Dengue In Children Research Articles

Clinico - Hematological profile of dengue in children in a tertiary care hospital

Dengue is one of the febrile illnesses which is caused by the Dengue fever virus. It affects people of all ages, from the infants to the elderly and is characterized by flu-like symptoms such as fever, anorexia, nausea, vomitings. 382 children below the age of 18 years who presented with symptoms of dengue fever and were admitted into the pediatric ward and intensive care unit and tested NS1 positive or IgM positive were included into the study. Blood was collected for serological, hematological and biochemical analysis especially SGPT and SGOT. 35.3% of them had dengue fever, 62.04% had dengue hemorrhagic fever and 2.6% had dengue shock syndrome. Fever was seen in 100%, abdominal pain in 67.3%, lethargy in 75.1%, 54.4% with headache, 58.6% with joint pains. The mean hemoglobin level among the children was 10.07 ± 3.19, platelet count below 10000 was seen in 3.4% of the cases, 10000-50000 cells/mm in 12.8%. leucocyte count <4 x 10in 48.2%, 4-6 x 10cells /cc in 47%, increased hematocrit in 15.2%. Increased SGPT was seen in 63.1% and elevated SGOT was in 59.2% of the patients. Since the treatment of dengue is relatively simple, the patients must be made aware to seek the medical help as soon as possible to reduce the amount of morbidity and mortality.

Predictors of severe dengue amongst children as per the revised WHO classification.

World Health Organization (WHO) revised its guidelines for classification and management of dengue in 2009. This revised system was found out to have good sensitivity and negative predictive value but poor specificity as well as positive predictive value. This retrospective study was carried out in a tertiary care hospital of Delhi, India to assess factors predicting the occurrence of severe dengue in children as per the revised classification. A total of 647 suspected dengue cases were admitted in the hospital in the year 2015. Detailed clinical and epidemiological data of 170 patients who were confirmed as dengue either by NS1 antigen test or by serology (Ig M positive) were recorded and statistically analyzed. The number of laboratory-confirmed cases was 170 and included thirty (17.65%) dengue fever (DF), 106 (62.35%) dengue with warning signs (DWS) and 34 (20.0%) severe dengue (SD) patients. Regression analysis revealed that presence of vomiting, altered sensorium, shock, peri-orbital edema, hepatomegaly, splenomegaly, severe anemia, thrombocytopenia, elevated urea and creatinine, decreased total protein and globulin were significantly associated with occurrence of severe disease. The addition of clinical features (peri-orbital edema and splenomegaly); and laboratory findings (elevated urea and creatinine, decreased serum protein and globulin) might help improve the sensitivity and specificity of the revised WHO dengue classification in predicting severe dengue.

Clinicolaboratory and treatment profile of dengue in children: Observations from a tertiary care hospital

Clinicolaboratory and treatment profile of dengue in children: Observations from a tertiary care hospital

Clinicolaboratory and treatment profile of dengue in children: Observations from a tertiary care hospital

Background: Dengue fever (DF) is an arboviral disease of public importance with high mortality and morbidity in tropics. The school-going children are at high risk of developing dengue as they are exposed to the vector, female Aedes aegypticus mosquito, during daytime. The paediatric patients may not present with typical symptoms like in adults. Aim: The aim of this study is to study the clinical and laboratory parameters in paediatric patients with emphasis on various haematological ratios. Materials and Methods: This was a retrospective study conducted in the Clinical Microbiology Department of Tertiary Care Hospital in the coastal part of Karnataka, India, to compare the clinichaematological parameters in the paediatric patients diagnosed with DF. The data were retrospectively collected from January 2015 to December 2018 entered into Microsoft excel, and statistical analysis was done by the Student's t-test. P

Risk factors of severe dengue in children: A nested case-control study

Background: Dengue is a mosquito-borne viral disease whose severity varies from a mild undifferentiated fever to severe fatal form. The objectives of this study were to determine the prevalence and risk factors of severe dengue. Subjects and Methods: This nested case–control study was done in a medical college hospital in South India from October 2019 to January 2020. Children between 1 month and 12 years of age who presented with fever without focus and tested positive for dengue serology were included. Demographic data, anthropometry, clinical features, and laboratory parameters were noted down from all children. Severity of illness was classified according to the World Health Organization dengue guidelines 2009. Prevalence of severe dengue was expressed in proportion with 95% confidence interval (CI). Bivariate analysis was performed using Chi-square test, Fisher's test, and Student's t-test, and a P Results: Out of 370 children, 192 (51.9%) had dengue without warning signs, 168 (45.4%) had dengue with warning signs, and 10 had severe dengue. The prevalence (95% CI) of severe dengue was 2.7% (1.3%–4.9%). Abdominal pain/tenderness (odd's ratio [OR] - 7.429), facial puffiness (OR - 4.333), hepatomegaly (OR - 3.857), and pleural effusion (OR - 13.222) were the significant risk factors for severe dengue. Conclusions: The significant risk factors for severe dengue were abdominal pain/tenderness, facial puffiness, hepatomegaly, and pleural effusion.

