Abstract
OBJECTIVES:Dengue cases range from asymptomatic to severe, eventually leading to hospitalization and death. Timely and appropriate management is critical to reduce morbidity. Since 1980, dengue has spread throughout Brazil, affecting an increasing number of individuals. This paper describes age and regional differences in dengue’s clinical presentation and associated risk of hospitalization based on more than 5 million cases reported to the Brazilian Ministry of Health from 2000-2014.METHODS:We performed a retrospective analysis of ∼5,450,000 dengue cases, relating clinical manifestations and the risk of hospitalization to age, gender, previous infection by dengue, dengue virus serotype, years of formal education, delay to first attendance and the occurrence of dengue during outbreaks and in different Brazilian regions.RESULTS:Complicated forms of dengue occurred more frequently among those younger than 10 years (3.12% vs 1.92%) and those with dengue virus 2 infection (7.65% vs 2.42%), with a delay to first attendance >2 days (3.18% vs 0.82%) and with ≤4 years of formal education (2.02% vs 1.46%). The risk of hospitalization was higher among those aged 6-10 years old (OR 4.57; 95% CI 1.43-29.96) and those who were infected by dengue virus 2 (OR 6.36; 95% CI 2.52-16.06), who lived in the Northeast region (OR 1.38; 95% CI 1.11-2.10) and who delayed first attendance by >5 days (composite OR 3.15; 95% CI 1.33-8.9).CONCLUSIONS:In Brazil, the occurrence of severe dengue and related hospitalization is associated with being younger than 10 years old, being infected by dengue virus 2 or 3, living in the Northeast region (the poorest and the second most populated) and delaying first attendance for more than 2 days.
Highlights
Over the past 50 years, dengue has become one of the top priorities of the World Health Organization (WHO) in terms of global health
Rash was more frequent in children younger than 5 years old, those infected by dengue virus (DENV) 1 and those living in the North region
Infection by any serotype of DENV results in a large spectrum of nonspecific clinical manifestations with an unpredictable clinical course and outcome, ranging from asymptomatic cases to severe clinical forms leading to hospitalization, a need for intensive care treatment and death
Summary
Over the past 50 years, dengue has become one of the top priorities of the World Health Organization (WHO) in terms of global health This infection occurs in more than 100 countries and is estimated to affect 50-100 million people, with 500,000 severe cases demanding hospitalization and approximately 20,000 deaths every year [1]. Since its reappearance in Brazil in the early 1980s, dengue has progressively spread throughout the country, affecting an increasing number of individuals, states and municipalities [3,4,5,6,7]. The increasing circulation of various serotypes of the virus has been associated with increases in the frequency and extent of epidemics, with increasing numbers of complicated dengue cases and hospitalizations [3,4,5,6]
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