Abstract
ObjectivesSince the 1990s, Singapore has experienced periodic dengue epidemics of increasing frequency and magnitude. In the aftermath of the 2004–2005 dengue epidemic, hospitals refined their admission criteria for dengue cases to right-site dengue case management and reduce the burden of healthcare utilization and negative outcomes. In this study, we describe the national trends of hospital admissions for dengue and disease severity in terms of length of stay (LOS), admission to the intensive care unit (ICU) and death in hospital, and case fatality rate (CFR) in Singapore.MethodsWe conducted a retrospective study of notified cases and laboratory confirmed dengue patients admitted to all public and private hospitals between 2003 and 2017. Case notifications for dengue and hospitalization records were extracted from national databases.ResultsThe proportion of dengue cases hospitalized was lower in recent years; 28.9% in the 2013–2014 epidemic, compared to 93.2% in the 2004–2005 epidemic, and 58.1% in the 2007 epidemic. Median LOS remained stable over the years; overall LOS was 3 to 4 days and ICU stay was 2 to 3 days. Less than 2% of hospitalized patients were admitted to the ICU. Overall CFR was low and remained below 0.5%. The proportions of dengue cases hospitalized and patients admitted to the ICU were highest in the elderly aged 65 years and older.ConclusionsWhile the proportion of dengue cases hospitalized saw a drastic decline due to more selective admission criteria, there was no concomitant increase in adverse outcomes, suggesting that admission criteria were appropriate to focus on severe dengue cases. Further studies are needed to optimize dengue management in older adults who are more likely to be hospitalized with greater disease severity, given the higher proportions of hospitalizations and severe disease among older adults.
Highlights
Dengue was ranked by the World Health Organisation (WHO) as the “most important mosquito-borne viral disease in the world” in 2012, in view of its increasing spread into previously unaffected areas and its high disease burden [1]
The proportion of dengue cases hospitalized was lower in recent years; 28.9% in the 2013– 2014 epidemic, compared to 93.2% in the 2004–2005 epidemic, and 58.1% in the 2007 epidemic
Less than 2% of hospitalized patients were admitted to the intensive care unit (ICU)
Summary
Dengue was ranked by the World Health Organisation (WHO) as the “most important mosquito-borne viral disease in the world” in 2012, in view of its increasing spread into previously unaffected areas and its high disease burden [1]. To tackle the public health impact of dengue in Singapore, a comprehensive nationwide Aedes prevention and control programme incorporating environmental management and source reduction, health education and law enforcement was launched in 1969 and successfully implemented since 1973, as evidenced by a sharp reduction in the Aedes house index (percentage of residential premises found to be breeding Aedes mosquitoes) and low disease incidence [6,7] Despite these efforts, dengue epidemics of increasing magnitude and an elevated level of endemicity have occurred since the late 1980s in a five- to six-year cycle [8,9,10]
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