Dengue seroepidemiology in Singapore

doi:10.1016/S0140-6736(00)04137-4

The Lancet

Volume 357, Issue 9257, 3 March 2001, Pages 685-686

https://doi.org/10.1016/S0140-6736(00)04137-4 Get rights and content

Summary

The resurgence of dengue in Singapore since 1986 had been associated with an adult predominance and a very low incidence in children. No study had been carried out to investigate this finding. Here we report a serological study of 1068 children aged 0 to 15 years. There is a significant rise in seroconversion in children aged 6 years and older coinciding with the start of formal schooling. This suggests that there may be a change in the location where dengue is acquired.

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Lancet
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F Rodhain et al.
Mosquito vectors and dengue virus-vector relationships

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Citation Excerpt :
Grades III and IV were categorized as dengue shock syndrome (DSS).5 Over the past decades, dengue has geographically expanded and increasingly affected adult populations.1–3,6–10 A wide variety of dengue clinical manifestations have continuously been unveiled, adding to the major dengue presentations that were initially conceived to be mainly confined to fever and hemorrhagia.11–13
Dengue cases, traditionally classified as dengue fever (DF) or dengue hemorrhagic fever (DHF) by the World Health Organization (WHO) dengue classification 1997 scheme, are categorized into Group A (without warning signs), Group B [with warning signs (e.g., abdominal pain/vomiting/fluid accumulation/mucosal bleeding/lethargy/liver enlargement/increasing hematocrit with decreasing platelets)], or Group C (severe plasma leakage/severe bleeding/organ failure) by the WHO 2009 version. We compared differences in clinical/laboratory features between patients separately classified as DF/DHF and in Group A/B/C.
We performed a retrospective analysis of dengue patients diagnosed between 2008 and 2010.
A total of 148 adult patients (119 DF/29 DHF; 64 Group A/77 Group B/7 Group C) were included. Compared with DF, significantly younger age, lower hospitalization rate, and higher platelet count were found in Group A. Compared with DHF, higher platelet count was found in Group B. Six of seven patients (86%) classified as Group C fulfilled the criteria of DHF. A cross tabulation showed DF cases were distributed in all of the severity groups stratified by the WHO dengue 2009 scheme (53.8% Group A/45.4% Group B/0.8% Group C); of the DHF cases, 23 (79%) were categorized as Group B, and six (20.7%) as Group C. All patients in Group A fell into the category DF.
The WHO 2009 scheme is effective in identifying severe dengue cases. Heterogeneity in severity suggests careful severity discrimination in patients classified in Group B is needed. Our data suggest that it is safe to treat patients classified as Group A on an outpatient basis.
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Research LettersDengue seroepidemiology in Singapore

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Lancet

Mosquito vectors and dengue virus-vector relationships

Research Letters
Dengue seroepidemiology in Singapore