A 15-year review of dengue hospitalizations in Singapore: Reducing admissions without adverse consequences, 2003 to 2017

Abstract

Objectives Since the 1990s, Singapore has experienced periodic dengue epidemics of increasing frequency and magnitude. In the aftermath of the 2004–2005 dengue epidemic, hospitals refined their admission criteria for dengue cases to right-site dengue case management and reduce the burden of healthcare utilization and negative outcomes. In this study, we describe the national trends of hospital admissions for dengue and disease severity in terms of length of stay (LOS), admission to the intensive care unit (ICU) and death in hospital, and case fatality rate (CFR) in Singapore. Methods We conducted a retrospective study of notified cases and laboratory confirmed dengue patients admitted to all public and private hospitals between 2003 and 2017. Case notifications for dengue and hospitalization records were extracted from national databases. Results The proportion of dengue cases hospitalized was lower in recent years; 28.9% in the 2013–2014 epidemic, compared to 93.2% in the 2004–2005 epidemic, and 58.1% in the 2007 epidemic. Median LOS remained stable over the years; overall LOS was 3 to 4 days and ICU stay was 2 to 3 days. Less than 2% of hospitalized patients were admitted to the ICU. Overall CFR was low and remained below 0.5%. The proportions of dengue cases hospitalized and patients admitted to the ICU were highest in the elderly aged 65 years and older. Conclusions While the proportion of dengue cases hospitalized saw a drastic decline due to more selective admission criteria, there was no concomitant increase in adverse outcomes, suggesting that admission criteria were appropriate to focus on severe dengue cases. Further studies are needed to optimize dengue management in older adults who are more likely to be hospitalized with greater disease severity, given the higher proportions of hospitalizations and severe disease among older adults.

Severe dengue in travellers: pathogenesis, risk and clinical management

“…With these criteria, the number of unnecessary hospitalisation was drastically reduced, without a concomitant increase in adverse clinical outcomes. 132 In the following, we focus on the management of severe dengue to reduce mortality. Every travel medicine provider and physician caring for ill returned travellers should be familiar with the clinical management of increased vascular permeability leading to intravascular volume depletion is the hall mark of severe dengue, which may progress to life-threatening dengue shock syndrome.…”

Experience of a Tertiary Hospital in Singapore with Management of a Dual Outbreak of COVID-19 and Dengue

“…Periodic switches in the prevailing dengue serotype are associated with dengue epidemics during the peak dengue season 13 and account for a significant burden in terms of hospitalizations. 14 In the week ending May 30, 2020, Singapore reported a record weekly high of 733 dengue cases, a peak not seen since 2013, the largest outbreak year in recent history. 15 Locally, there have been sporadic case reports of COVID-19 initially diagnosed as dengue due to false-positive dengue serology on RDTs.…”

Use of seroprevalence to guide dengue vaccination plans for older adults in a dengue non-endemic country

“…In addition, several studies following the 2002 dengue epidemic in Taiwan [ 22 – 24 ] found that older and elderly adults are at higher risk of developing severe dengue, previously known as dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS). Investigators in Singapore, Malaysia and Vietnam also demonstrated an increased risk of high clinical severity and case fatality among the older population [ 25 – 27 ]. As the higher incidence of severe dengue and DHF/DSS cases has led to higher rates of hospitalization, admission to intensive care units (ICUs), and deaths in older adults, especially in the elderly, an effective dengue intervention strategy targeting older and elderly adults in non-endemic areas with DENV infection risk has become increasingly important.…”