Abstract
Measuring heterogeneity of dengue illness is necessary to define suitable endpoints in dengue vaccine and therapeutic trials and will help clarify behavioral responses to illness. To quantify heterogeneity in dengue illness, including milder cases, we developed the Dengue Illness Perceptions Response (IPR) survey, which captured detailed symptom data, including intensity, duration, and character, and change in routine activities caused by illness. During 2016–2019, we collected IPR data daily during the acute phase of illness for 79 persons with a positive reverse transcription PCR result for dengue virus RNA. Most participants had mild ambulatory disease. However, we measured substantial heterogeneity in illness experience, symptom duration, and maximum reported intensity of individual symptoms. Symptom intensity was a more valuable predicter of major activity change during dengue illness than symptom presence or absence alone. These data suggest that the IPR measures clinically useful heterogeneity in dengue illness experience and its relation to altered human behavior.
Highlights
Measuring heterogeneity of dengue illness is necessary to define suitable endpoints in dengue vaccine and therapeutic trials and will help clarify behavioral responses to illness
As part of a larger epidemiologic study we developed the dengue Illness Perceptions Response (IPR) survey to gather data to characterize the dengue illness experience of a person, including the range and intensity of symptoms, and to measure the response of a person to their illness
Development of IPR Survey On the basis of the experience of our team in collecting dengue symptom data and the available literature, we developed a focus group guide used to facilitate 6 mixed-sex focus groups to assess how persons who had recently had dengue illness described the experience, including the range, duration, and precise location of symptoms; ways to describe the severity of the symptoms; and word choices related to the symptoms
Summary
Measuring heterogeneity of dengue illness is necessary to define suitable endpoints in dengue vaccine and therapeutic trials and will help clarify behavioral responses to illness. Symptom intensity was a more valuable predicter of major activity change during dengue illness than symptom presence or absence alone These data suggest that the IPR measures clinically useful heterogeneity in dengue illness experience and its relation to altered human behavior. Behavioral responses and reactions to illness depend on the illness experience of a person and will determine whether they attend work or school, selfmedicate, seek medical attention, and move around their neighborhood, potentially infecting mosquitoes at other sites (7). Quantifying these relationships will help identify the human factors essential for virus. We outline the development and application of the IPR, and to illustrate its potential value, we describe and quantify the heterogeneity of dengue illness and its associations with behavior changes
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