ViewpointThe WHO dengue classification and case definitions: time for a reassessment
Section snippets
The burden of disease
In hyperendemic Asian countries, where there is concurrent transmission of several serotypes, primary dengue virus infections are seen in young children, whereas symptomatic dengue generally occurs during secondary dengue virus infections in school-age children or young adults.15, 16, 17, 18, 19 Prospective, population-based studies in several Asian countries have shown geographic and temporal variation in the incidence of dengue virus infection and disease in children (table 1).16, 17, 18, 19
Limitations of the WHO classification scheme and case definitions
The WHO scheme classifies symptomatic dengue virus infections into three categories; undifferentiated fever, dengue fever, and DHF (figure).11 Dengue fever is clinically defined as an acute febrile illness with two or more manifestations (headache, retro-orbital pain, myalgia, arthralgia, rash, haemorrhagic manifestations, or leucopenia) and occurrence at the same location and time as other confirmed cases of dengue fever. A case must meet all four of the following criteria to be defined as
Potential solution
Few prospective data support the WHO classification scheme for dengue. A large multicentre descriptive study is needed to obtain the evidence to establish a robust dengue classification scheme for use by clinicians, epidemiologists, public-health authorities, vaccine specialists, and scientists involved in dengue pathogenesis research. Dengue case definitions derived in this way might prove more useful for presumptive diagnosis, management, and final diagnosis, than the existing scheme.
In such
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