Evaluation of host and viral factors associated with severe dengue based on the 2009 WHO classification
Abstract Background Dengue fever (DF) is the most prevalent arthropod-borne viral disease affecting humans. The World Health Organization (WHO) proposed a revised classification in 2009 to enable the more effective identification of cases of severe dengue (SD). This was designed primarily as a clini...
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| Format: | Article |
| Language: | English |
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BMC
2014-12-01
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| Series: | Parasites & Vectors |
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| Online Access: | https://doi.org/10.1186/s13071-014-0590-7 |
| _version_ | 1797811680479019008 |
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| author | Jorge O Pozo-Aguilar Verónica Monroy-Martínez Daniel Díaz Jacqueline Barrios-Palacios Celso Ramos Armando Ulloa-García Janet García-Pillado Blanca H Ruiz-Ordaz |
| author_facet | Jorge O Pozo-Aguilar Verónica Monroy-Martínez Daniel Díaz Jacqueline Barrios-Palacios Celso Ramos Armando Ulloa-García Janet García-Pillado Blanca H Ruiz-Ordaz |
| author_sort | Jorge O Pozo-Aguilar |
| collection | DOAJ |
| description | Abstract Background Dengue fever (DF) is the most prevalent arthropod-borne viral disease affecting humans. The World Health Organization (WHO) proposed a revised classification in 2009 to enable the more effective identification of cases of severe dengue (SD). This was designed primarily as a clinical tool, but it also enables cases of SD to be differentiated into three specific subcategories (severe vascular leakage, severe bleeding, and severe organ dysfunction). However, no study has addressed whether this classification has advantage in estimating factors associated with the progression of disease severity or dengue pathogenesis. We evaluate in a dengue outbreak associated risk factors that could contribute to the development of SD according to the 2009 WHO classification. Methods A prospective cross-sectional study was performed during an epidemic of dengue in 2009 in Chiapas, Mexico. Data were analyzed for host and viral factors associated with dengue cases, using the 1997 and 2009 WHO classifications. The cost–benefit ratio (CBR) was also estimated. Results The sensitivity in the 1997 WHO classification for determining SD was 75%, and the specificity was 97.7%. For the 2009 scheme, these were 100% and 81.1%, respectively. The 2009 classification showed a higher benefit (537%) with a lower cost (10.2%) than the 1997 WHO scheme. A secondary antibody response was strongly associated with SD. Early viral load was higher in cases of SD than in those with DF. Logistic regression analysis identified predictive SD factors (secondary infection, disease phase, viral load) within the 2009 classification. However, within the 1997 scheme it was not possible to differentiate risk factors between DF and dengue hemorrhagic fever or dengue shock syndrome. The critical clinical stage for determining SD progression was the transition from fever to defervescence in which plasma leakage can occur. Conclusions The clinical phenotype of SD is influenced by the host (secondary response) and viral factors (viral load). The 2009 WHO classification showed greater sensitivity to identify SD in real time. Timely identification of SD enables accurate early decisions, allowing proper management of health resources for the benefit of patients at risk for SD. This is possible based on the 2009 WHO classification. |
| first_indexed | 2024-03-13T07:27:19Z |
| format | Article |
| id | doaj.art-582ed2f148bf43f0b30a1fdc6264e482 |
| institution | Directory Open Access Journal |
| issn | 1756-3305 |
| language | English |
| last_indexed | 2024-03-13T07:27:19Z |
| publishDate | 2014-12-01 |
| publisher | BMC |
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| series | Parasites & Vectors |
