Dengue in travellers: applicability of the 1975–1997 and the 2009 WHO classification system of dengue fever

Wieten, Rosanne W.; Vlietstra, Wytze J.; Goorhuis, Abraham; Vugt, Michèle van; Hodiamont, Caspar J.; Leenstra, Tjalling; Vries, Peter J. de; Janssen, Saskia; Thiel, Pieter P. van; Stijnis, Kees; Grobusch, Martin P.

doi:10.1111/j.1365-3156.2012.03020.x

Cited by 16 publications

(11 citation statements)

References 25 publications

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“…After the screening of titles and abstracts, 25 studies remained eligible 10–34. Eligible studies are tabulated in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…These studies were excluded from the analysis but reflected in the discussion for the purpose of highlighting the different opinions. Three additional studies were excluded after full assessment of the text, because they only assessed DF/DHF/DSS without comparison with D/SD32,33 or dealt with a particular subgroup of cases not representative of dengue-endemic countries (dengue in travellers34). …”

Section: Resultsmentioning

confidence: 99%

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Comparing the Usefulness of the 1997 and 2009 WHO Dengue Case Classification: A Systematic Literature Review

Horstick¹,

Jaenisch²,

Martínez³

et al. 2014

The American Society of Tropical Medicine and Hygiene

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The 1997 and 2009 WHO dengue case classifications were compared in a systematic review with 12 eligible studies (4 prospective). Ten expert opinion articles were used for discussion. For the 2009 WHO classification studies show: when determining severe dengue sensitivity ranges between 59–98% (88%/98%: prospective studies), specificity between 41–99% (99%: prospective study) - comparing the 1997 WHO classification: sensitivity 24.8–89.9% (24.8%/74%: prospective studies), specificity: 25%/100% (100%: prospective study). The application of the 2009 WHO classification is easy, however for (non-severe) dengue there may be a risk of monitoring increased case numbers. Warning signs validation studies are needed. For epidemiological/pathogenesis research use of the 2009 WHO classification, opinion papers show that ease of application, increased sensitivity (severe dengue) and international comparability are advantageous; 3 severe dengue criteria (severe plasma leakage, severe bleeding, severe organ manifestation) are useful research endpoints. The 2009 WHO classification has clear advantages for clinical use, use in epidemiology is promising and research use may at least not be a disadvantage.

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“…After the screening of titles and abstracts, 25 studies remained eligible 10–34. Eligible studies are tabulated in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Comparing the Usefulness of the 1997 and 2009 WHO Dengue Case Classification: A Systematic Literature Review

Horstick¹,

Jaenisch²,

Martínez³

et al. 2014

The American Society of Tropical Medicine and Hygiene

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“…In fact the new classification criteria were found to be far more sensitive and specific in detection of patients with severe dengue, when compared to the traditional criteria [15,20]. After carrying out extensive multicentre studies, simple clinical signs and symptoms, which would enable medical personal to clearly distinguish between severe and non severe forms of dengue were developed [14].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the WHO revised criteria for classification of clinical disease severity in acute adult dengue infection

et al. 2012

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BackgroundThe WHO guidelines were revised recently to identify patients with severe dengue (SD) early. We proceeded to determine the usefulness of the warning signs in the new WHO guidelines in predicting SD and we have also attempted to define other simple laboratory parameters that could be useful in predicting SD.MethodsClinical and laboratory parameters were recorded in 184 patients in 2011, with confirmed dengue viral infections, admitted to a medical ward in two tertiary care hospitals in Colombo, Sri Lanka.ResultsWe found that the presence of 5 or more dengue warning signs were significantly (p = 0.02) associated with the development of SD (odds ratio 5.14, 95% CI = 1.312 to 20.16). The AST levels were significantly higher (p = 0.0001) in patients with abdominal pain (mean 243.5, SD ± 200.7), when compared to those who did not have abdominal pain (mean 148.5, SD ± 218.6). Lymphocyte counts <1,500 cells/mm3 were significantly (p = 0.005) associated with SD (odds ratio 3.367, 95% CI 1.396 to 8.123). High AST levels were also significantly associated (p < 0.0001) with SD (odds ratio 27.26, 95% CI 1.632 to 455.2). Platelet counts <20,000cells/mm3, were again significantly associated (p < 0.001) with severe disease (odds ratio 1.632 to 455.2, 95% CI 3.089 to 14.71). The PCR was positive in 26/84 of the patients and we found that the infecting serotype was DEN-1 in all 26 patients.ConclusionsThe presence of 5 or more warning signs appears to be a predictor of SD. Lymphocyte counts <1,500 cells/mm3, platelet counts <20,000/mm3 and raised AST levels were associated with SD and could be used to help identify patients who are likely to develop SD.

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“…Twenty‐two of 44 studies gave definitions for ‘increase in hematocrit’ as a WS of dengue. Nineteen studies defined it as an increase in hematocrit by more than 20% from the baseline . Macedo et al specified that the 20% increase should be from the baseline value during the convalescent phase of the disease.…”

Section: Resultsmentioning

confidence: 99%

Definitions for warning signs and signs of severe dengue according to the WHO 2009 classification: Systematic review of literature

Morra

Altibi

Iqtadar

et al. 2018

Reviews in Medical Virology

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Since warning signs and signs of severe dengue are defined differently between studies, we conducted a systematic review on how researchers defined these signs. We conducted an electronic search in Scopus to identify relevant articles, using key words including dengue, "warning signs," "severe dengue," and "classification." A total of 491 articles were identified through this search strategy and were subsequently screened by 2 independent reviewers for definitions of any of the warning or severe signs in the 2009 WHO dengue classification. We included all original articles published in English after 2009, classifying dengue by the 2009 WHO classification or providing the additional definition or criterion of warning signs and severity (besides the information of 2009 WHO). Analysis of the extracted data from 44 articles showed wide variations among definitions and cutoff values used by physicians to classify patients diagnosed with dengue infection. The establishment of clear definitions for warning signs and severity is essential to prevent unnecessary hospitalization and harmonizing the interpretation and comparability of epidemiological studies dedicated to dengue infection.

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Dengue in travellers: applicability of the 1975–1997 and the 2009 WHO classification system of dengue fever

Cited by 16 publications

References 25 publications

Comparing the Usefulness of the 1997 and 2009 WHO Dengue Case Classification: A Systematic Literature Review

Comparing the Usefulness of the 1997 and 2009 WHO Dengue Case Classification: A Systematic Literature Review

Evaluation of the WHO revised criteria for classification of clinical disease severity in acute adult dengue infection

Definitions for warning signs and signs of severe dengue according to the WHO 2009 classification: Systematic review of literature

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