Abstract
In 2009, based on a multicenter study conducted in Asia and Latin Americaand subsidized by the Dengue Control (DENCO) Research Program, the World Health Organization (WHO) proposed a new classification for dengue cases. The purpose of the present study was to evaluate the applicability of the new classification, relative to its previous version [1]. The evaluation, conducted in Campo Grande county, Mato Grosso do Sul state, Brazil, drew on secondary data from referral healthcare centers that assist high-severity dengue patients. A total of 156 medical records of patients with laboratory diagnosis of dengue were investigated. The records covered two epidemic periods: summer of 2006-2007 and summer of 2009-2010. The results showed that 64.6% of cases classified as dengue fever under the 1997 criteria presented manifestations of severity, warranting their reclassification as dengue with warning signs (49) or severe dengue (15) under the 2009 revised criteria. Bleeding, persistent vomiting, and severe, continuous abdominal pain were the most prevalent warning signs, indicative of risk of progression to severe disease. The revised classification was proved less complex than the current version, facilitating the identification of cases and the clinical management of patients.
Highlights
In Brazil, dengue fever—the arbovirosis most widely distributed among humans—is a disease of mandatory reporting and constitutes a serious public health issue
The results showed that 64.6% of cases originally categorized as dengue fever (DF) exhibited manifestations of severity, warranting their reclassification as dengue with warning signs (49) or severe disease (15) under the 2009 revised criteria
Because the traditional World Health Organization (WHO) classification requires four simultaneous criteria to classify cases as dengue hemorrhagic fever (DHF), the absence of one or more criteria may lead to misclassification of severe cases—an issue reported by several investigators
Summary
In Brazil, dengue fever—the arbovirosis most widely distributed among humans—is a disease of mandatory reporting and constitutes a serious public health issue. Proper classification of cases and their subsequent management have become a global challenge, since timely, accurate diagnosis is crucial to reducing mortality rates. The current classification of dengue cases, implemented in 1974 and revised in 1997, comprises three levels of severity: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS) [1]. In 2009, based on a multicenter study conducted in Asia and Latin America, subsidized by the Dengue Control (DENCO) Research Program, the World Health Organization (WHO) proposed a new classification for dengue cases into two categories: dengue fever (which includes cases with and without warning signs) and severe dengue [3]. Warning signs are key to reducing mortality and providing the cases, which are properly classified and managed [4]. The purpose of the present study was to evaluate the applicability of the new classification, relative to its previous version
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