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

2011; BioMed Central; Volume: 11; Issue: 1 Linguagem: Inglês

10.1186/1471-2334-11-106

1471-2334

Judit Barniol, Roger Gaczkowski, Eliana Vega Barbato, Rivaldo Venâncio da Cunha, Doris M. Salgado, Eric Martínez, Carmita Soria Segarra, Ernesto Benjamín Pleites Sandoval, Ajay Kumar Mishra, Ida Safitri Laksono, Lucy Chai See Lum, José González Martínez, Andrea C. Nunez, Angel Balsameda, I Allende, Gladys Ramírez, Efren M. Dimaano, Kay Thomacheck, Naeema Akbar, Eng Eong Ooi, Elci Villegas, Tran Tinh Hien, Jeremy Farrar, Olaf Horstick, Axel Kroeger, Thomas Jaenisch,

Viral Infections and Vectors

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