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Meta-Analysis
. 2018 Jul 10;13(7):e0200200.
doi: 10.1371/journal.pone.0200200. eCollection 2018.

Prevalence of chronic comorbidities in dengue fever and West Nile virus: A systematic review and meta-analysis

Alaa Badawi  1   2 , Russanthy Velummailum  2 , Seung Gwan Ryoo  3 , Arrani Senthinathan  4 , Sahar Yaghoubi  5 , Denitsa Vasileva  3 , Emma Ostermeier  3 , Mikayla Plishka  3 , Marcel Soosaipillai  6 , Paul Arora  7
Affiliations
Meta-Analysis

Prevalence of chronic comorbidities in dengue fever and West Nile virus: A systematic review and meta-analysis

Alaa Badawi et al. PLoS One. .

Abstract

Background: Flavivirus diseases such as dengue fever (DENV), West Nile virus (WNV), Zika and yellow fever represent a substantial global public health concern. Preexisting chronic conditions such as cardiovascular diseases, diabetes, obesity, and asthma were thought to predict risk of progression to severe infections.

Objective: We aimed to quantify the frequency of chronic comorbidities in flavivirus diseases to provide an estimate for their prevalence in severe and non-severe infections and examine whether chronic diseases contribute to the increased risk of severe viral expression.

Methods: We conducted a comprehensive search in PubMed, Ovid MEDLINE(R), Embase and Embase Classic and grey literature databases to identify studies reporting prevalence estimates of comorbidities in flavivirus diseases. Study quality was assessed with the risk of bias tool. Age-adjusted odds ratios (ORs) were estimated for severe infection in the presence of chronic comorbidities.

Results: We identified 65 studies as eligible for inclusion for DENV (47 studies) and WNV (18 studies). Obesity and overweight (i.e., BMI> 25 kg/m2, prevalence: 24.5%, 95% CI: 18.6-31.6%), hypertension (17.1%, 13.3-21.8%) and diabetes (13.3%, 9.3-18.8%) were the most prevalent comorbidities in DENV. However, hypertension (45.0%, 39.1-51.0%), diabetes (24.7%, 20.2-29.8%) and heart diseases (25.6%, 19.5-32.7%) were the most prevalent in WNV. ORs of severe flavivirus diseases were about 2 to 4 in infected patients with comorbidities such as diabetes, hypertension and heart diseases. The small number of studies in JEV, YFV and Zika did not permit estimating the prevalence of comorbidities in these infections.

Conclusion: Higher prevalence of chronic comorbidities was found in severe cases of flavivirus diseases compared to non-severe cases. Findings of the present study may guide public health practitioners and clinicians to evaluate infection severity based on the presence of comorbidity, a critical public health measure that may avert severe disease outcome given the current dearth of clear prevention practices for some flavivirus diseases.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of study selection and systematic literature review process.
The flow diagram describes the systematic review of literature on the prevalence of comorbidities in flavivirus infections. A total of 65 unique studies were identified (47 studies for dengue fever and 18 for West Nile virus from an initial 1373 examined titles). aSome studies reported on more than one flavivirus disease. Studies drawn from the same population were not included in the meta-analyses.
Fig 2
Fig 2. Meta-analysis for the proportion of comorbidities in dengue fever cases.
Weights are calculated from binary random-effects model analysis. Values represent proportion of diabetes (a), hypertension (b), heart diseases (c), asthma (d), stroke (e) and obesity/overweight (f) in dengue fever patients and 95% CI. Heterogeneity analysis was carried out using Q test, the among studies variation (I2 index) and within-study variance in the random-effects model (τ2).
Fig 3
Fig 3. Meta-analysis for the proportion of comorbidities in West Nile virus cases.
Weights are calculated from binary random-effects model analysis. Values represent proportion of diabetes (a), hypertension (b), heart diseases (c) and stroke (d) in West Nile virus patients and 95% CI. Heterogeneity analysis was carried out using Q test, the among studies variation (I2 index) and within-study variance in the random-effects model (τ2).
See this image and copyright information in PMC

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