Description and Validation of Nursing Diagnosis Using Electronic Documentation: Study Cases in Mother and Child Hospital Indonesia

Background: A nursing diagnosis is a clinical judgment concerning a human response to a health condition, vulnerability for that response, by an individual, family, group, or community. For the determination of the right nursing diagnosis, a system that guides nurses in implementing care professionally is needed. Objective: To describe the nursing diagnosis in mother and child cases validated by using a management nursing information system. Methods: This case study used secondary data from 5.294 medical records. Medical records were retrieved from the server, analyzed, and validated by using the mapping model in accordance with the most frequent cases in mothers and children in the hospital. Approximately ten million (10.021) nursing diagnoses were performed by nurses and validated by using a mapping model of medical cases and nursing assessment. The selected medical cases were the five most frequent cases, namely normal delivery, cesarean delivery, healthy newborn, fever, and dengue in children. Results: This study yielded the five most frequent nursing diagnoses, namely risk for infection (20.1%), pain (13.37%), anxiety (9.37%), the risk for imbalanced fluid volume (9.36%), and risk for bleeding (9.27%). Conclusion: The electronic nursing documentation could help to determine a nursing diagnosis and had been validated for its appropriateness with assessment and the most common cases in mothers and children. Information and system training development are required to carry out the nursing process comprehensively.

The Usefulness of High Sensitivity C-Reactive Protein (hs-CRP) to Differentiate between Severe and Non-Severe Dengue in Children

The Usefulness of High Sensitivity C-Reactive Protein (hs-CRP) to Differentiate between Severe and Non-Severe Dengue in Children

Neurological and Cardiac Manifestations of Children with Dengue Presenting to a Tertiary Care Institute: An Observational Study

Introduction: Dengue is a common arboviral infection in tropical areas of world with increased incidence in the past few years. Spread of disease has led to increased recognition of various atypical manifestations apart from the classical features. This study was conducted to find out the neurological and cardiac manifestations of dengue in children. 
 Methods: This observational study was conducted in a tertiary referral centre in Central India. Cases were classified based on the WHO 2009 Dengue guidelines for the diagnosis, treatment, prevention and control. The neurological and cardiac manifestations of dengue were studied and compared with those cases without manifestations. 
 Results: In this study, a total of 75 dengue cases were included and out of them, five (6.75%) cases presented with CNS abnormalities. The most common neurological manifestations were fever with seizures, altered sensorium, vomiting and headache. Hepatomegaly, hypotension, coagulopathy, and leucocytosis (> 11,000 cells/mm3) were significantly associated with neurological dysfunction (p < 0.05). Ten children out of 75 (13.33%) had cardiac manifestations. They included bradycardia in five cases, tachycardia and signs of CCF in three cases and shock in two cases. Echocardiographic evaluation showed mild pericardial effusion in one patient. 
 Conclusions: Dengue poses a huge burden to healthcare system with its various atypical manifestations. A better understanding of neurological and cardiac clinical manifestations of dengue will reduce morbidity and mortality in such cases.

Management of Dengue in Children: An Update

Dengue viruses cause symptomatic infections or asymptomatic seroconversion. Symptomatic dengue infection is a systemic and dynamic disease. It has a wide clinical spectrum that includes both severe and non-severe clinical manifestations. Due to its dynamic nature, the severity of the disease will usually only be apparent around defervescence which often coincides with the onset of the critical phase. For a disease that is complex in its manifestations, management is relatively simple, inexpensive and very effective in saving lives, so long as correct and timely interventions are instituted. The main hemodynamic elements of dengue shock is hypovolemia with decreased vascular capacitance resulting from plasma leakage. Thus, the strategy of aggressive fluid resuscitation of septic shock is not applicable to severe dengue with plasma leakage. Volume replacement in children with dengue shock is a challenging management problem. Aggressive fluid resuscitation may indeed be harmful and should be limited to dengue shock with hypotension. There is a “narrow therapeutic index”; therefore, fluids have to be given timely, at the appropriate volume, rate, of the appropriate type (crystalloids, colloid and/or blood) and for the appropriate duration. Therein lies the challenge to physicians who are not familiar with the important practice of fluid titration through frequent and meticulous assessment. Progression of the disease through the critical phase should be tracked in hours of plasma leakage. Recognizing the cues to discontinue intravenous fluid therapy is just as important as knowing when to start it. Given time and hemodynamic stability, other issues such as thrombocytopenia, coagulopathy and raised liver enzymes will recover spontaneously or with supportive care.
 DS (Child) H J 2019; 35(2) : 162-178

