be difficult, as both may present as undifferentiated febrile illness. COVID-19 cases may also present with false-positive dengue serology. Hospitalisation protocols for managing undifferentiated febrile illness are essential in mitigating the risk from both COVID-19 and dengue. Methods: At a tertiary hospital contending with COVID-19 during a dengue epidemic, a triage strategy of routine COVID-19 testing for febrile patients with viral prodromes was used. All febrile patients with viral prodromes and no epidemiologic risk for COVID-19 were first admitted to a designated ward for COVID-19 testing, from January 2020 to December 2021. Results: A total of 6103 cases of COVID-19 and 1251 cases of dengue were managed at our institution, comprising a total of 3.9% (6103/155,452) and 0.8% (1251/155,452) of admissions, respectively. A surge in dengue hospitalisations in mid-2020 corresponded closely with the imposition of a community-wide lockdown. A total of 23 cases of PCR-proven COVID-19 infection with positive dengue serology were identified, of whom only two were true co-infections; both had been appropriately isolated upon admission. Average length-of-stay for dengue cases initially admitted to isolation during the pandemic was 8.35 days (S.D. = 6.53), compared with 6.91 days (S.D. = 8.61) for cases admitted outside isolation (1.44 days, 95%CI = 0.58–2.30, p = 0.001). Pre-pandemic, only 1.6% (9/580) of dengue cases were admitted initially to isolation-areas; in contrast, during the pandemic period, 66.6% (833/1251) of dengue cases were initially admitted to isolation-areas while awaiting the results of SARS-CoV-2 testing. Conclusions: During successive COVID-19 pandemic waves in a dengue-endemic country, coinfection with dengue and COVID-19 was uncommon. Routine COVID-19 testing for febrile patients with viral prodromes mitigated the potential infection-prevention risk from COVID-19 cases, albeit with an increased length-of-stay for dengue hospitalizations admitted initially to isolation.

Asia’s “twindemic”: dengue fever cases rocket as covid-19 rages on

“…Distinguishing dengue from covid-19 in endemic areas is difficult because in both diseases patients may show symptoms of fever that are difficult to differentiate. 9 For instance, a 2021 study described a Filipino patient treated as a suspected case of covid-19 but whose symptoms of body ache, retro-orbital pain, and headache could also be indications of dengue. 10 In Singapore, two patients were first incorrectly diagnosed as having dengue owing to a false positive dengue rapid diagnostic test, and were later confirmed positive for covid-19.…”

“…Distinguishing dengue from covid-19 in endemic areas is difficult because in both diseases patients may show symptoms of fever that are difficult to differentiate 9. For instance, a 2021 study described a Filipino patient treated as a suspected case of covid-19 but whose symptoms of body ache, retro-orbital pain, and headache could also be indications of dengue 10.…”

COVID-19: Current Status and Future Prospects

“…Our knowledge has expanded on the pathogenesis and treatment of COVID-19 and experience gained within different countries, and this is reflected in the enormous number of scientific papers generated, including those in this Special Issue. There have been 24 papers published upon peer review acceptance in this Special Issue, including 17 research papers [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ], 2 review papers [ 20 , 21 ], 1 opinion piece [ 22 ], 1 commentary [ 23 ], and 3 systematic reviews [ 24 , 25 , 26 ]. Each paper in this Special Issue contributes to our understanding of COVID-19.…”

“…During successive COVID-19 pandemic waves in a dengue-endemic country, coinfection with dengue and COVID-19 was uncommon. [ 12 ]. The eleventh of these was a descriptive longitudinal study conducted for determining the community transmission of SARS-CoV-2 in high- and low-density areas in Dhaka city.…”