Introduction: Dengue is a major acute febrile illness in Sri Lanka and reported in epidemic proportions. From 2009 to 2013 an average of 35 000 cases were reported annually with over 60% above 15 years of age. Clinical case classiﬁcation of dengue was originally based on paediatric patients. Here we assess severity of dengue illness among adults according to both WHO classical and TDR classiﬁcations.
Methods: A study was conducted in 100 adult patients presenting to ID Hospital, Colombo with fever <7 days, in 2013. All were tested for dengue ELISA NS1/IgM and RT-PCR. Of them 88 were conﬁrmed as having dengue, and were classiﬁed into two WHO classiﬁcations. Type of care received was categorized into three levels as:
Category 1 – general ward,
Category 2 – special dengue unit,
Category 3 – intensive care unit.
Results: According to classical classiﬁcation, 47 (53.4%) were Dengue Fever (DF) patients. Of them 31and 16 received Category 1 and 2 care respectively. None received Category 3 care. 41 (46.6%) Dengue Haemorrhagic Fever (DHF) patients. Of them 14 received category 1 care while 25 and two received Category 2 and Category 3 care respectively. Classical classiﬁcation and level of care sensitivity was 62.8% (CI 48–78) while speciﬁcity was 68.9% (CI 55–82). According to TDR classiﬁcation 29 (32.9%) were Dengue patients without warning signs. Of them 22 and 07 received Category 1 and 2 level of care respectively and none went into category 3. 48 (55%) were Dengue with warning signs and 11 (13%) severe dengue patients. Of them 18 received Category 1 care while 39 and two received category 2 and category 3 care respectively. TDR classiﬁcation and level of care sensitivity was 85.4% (CI 75–95) Speciﬁcity 55% (CI 39–70).
Conclusions: WHO TDR classiﬁcation captures more patients who need closer observation in Category 2 and three levels of care than classical classiﬁcation. This may warrant additional hospital resources in developing country settings.
Disclosure: This research was funded by the European Union 7th Framework Programme through 'DengueTools'.
Wiley-Blackwell, 2015. Vol. 20, no Suppl. 1, 416-416 p.
The 9th European Congress on Tropical Medicine and International Health (ECTMIH), Basel, Switzerland, September 6-10, 2015