Ferritin as a Marker of Severe Dengue in Children

Background: The aim is to evaluate ferritin levels in fever caused by dengue virus and their association with the severity of infection with dengue virus in children. Subjects and Methods: It is a Prospective that was done for 1 year in the department of pediatrics. 56 reported cases with a history of dengue fever for clinical evaluation by positive IgG and IgM antibodies and positive NS1 antigen and were included in the sample. All 16-year-old subjects with clinical dengue suspicion presenting in the department of emergency. Results: Out of total of 56 children with mean age of the children were 11.5 years and SD 3.5 years, and 59% were male who were majority. Mean hospital stay duration was 5 3 days. Most of the patients in study discharged in 5-7 days of admission in hospital. The mean serum ferritin levels among cases with DHF were raised than those with DF with significant p-values of< 0.05 on Day 5 and 6 of illness. During Days 5, 6, and 7 after the onset of fever, the results for sensitivity were 83, 86, and 92 per cent respectively. Conclusion: The incidence of hyperferritinaemia in patients infected with dengue virus is suggestive of highly active use of ferritin level in serum is 1,200 ng/ml as a method for predicting progression to DHF starting on Day 4 of the disease and continuing to recover.

WHO 2009 Warning Signs as Predictors of Time Taken for Progression to Severe Dengue in Children

To identify WHO 2009 warning signs that can predict time taken for progression to severe dengue in a pediatric population. Prospective analytical study over 1 year and 2 months. Tertiary care center. 350 children aged 1 mo-12 y with serologically confirmed dengue without co-morbidities/co-infections; conse-cutive sampling. At admission, clinical and laboratory details were noted. Disease progression, time of onset of each warning sign, hematocrit, and platelet counts were recorded daily till discharge/ death. If progressing to severe dengue, its time of onset was noted. Time to event analysis with Log Rank test, Kaplan Meier plots and Cox Proportional Hazards Model was done. Primary outcome was time interval from onset of first warning sign to onset of severe dengue (defined as per WHO 2009 guidelines). Predictors were WHO 2009 warning signs: abdominal pain, lethargy, persistent vomiting, mucosal bleed, clinical fluid accumulation, hepatomegaly >2 cm, hematocrit ≥0.40 and platelet count <100x109/L. Among 350 children followed up completely till discharge/death, 90 developed severe dengue (event) while 260 did not (censored). Median age of study population was 7.75 y. Clinical fluid accumulation [(P=0.002, Hazard Ratio (HR) 2.19, 95% CI 1.33-3.60)] and hematocrit ≥0.40 [(P=0.009, HR (95%CI) 1.715, (1.13-2.60)] were significant in univariate analysis. Final multivariate model includes clinical fluid accumulation [(P=0.02, HR (95%CI) 1.89, (1.116-3.202)], hematocrit ≥0.40 (P=0.07), mucosal bleed (P=0.56) and persistent vomiting (P=0.32). WHO warning signs that predict time taken for progression to severe dengue in children include clinical fluid accumulation, hematocrit ≥0.40, persistent vomiting and mucosal bleed. Study results have implications in policy making and practice guidelines to triage children attending a health care facility with or without warning signs.

Clinical and laboratory profile of dengue fever in children in a tertiary care hospital of Navi Mumbai, India

