Dengue and Other Common Causes of Acute Febrile Illness in Asia: An Active Surveillance Study in Children

Abstract

BackgroundCommon causes of acute febrile illness in tropical countries have similar symptoms, which often mimic those of dengue. Accurate clinical diagnosis can be difficult without laboratory confirmation and disease burden is generally under-reported. Accurate, population-based, laboratory-confirmed incidence data on dengue and other causes of acute fever in dengue-endemic Asian countries are needed.Methods and principal findingsThis prospective, multicenter, active fever surveillance, cohort study was conducted in selected centers in Indonesia, Malaysia, Philippines, Thailand and Vietnam to determine the incidence density of acute febrile episodes (≥38°C for ≥2 days) in 1,500 healthy children aged 2–14 years, followed for a mean 237 days. Causes of fever were assessed by testing acute and convalescent sera from febrile participants for dengue, chikungunya, hepatitis A, influenza A, leptospirosis, rickettsia, and Salmonella Typhi. Overall, 289 participants had acute fever, an incidence density of 33.6 per 100 person-years (95% CI: 30.0; 37.8); 57% were IgM-positive for at least one of these diseases. The most common causes of fever by IgM ELISA were chikungunya (in 35.0% of in febrile participants) and S. Typhi (in 29.4%). The overall incidence density of dengue per 100 person-years was 3.4 by nonstructural protein 1 (NS1) antigen positivity (95% CI: 2.4; 4.8) and 7.3 (95% CI: 5.7; 9.2) by serology. Dengue was diagnosed in 11.4% (95% CI: 8.0; 15.7) and 23.9% (95% CI: 19.1; 29.2) of febrile participants by NS1 positivity and serology, respectively. Of the febrile episodes not clinically diagnosed as dengue, 5.3% were dengue-positive by NS1 antigen testing and 16.0% were dengue-positive by serology.ConclusionsDuring the study period, the most common identified causes of pediatric acute febrile illness among the seven tested for were chikungunya, S. Typhi and dengue. Not all dengue cases were clinically diagnosed; laboratory confirmation is essential to refine disease burden estimates.

Caracterización clínica de los pacientes que consultan por dengue en un hospital de tercer nivel en la ciudad de Cali, Colombia, 2013

“…7 El denominador incluye a mujeres en edad fértil (n=80). 8 El denominador incluye a mujeres en edad fértil (n=224). N/A: no aplica…”

“…La presentación clínica del dengue varía ampliamente, especialmente los primeros síntomas, que no son específicos y se pueden confundir con los de otras condiciones febriles prevalentes en la zona, por lo cual el diagnóstico de laboratorio es fundamental para la posterior vigilancia de los pacientes y para garantizar el tratamiento adecuado de quienes presentan otros síndromes febriles que, mal atendidos, pueden conducir a la muerte (8)(9)(10).…”

Chikungunya Virus Infections Among Patients with Dengue-Like Illness at a Tertiary Care Hospital in the Philippines, 2012–2013

“…[19][20][21][22][23][24] However, in a recent study by Capeding and others, chikungunya was the most common cause of febrile illnesses in a multicountry prospective cohort study including two sites from the Philippines in 2010-2011 with an overall incidence density of 10.8 per 100 person-years. 25 In another study by Yoon and others, a high rate of subclinical and symptomatic CHIKV infections was reported in a prospective community cohort in Cebu, Philippines, from 2012 to 2013 with a total incidence density of 12.22 CHIKV infections per 100 person-years. 26 These studies provide further evidence that chikungunya has re-emerged as an important disease in the Philippines as well as in Asia, 17,27 and highlights the importance of distinguishing symptomatic CHIKV infection especially in the background of hyperendemic DENV transmission.…”

Update Management of Chikungunya

“…Malaria, Meningitis: All cases of meningo-encephalitis during an outbreak of Chikungunya must be suspected to have Chikungunya related meningoencephalitis. Rheumatic fever, Leptospirosis, Rickettsial disease 13 may also considered as differential diagnosis.…”