Open Access Highly Accessed Research article

Usefulness and applicability of the revised dengue case classification by disease: multi-centre study in 18 countries

Judit Barniol1*, Roger Gaczkowski1, Eliana Vega Barbato2, Rivaldo V da Cunha3, Doris Salgado4, Eric Martínez5, Carmita Soria Segarra6, Ernesto B Pleites Sandoval7, Ajay Mishra8, Ida Safitri Laksono9, Lucy CS Lum10, José G Martínez11, Andrea Núnez12, Angel Balsameda12, Ivan Allende13, Gladys Ramírez14, Efren Dimaano15, Kay Thomacheck16, Naeema A Akbar17, Eng E Ooi18, Elci Villegas19, Tran T Hien20, Jeremy Farrar21, Olaf Horstick22, Axel Kroeger2223 and Thomas Jaenisch1

Author Affiliations

1 Section Clinical Tropical Medicine, Department for Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany

2 Hospital Municipal Francés, Santa Cruz de la Sierra, Santa Cruz, Bolivia

3 Universidad Federal de Mato Grosso do Sul, Brazil

4 Hospital Universitario de Neira, Universidad Surcolombiana, Neira, Colombia

5 Instituto de Medicina Tropical Pedro Kouri, Autopista Novia del Mediodía Km6, PO Box 601, Marianao 13, Ciudad de la Habana, Cuba

6 Hospital de Infecciología, Guayaquil, Ecuador

7 Hospital Nacional de Niños Benjamin Bloom, Final 25 Avenida Norte y Boulevar de los Héroes, San Salvador, El Salvador

8 Sunderlal Memorial Hospital, Dilshad Garden, Delhi 110095, India

9 Tropical and Infectious Disease Sub Division, Paediatric Department, Dr. Sardjito Hospital/Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

10 Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

11 Servicios de Salud de Nuevo León, Monterrey, Nuevo León, México

12 Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Managua, Nicaragua

13 Dirección General de Vigilancia de la Salud/Estrategia de Gestión Integrada para prevención y control del Dengue en Paraguay, Asunción, Paraguay

14 Dirección de Salud II Lima Sur, Ministerio de Salud, Jr. Martínez de Pinillos 124-B, Lima 4, Perú

15 San Lazaro Hospital, San Lazaro Compound, Quiricada Street, Sta Cruz, Manila 1003, Philippines

16 Centers for Disease Control and Prevention, Division of Vector Borne Infectious Diseases, 1324 Calle Cañada, San Juan, Puerto Rico

17 Preventive Affair Department, Jeddah Governorate, MOH, P.O. Box 54165 Jeddah 21514, Saudi Arabia

18 Duke-NUS Graduate Medical School, 8 College Drive, Singapore 169857

19 Instituto Experimental José Torrealba, Núcleo Universitario Rafael Rangel, Universidad de los Andes, Trujillo, Venezuela

20 Hospital for Tropical Diseases 190 Ben Ham Tu, Quan 5 Ho Chi Minh City, Viet Nam

21 Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam

22 Special Programme for Research and Training in Tropical Diseases, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland

23 Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK

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BMC Infectious Diseases 2011, 11:106  doi:10.1186/1471-2334-11-106

Published: 21 April 2011

Abstract

Background

In view of the long term discussion on the appropriateness of the dengue classification into dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), the World Health Organization (WHO) has outlined in its new global dengue guidelines a revised classification into levels of severity: dengue fever with an intermediary group of "dengue fever with warning sings", and severe dengue. The objective of this paper was to compare the two classification systems regarding applicability in clinical practice and surveillance, as well as user-friendliness and acceptance by health staff.

Methods

A mix of quantitative (prospective and retrospective review of medical charts by expert reviewers, formal staff interviews), semi-quantitative (open questions in staff interviews) and qualitative methods (focus group discussions) were used in 18 countries. Quality control of data collected was undertaken by external monitors.

Results

The applicability of the DF/DHF/DSS classification was limited, even when strict DHF criteria were not applied (13.7% of dengue cases could not be classified using the DF/DHF/DSS classification by experienced reviewers, compared to only 1.6% with the revised classification). The fact that some severe dengue cases could not be classified in the DF/DHF/DSS system was of particular concern. Both acceptance and perceived user-friendliness of the revised system were high, particularly in relation to triage and case management. The applicability of the revised classification to retrospective data sets (of importance for dengue surveillance) was also favourable. However, the need for training, dissemination and further research on the warning signs was highlighted.

Conclusions

The revised dengue classification has a high potential for facilitating dengue case management and surveillance.