Background: Dengue fever is a mosquito born arboviral illness endemic in tropical countries and causes significant mortality and morbidity due to lack of definitive treatment. The objective of this study was to assess the clinical and laboratory profile of confirmed cases of dengue in children up to 12 years of age and also to charactrise the risk factors for severe dengue.Methods: This is a descriptive, observational, retrospective study done in the Department of Pediatrics, Terna Medical College, Nerul, Navi Mumbai, India. Medical records of all children up to 12 years of age diagnosed to have dengue were reviewed. Their clinical and laboratory profile were recorded in a pro forma and analyzed. All cases were classified as per WHO guidelines into non severe and severe dengue cases.Results: Among the 117 confirmed dengue cases, (84.6%) had non severe dengue and (15.4%) had severe dengue. The most common age group affected was 9-12 years (45.3%) with a male to female ratio of 2.4:1. Fever was the most common clinical feature seen in all cases followed by headache (83%), myalgia (81%), ascites (24.7%), vomiting (17.9%). Clinical signs of ascitis, hepatomegally, gastrointestinal bleeding, pleural effusion and shock were predominantly associated with severe dengue cases. Laboratory parameters showed leukopenia in 58.1% and thrombocytopenia (platelet counts &lt;20,000/cumm3) in16.2% cases. Elevated liver enzymes, raised hematocrit (36.3%) and coagulation abnormalities were seen in over 50% dengue cases and were significantly associated with severe dengue dengue.Conclusions: Knowledge of clinical and laboratory profile of dengue cases of a particular area will help in early prediction of risk factors for severe dengue resulting in favourable outcome of such cases.

Notified dengue deaths in Myanmar (2017-18): profile and diagnosis delays

Background: Complications in dengue usually occur between day four and day six after fever onset. Hence, early diagnosis and haematological monitoring are vital. Among all hospital reported dengue deaths in Myanmar in 2017-18, we assessed the i) patient profile, ii) proportion of patients who arrived with a dengue diagnosis at admission and iii) delays in diagnosis after fever onset. Methods: This was a descriptive study involving secondary data. For all the notified deaths, death investigation forms were not available in prescribed format and therefore, data were extracted from hospital case records. Results: Of 304 deaths, 184 (60.5%) were female and 233 (76.6%) were less than 10 years old. Township level hospitals or below reported 36 deaths (11.8%) and the remaining deaths were from higher level facilities. Dengue was diagnosed before admission in 26 (8.5%) people and 169 (55.6%) were in shock at admission. Of 208 with date of fever onset recorded, the median diagnosis delay was four (interquartile range-IQR: 3, 5) days. Patient level delay (median three days) was a major contributor to the diagnosis delay. Conclusions: Most of the patients who died did not have a diagnosis of dengue before admission. This calls for an urgent review of health system preparedness in peripheral health facilities to suspect, diagnose, monitor, refer and treat dengue in children and patient level factors for better understanding of the reasons of delay. Timely filling of death investigation forms in a prescribed format and quarterly death reviews based on these is recommended.

Notified dengue deaths in Myanmar (2017-18): profile and diagnosis delays.

Background: Complications in dengue usually occur between day four and day six after fever onset. Hence, early diagnosis and haematological monitoring are vital. Among all hospital reported dengue deaths in Myanmar in 2017-18, we assessed the i) patient profile, ii) proportion of patients who arrived with a dengue diagnosis at admission and iii) delays in diagnosis after fever onset. Methods: This was a descriptive study involving secondary data. For all the notified deaths, death investigation forms were not available in prescribed format and therefore, data were extracted from hospital case records. Results: Of 304 deaths, 184 (60.5%) were female and 233 (76.6%) were less than 10 years old. Township level hospitals or below reported 36 deaths (11.8%) and the remaining deaths were from higher level facilities. Dengue was diagnosed before admission in 26 (8.5%) people and 169 (55.6%) were in shock at admission. Of 208 with date of fever onset recorded, the median diagnosis delay was four (interquartile range-IQR: 3, 5) days. Patient level delay (median three days) was a major contributor to the diagnosis delay. Conclusions: Most of the patients who died did not have a diagnosis of dengue before admission. This calls for an urgent review of health system preparedness in peripheral health facilities to suspect, diagnose, monitor, refer and treat dengue in children and patient level factors for better understanding of the reasons of delay. Timely filling of death investigation forms in a prescribed format and quarterly death reviews based on these is recommended.

