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Comparative Study
. 2011 Apr 21:11:106.
doi: 10.1186/1471-2334-11-106.

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

Judit Barniol  1 , Roger Gaczkowski, Eliana Vega Barbato, Rivaldo V da Cunha, Doris Salgado, Eric Martínez, Carmita Soria Segarra, Ernesto B Pleites Sandoval, Ajay Mishra, Ida Safitri Laksono, Lucy C S Lum, José G Martínez, Andrea Núnez, Angel Balsameda, Ivan Allende, Gladys Ramírez, Efren Dimaano, Kay Thomacheck, Naeema A Akbar, Eng E Ooi, Elci Villegas, Tran T Hien, Jeremy Farrar, Olaf Horstick, Axel Kroeger, Thomas Jaenisch
Affiliations
Comparative Study

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

Judit Barniol et al. BMC Infect Dis. .

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.

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Figures

Figure 1
Figure 1
The revised dengue case classification. (Source: Dengue Guidelines for diagnosis, treatment, prevention and control, New edn. Geneva: WHO; 2009)
Figure 2
Figure 2
Timeline of training and completion of the different data collection instruments in the year 2009. • as by last day of respective activity. # only sites with prospective data
See this image and copyright information in PMC

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