Abstract
Studies on serotype-specific features of dengue and disease severity on adults are limited. We prospectively recruited adult febrile patients without alternate diagnosis to dengue from April 2005 to December 2011. Outcomes were defined using both the World Health Organization (WHO) 1997 and 2009 criteria; Dengue hemorrhagic fever (DHF) and severe dengue (SD). Infecting serotype was identified in 469 dengue-confirmed patients comprising 22.0% dengue virus serotype 1 (DENV-1), 57.1% DENV-2, 17.1% DENV-3, and 3.8% DENV-4. Cases infected with DENV-1 were more likely to present with red eyes whereas presence of joint pain and lower platelet count was associated with DENV-2 cases. After adjusting for potential confounders, DENV-1 was associated with both DHF (adjusted Relative Risk [aRR] = 1.74) and SD (aRR = 2.1) whereas DENV-2 had a lower risk of DHF (aRR = 0.5). DENV-1 genotype 1 and DENV-2 cosmopolitan were the predominant genotypes identified. Infecting dengue serotype and possibly genotype may play an important role in disease severity among adult dengue patients in Singapore.
Highlights
Dengue fever is the most prevalent arboviral infection worldwide, with up to 40% (2.5–3 billion people) of the world’s population living in endemic regions
Cases infected with dengue virus serotype 1 (DENV-1) were more likely to present with red eyes whereas presence of joint pain and lower platelet count was associated with dengue virus (DENV)-2 cases
The higher proportion of secondary infection in DENV-2 followed by DENV-1 and DENV-3 in our cohort reflected the epidemiology of dengue in Singapore where the DENV-2 is the main serotype since 2007 after a major outbreak of DENV-1 in 2005.4 Most DENV-1 cases were recruited from primary care since enrollment at the site started in 2005 just before a national DENV-1 outbreak
Summary
Dengue fever is the most prevalent arboviral infection worldwide, with up to 40% (2.5–3 billion people) of the world’s population living in endemic regions. DENV-1 and DENV-2 are the main circulating serotypes, all four dengue virus are detected.[5] Infections with different serotypes may cause nearly identical clinical syndrome,[6] but some differences in clinical manifestations have been reported, conclusions are usually based on limited serotype comparisons and small sample sizes.[7,8] The exception is a recent large cross-sectional study from the Americas comprising 1,716 children and adults.[9] in view of differences in dominant genotypes circulating in the Americas compared with this part of world, there is currently no data to support extrapolation of these findings
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