A Study of Hepatic Profile in Dengue in Children

A Study of Hepatic Profile in Dengue in Children

Efficacy of a tetravalent dengue vaccine in healthy children aged 4–16 years: a randomised, placebo-controlled, phase 3 trial

A substantial unmet need remains for safe and effective vaccines against dengue virus disease, particularly for individuals who are dengue-naive and those younger than 9 years. We aimed to assess the efficacy, safety, and immunogenicity of a live attenuated tetravalent dengue vaccine (TAK-003) in healthy children aged 4-16 years. We present data up to 18 months post-vaccination from an ongoing phase 3, randomised, double-blind trial of TAK-003 in endemic regions of Asia and Latin America (26 medical and research centres across Brazil, Colombia, Dominican Republic, Nicaragua, Panama, Philippines, Sri Lanka, and Thailand). Healthy children aged 4-16 years were randomly assigned 2:1 (stratified by age and region) to receive two doses of TAK-003 or two doses of placebo, 3 months apart. Investigators, participants and their parents or guardians, and sponsor representatives advising on trial conduct were masked to trial group assignments. Participants presenting with febrile illness were tested for virologically confirmed dengue (VCD) by serotype-specific RT-PCR. In timeframes beginning 30 days post-second dose, the primary endpoint (overall vaccine efficacy) was assessed in the first 11 months, and the secondary endpoints (efficacy by baseline serostatus, serotype, hospitalised dengue, and severe dengue) in the first 17 months. This study is registered with ClinicalTrials.gov, NCT02747927. 20 099 participants were randomly assigned and vaccinated between Sept 7, 2016, and Aug 18, 2017; 19 021 (94·6%) were included in the per protocol analysis, and 20 071 (99·9%) in the safety set. The primary endpoint was achieved with an overall vaccine efficacy of 80·2% (95% CI 73·3 to 85·3; 61 cases of VCD in the TAK-003 group vs 149 cases of VCD in the placebo group). In the secondary endpoint assessment timeframe, an overall vaccine efficacy of 73·3% (95% CI 66·5 to 78·8) was observed. Analysis of secondary endpoints showed efficacies of 76·1% (95% CI 68·5 to 81·9) in individuals who were seropositive at baseline, 66·2% (49·1 to 77·5) in individuals who were seronegative at baseline, 90·4% (82·6 to 94·7) against hospitalised dengue, and 85·9% (31·9 to 97·1) against dengue haemorrhagic fever. Efficacy varied by individual serotypes (DENV 1, 69·8% [95% CI 54·8 to 79·9]; DENV 2, 95·1% [89·9 to 97·6]; DENV 3, 48·9% [27·2 to 64·1]; DENV 4, 51·0% [-69·4 to 85·8]). Cumulative rates of serious adverse events were similar in TAK-003 (4·0%) and placebo (4·8%) recipients, and were consistent with expected medical disorders in the study population. Infection was the most frequent reason leading to serious adverse events. 20 participants (<0·1% of the safety set) were withdrawn from the trial due to 21 adverse events by the end of part two; 14 of these participants received TAK-003 and six received placebo. TAK-003 was well tolerated and efficacious against symptomatic dengue in children regardless of serostatus before immunisation. Vaccine efficacy varied by serotype, warranting continued follow-up to assess longer-term vaccine performance. Takeda Vaccines.

Non-structural protein 1 (NS1) of dengue virus detection correlates with severity in primary but not in secondary dengue infection

BackgroundNon-structural protein 1 (NS1) of dengue virus circulates in the serum of patients during the acute phase of the disease. ObjectivesTo determine whether NS1 screening can serve in diagnosing primary and secondary infection and to evaluate its utility as a marker for predicting the severity of dengue in children. Study designPatients ≤15 years of age hospitalized for dengue between 2012–2018, with NS1 determination (Panbio, Australia) were included. Clinical y laboratorial characteristics were collected in a standardized data table for analysis of correlation between serotypes, primary or secondary condition of infection, severity, and presence of NS1. ResultsOf 709 children hospitalized for dengue with NS1 determination, 479 (67.5 %) had the positive test. Of the 378 primary cases, 320 (85 %) were NS1 (+). while among the 242 secondary cases only 103 (42.5 %) were NS1 (+) (p < 0001). Of the 479 patients with NS1 (+), 344 (72 %) were warnig-signed cases (WSC) and 94 (19 %) were severe cases (SC), being these figures 62 % and 34 %, in the NS1 negative patients respectively (p < 0.001). There was no difference in the frequency of WSC or SC between patients with NS1 positive or negative test in secondary dengue; however, in primary dengue, the figures were 68 % vs 32 % (p < 0.001), and 87 % vs 12 % (p < 0.001), respectively. ConclusionsThe presence of NS1 positive test is associated with the condition of infection (primary or secondary) and exhibited an increased risk of developing forms with warning signs or severe dengue in primary cases, but not in secondary cases.

Dengue in children and young adults, a cross-sectional study from the western part of Uttar Pradesh.