| spelling | doaj.art-582ed2f148bf43f0b30a1fdc6264e4822023-06-04T11:18:28ZengBMCParasites & Vectors1756-33052014-12-017111110.1186/s13071-014-0590-7Evaluation of host and viral factors associated with severe dengue based on the 2009 WHO classificationJorge O Pozo-Aguilar0Verónica Monroy-Martínez1Daniel Díaz2Jacqueline Barrios-Palacios3Celso Ramos4Armando Ulloa-García5Janet García-Pillado6Blanca H Ruiz-Ordaz7Departamento de Biología Molecular y Biotecnología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM)Departamento de Biología Molecular y Biotecnología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM)Departamento de Biología Celular y Fisiología, Instituto de Investigaciones Biomédicas, UNAM, Sede del tercer Circuito ExteriorDepartamento de Biología Molecular y Biotecnología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM)Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública (INSP)Centro Regional de Investigación en Salud PúblicaDepartamento de Biología Molecular y Biotecnología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM)Departamento de Biología Molecular y Biotecnología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM)Abstract Background Dengue fever (DF) is the most prevalent arthropod-borne viral disease affecting humans. The World Health Organization (WHO) proposed a revised classification in 2009 to enable the more effective identification of cases of severe dengue (SD). This was designed primarily as a clinical tool, but it also enables cases of SD to be differentiated into three specific subcategories (severe vascular leakage, severe bleeding, and severe organ dysfunction). However, no study has addressed whether this classification has advantage in estimating factors associated with the progression of disease severity or dengue pathogenesis. We evaluate in a dengue outbreak associated risk factors that could contribute to the development of SD according to the 2009 WHO classification. Methods A prospective cross-sectional study was performed during an epidemic of dengue in 2009 in Chiapas, Mexico. Data were analyzed for host and viral factors associated with dengue cases, using the 1997 and 2009 WHO classifications. The cost–benefit ratio (CBR) was also estimated. Results The sensitivity in the 1997 WHO classification for determining SD was 75%, and the specificity was 97.7%. For the 2009 scheme, these were 100% and 81.1%, respectively. The 2009 classification showed a higher benefit (537%) with a lower cost (10.2%) than the 1997 WHO scheme. A secondary antibody response was strongly associated with SD. Early viral load was higher in cases of SD than in those with DF. Logistic regression analysis identified predictive SD factors (secondary infection, disease phase, viral load) within the 2009 classification. However, within the 1997 scheme it was not possible to differentiate risk factors between DF and dengue hemorrhagic fever or dengue shock syndrome. The critical clinical stage for determining SD progression was the transition from fever to defervescence in which plasma leakage can occur. Conclusions The clinical phenotype of SD is influenced by the host (secondary response) and viral factors (viral load). The 2009 WHO classification showed greater sensitivity to identify SD in real time. Timely identification of SD enables accurate early decisions, allowing proper management of health resources for the benefit of patients at risk for SD. This is possible based on the 2009 WHO classification.https://doi.org/10.1186/s13071-014-0590-7Dengue virusSevere dengue1997 WHO dengue case classification2009 WHO case classificationRisk factorsViral load |
| spellingShingle | Jorge O Pozo-Aguilar Verónica Monroy-Martínez Daniel Díaz Jacqueline Barrios-Palacios Celso Ramos Armando Ulloa-García Janet García-Pillado Blanca H Ruiz-Ordaz Evaluation of host and viral factors associated with severe dengue based on the 2009 WHO classification Parasites & Vectors Dengue virus Severe dengue 1997 WHO dengue case classification 2009 WHO case classification Risk factors Viral load |
| title | Evaluation of host and viral factors associated with severe dengue based on the 2009 WHO classification |
| title_full | Evaluation of host and viral factors associated with severe dengue based on the 2009 WHO classification |
| title_fullStr | Evaluation of host and viral factors associated with severe dengue based on the 2009 WHO classification |
| title_full_unstemmed | Evaluation of host and viral factors associated with severe dengue based on the 2009 WHO classification |
| title_short | Evaluation of host and viral factors associated with severe dengue based on the 2009 WHO classification |
| title_sort | evaluation of host and viral factors associated with severe dengue based on the 2009 who classification |
| topic | Dengue virus Severe dengue 1997 WHO dengue case classification 2009 WHO case classification Risk factors Viral load |
| url | https://doi.org/10.1186/s13071-014-0590-7 |
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