Usefulness and applicability of the revised dengue case classification by disease: multi-centre study in 18 countries

Abstract

BackgroundIn view of the long term discussion on the appropriateness of the dengue classification into dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), the World Health Organization (WHO) has outlined in its new global dengue guidelines a revised classification into levels of severity: dengue fever with an intermediary group of "dengue fever with warning sings", and severe dengue. The objective of this paper was to compare the two classification systems regarding applicability in clinical practice and surveillance, as well as user-friendliness and acceptance by health staff.MethodsA mix of quantitative (prospective and retrospective review of medical charts by expert reviewers, formal staff interviews), semi-quantitative (open questions in staff interviews) and qualitative methods (focus group discussions) were used in 18 countries. Quality control of data collected was undertaken by external monitors.ResultsThe applicability of the DF/DHF/DSS classification was limited, even when strict DHF criteria were not applied (13.7% of dengue cases could not be classified using the DF/DHF/DSS classification by experienced reviewers, compared to only 1.6% with the revised classification). The fact that some severe dengue cases could not be classified in the DF/DHF/DSS system was of particular concern. Both acceptance and perceived user-friendliness of the revised system were high, particularly in relation to triage and case management. The applicability of the revised classification to retrospective data sets (of importance for dengue surveillance) was also favourable. However, the need for training, dissemination and further research on the warning signs was highlighted.ConclusionsThe revised dengue classification has a high potential for facilitating dengue case management and surveillance.

An evaluation of the World Health Organization’s 1997 and 2009 dengue classifications in hospitalized dengue patients in Malaysia

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“…Due to limitations of World Health Organization (WHO) 1997 dengue classification guidelines WHO revised their guidelines in 2009 5 and accordingly the clinical classification was revised as dengue without warning signs, dengue with warning signs, and severe dengue which was much easier to understand. [6][7][8] The present study is an attempt to describe the salient clinical as well as laboratory findings of serologically confirmed hospitalized cases of dengue fever.…”

Autopsy findings in fatal dengue haemorrhagic fever – 06 Cases

“…2 Currently, there is no therapeutics available beyond supportive care. According to WHO, DSS/DHF is the leading cause of childhood mortality in some Asian countries.…”