Background:Dengue has emerged as a major public health problem in India. It presents more aggressively among younger age groups as compared to adults. Therefore, it necessitates the accurate estimation of prevalence in younger age groups.Materials and Method:Of all the 1026 clinically suspected cases of dengue up to the age of 18 years were enrolled in this study and grouped into four age groups (Group I - <0 to 1 year, Group II- 1 to 6 years, Group III- 7 to 12 years, and Group IV- 13 to 18 years). Their blood samples were aseptically collected from different clinical departments and were submitted to the Viral Research and Diagnostic Laboratory (VRDL), Department of Microbiology during the outbreak of 2016–17. Serum was separated and processed for dengue Non Structural Protein 1 antigen (NS1 Ag)and Immunoglobuline M antibody (IgM Ab) enzyme-linked immunosorbent assay (ELISA). All the relevant variables like age, sex, and demographic profile were recorded and statistically analyzed.Results:A total 295 of the 1026 cases were detected positive for dengue either by NS1 Ag or IgM Ab ELISA. The results show the susceptibility to dengue being increased in the order of age Group I to IV. We analyzed the outbreak of year 2016 and 2017, of these 159/483 (33%) cases and 136/543 (25%) cases, respectively, were found seropositive during these years. The months of September, October, and November are more prone to dengue infection.Conclusion:Group III and IV were more susceptible to dengue fever (DF). The months of postmonsoon season are more favorable for spread of dengue among different age groups of the population.

The Impact of COVID–19&amp;nbsp;Lockdown on Dengue Transmission in Sri Lanka;&amp;nbsp;A Natural Experiment for Understanding the Influence of Human Mobility

Background: Dengue is one of the major public health problems in Sri Lanka. It´s outbreak pattern depends on a multitude of drivers, including human mobility. Here we evaluate the impact of COVID–19 related mobility restriction (lockdown) on the risk of dengue in Sri Lanka.Methods: Two-stage hierarchical models were fitted using an interrupted timeseries design based on the notified dengue cases, January 2015 to July 2020. In the first stage model, the district level impact was estimated using quasi-Poisson regression models while accounting for temporal trends. Estimates were pooled at zonal and national levels in the second stage model using meta-analysis. The influence of the extended period of school closure on dengue in children in the western province was compared to adults.Results: Statistically significant and homogeneous reduction of dengue risk was observed at all levels during lockdown. Overall an 88% reduction in risk (RR 0·12; 95% CI from 0·08 to 0·17) was observed at the national level. The highest impact was observed among children aged less than 19 years showing 92% reduction (RR 0·09; 95% CI from 0·05 to 0·15). We observed higher impact on the dry zone having 91% reduction (RR 0·09; 95% CI from 0·05 to 0·15) compared to wet zone showing 73% reduction (RR 0·17; 95% CI from 0·09 to 0·30). Interpretation: This study offers a broad understanding on the change in risk of dengue during the COVID–19 pandemic and associated mobility restrictions in Sri Lanka. The analysis using the mobility restrictions as a natural experiment suggest mobility patterns are a very important driver of dengue.Funding: None.Conflict of Interest: We declare no competing interests.

Clinical Course and Management of Dengue in Children Admitted to Hospital: A 5 Years Prospective Cohort Study in Jakarta, Indonesia.

Dengue incidence is rising globally which was estimated 100 million per year, whereas in Indonesia was estimated 7.5 million per year. Dengue clinical course varies from mild dengue fever (DF) to dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Patients, clinicians and care facilities would benefit if reliable predictors can determine at admission which cases with clinically suspected dengue will progress to DHF or DSS. From 2009 through 2013, a cohort of 494 children admitted with clinically suspected dengue at a tertiary care hospital in Jakarta, Indonesia, was followed until discharge. We evaluated the clinical course and disease outcome of admitted patients and estimated the burden of dengue cases hospitalized over time. Of all 494 children, 185 (37%) were classified at admission as DF, 158 (32%) as DHF and 151 (31%) as DSS. Of DF patients, 52 (28%) progressed to DHF or DSS, 10 (5%) had other viral diseases. Of DHF patients, 9(6%) progressed to DSS. Of 33 routinely collected parameters at admission, duration of fever ≤4 days was the only significant predictor of disease progression (P = 0.01). Five cases (3%) admitted with DSS died. Between 2009 and 2013, annual dengue admissions declined, while distribution of disease severity remained stable. Almost a third of children admitted to tertiary care with clinically suspected DF progress to DHF or DSS. Among routinely collected parameters at admission, only fever duration was significantly associated with clinical progression, emphasizing unpredictability of dengue disease course from parameters currently routinely collected.