Comparing the 2009 and 1997 World Health Organization dengue case classifications in a large cohort of South Asian patients

  • Umesh Jayarajah Dengue Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
  • Upul Dissanayake Department of Medicine, Base Hospital, Panadura, Sri Lanka
  • Visula Abeysuriya Nawaloka Hospital, Colombo, Sri Lanka
  • Pradeep K de Silva Dengue Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
  • Priyankara Jayawardena Dengue Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
  • Aruna Kulatunga Department of Medicine, National Hospital of Sri Lanka, Colombo, Sri Lanka
  • Harshini Fernando Department of Medicine, National Hospital of Sri Lanka, Colombo, Sri Lanka
  • Manohari Madarasinghe Department of Paediatrics, Base Hospital, Panadura, Sri Lanka
  • Damayanthi Hapugoda Department of Paediatrics, Base Hospital, Panadura, Sri Lanka
  • Lakshika Perera Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
  • Vibhavee Kannangara Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
  • Champika Udayangani Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
  • Ranga Peiris Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
  • Shuaib Faizer Dengue Research Group, Colombo, Sri Lanka
  • Pamodh Yasawardene Dengue Research Group, Colombo, Sri Lanka
  • Sanjay de Mel Nawaloka Hospital, Colombo, Sri Lanka
  • Ishan de Zoysa Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
  • Suranjith L Seneviratne Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
Keywords: dengue virus infections, 2009 WHO dengue case definitions, 1997 WHO dengue case definitions, Sri Lanka

Abstract

Introduction: Due to the shortcomings in the 1997-World Health Organisation (WHO) dengue case classification (DCC), a revised classification was proposed in 2009. This study was aimed to assess the clinical usefulness of the two classifications during a large dengue epidemic.

Methodology: Clinical data of dengue patients admitted to selected units at National Hospital of Sri Lanka, Panadura Base Hospital and Nawaloka Hospital Colombo between June and August 2017 were collected prospectively. Cases were classified using the 1997 and 2009 WHO DCCs.

Results: 1,878 patients [adult = 1,573 (83.8%)] were studied. Based on 1997-WHO-DCC-DF (Dengue Fever): 1,316 (70.1%), DHF (Dengue Haemorrhagic Fever) -1: 468 (24.9%), DHF-2: 86 (4.6%) and DHF-3: 8 (0.4%). Based on 2009-WHO-DCC–Dengue with warning signs (WS): 1647 (87.7%), Dengue without WS: 231 (12.3%) and severe dengue (SD): 41 (2.18%). A total of 1,088 (82.7%) DF and 559 (99.5%) DHF patients developed WS. Of those without WS, 228 (17.3%) were DF patients and 3 (0.5%) were DHF patients. Three (0.23%) DF and 38 (6.76%) DHF patients had SD. All SD patients had WS. The level of agreement between the two systems of classification was poor (Kappa = - 0.035, p < 0.001).

Conclusions: The 2009-WHO-DCC was more useful than 1997-WHO-DCC in predicting dengue disease severity as few DF patients also had SD. Furthermore, the presence of WS identified patients with SD. However, the 2009-WHO-DCC may not suit the resource limited countries as WS are non-specific, and lack of diagnostic tests can result in case overload.

Published
2020-07-31
How to Cite
1.
Jayarajah U, Dissanayake U, Abeysuriya V, de Silva PK, Jayawardena P, Kulatunga A, Fernando H, Madarasinghe M, Hapugoda D, Perera L, Kannangara V, Udayangani C, Peiris R, Faizer S, Yasawardene P, de Mel S, de Zoysa I, Seneviratne SL (2020) Comparing the 2009 and 1997 World Health Organization dengue case classifications in a large cohort of South Asian patients. J Infect Dev Ctries 14:781-787. doi: 10.3855/jidc.12468
Section
Original Articles