Dengue Outbreaks in High-Income Area, Kaohsiung City, Taiwan, 2003–2009

Lin, Chia‐Her; Schiøler, Karin L.; Jepsen, Martin Rudbeck; Ho, Chi-Kung; Li, Shuhua; Konradsen, Flemming

doi:10.3201/eid1810.111929

Cited by 53 publications

(40 citation statements)

References 27 publications

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“…In our study this did not result in increased mortality unlike in Puerto Rico [17] and Taiwan [7], [18]. The reasons for this are unclear as the elderly cohort suffered more severe disease.…”

Section: Discussioncontrasting

confidence: 51%

Challenges in Dengue Fever in the Elderly: Atypical Presentation and Risk of Severe Dengue and Hospita-Acquired Infection

et al. 2014

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Background/methodsTo better understand dengue fever in the elderly, we compared clinical features, World Health Organization (WHO) dengue classification and outcomes between adult (<60) and elderly (≥60) dengue patients. We explored the impact of co-morbidity and hospital-acquired infection (HAI) on clinical outcomes in the elderly. All patients managed at the Communicable Disease Centre, Singapore, between 2005 and 2008 with positive dengue polymerase chain reaction (PCR) or who fulfilled WHO 1997 or 2009 probable dengue criteria with positive dengue IgM were included.ResultsOf the 6989 cases, 295 (4.4%) were elderly. PCR was positive in 29%. The elderly suffered more severe disease with more dengue haemorrhagic fever (DHF) (29.2% vs. 21.4%) and severe dengue (SD) (20.3% vs. 14.6%) (p<0.05). Classic dengue symptoms were more common in the adult group. The elderly were less likely to fulfill WHO 1997 (93.6% vs. 96.4%) (p = 0.014), but not WHO 2009 probable dengue (75.3% vs. 71.5%). Time to dengue diagnosis was similar. There was no significant difference in the frequency of warning signs between the two groups, but the elderly were more likely to have hepatomegaly (p = 0.006) and malaise/lethargy (p = 0.033) while the adults had significantly more mucosal bleeding (p<0.001). Intensive care admission occurred in 15 and death in three, with no age difference. Notably, the elderly stayed in hospital longer (median 5 vs. 4 days), and suffered more pneumonia (3.8% vs. 0.7%) and urinary infection (1.9% vs. 0.3%) (p = 0.003). Predictors of excess length of stay were age (adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 1.37–2.88), critical illness (aOR 5.13, 95%CI 2.59–9.75), HAI (aOR 12.06, 95%CI 7.39–19.9), Charlson score (aOR 6.9, 95%CI 2.02–22.56) and severe dengue (DHF/dengue shock syndrome/SD) (aOR 2.24, 95%CI 1.83–2.74).ConclusionElderly dengue patients present atypically and are at higher risk of DHF, SD and HAI. Aside from dengue severity, age, co-morbidity and HAI were associated with longer hospital stay.

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Section: Discussioncontrasting

confidence: 51%

Challenges in Dengue Fever in the Elderly: Atypical Presentation and Risk of Severe Dengue and Hospita-Acquired Infection

et al. 2014

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“…Dengue fever is an acute mosquito-borne viral infection caused by the dengue virus (DENV) that imposes considerable morbidity globally, particularly in the tropics and subtropics [ 1 – 3 ]. DENV is transmitted by several mosquito species within the genus Aedes , principally A .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the National Notifiable Diseases Surveillance System for Dengue Fever in Taiwan, 2010–2012

McKerr

Lo²,

Edeghere

et al. 2015

PLoS Negl Trop Dis

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BackgroundIn Taiwan, around 1,500 cases of dengue fever are reported annually and incidence has been increasing over time. A national web-based Notifiable Diseases Surveillance System (NDSS) has been in operation since 1997 to monitor incidence and trends and support case and outbreak management. We present the findings of an evaluation of the NDSS to ascertain the extent to which dengue fever surveillance objectives are being achieved.MethodologyWe extracted the NDSS data on all laboratory-confirmed dengue fever cases reported during 1 January 2010 to 31 December 2012 to assess and describe key system attributes based on the Centers for Disease Control and Prevention surveillance evaluation guidelines. The system’s structure and processes were delineated and operational staff interviewed using a semi-structured questionnaire. Crude and age-adjusted incidence rates were calculated and key demographic variables were summarised to describe reporting activity. Data completeness and validity were described across several variables.Principal FindingsOf 5,072 laboratory-confirmed dengue fever cases reported during 2010–2012, 4,740 (93%) were reported during July to December. The system was judged to be simple due to its minimal reporting steps. Data collected on key variables were correctly formatted and usable in > 90% of cases, demonstrating good data completeness and validity. The information collected was considered relevant by users with high acceptability. Adherence to guidelines for 24-hour reporting was 99%. Of 720 cases (14%) recorded as travel-related, 111 (15%) had an onset >14 days after return, highlighting the potential for misclassification. Information on hospitalization was missing for 22% of cases. The calculated PVP was 43%.Conclusions/SignificanceThe NDSS for dengue fever surveillance is a robust, well maintained and acceptable system that supports the collection of complete and valid data needed to achieve the surveillance objectives. The simplicity of the system engenders compliance leading to timely and accurate reporting. Completeness of hospitalization information could be further improved to allow assessment of severity of illness. To minimize misclassification, an algorithm to accurately classify travel cases should be established.

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“…The Aedes aegypti mosquitoes are predominant in southern Taiwan and highly correlated with dengue epidemics or outbreaks. 2 Previous reports have indicated that dengue epidemics or outbreaks have mainly occurred in the south of Taiwan, such as Tainan and Kaohsiung, 3 which are neighboring cities. Dengue activity has mainly been found in Kaohsiung city.…”

mentioning

confidence: 99%

“…Dengue activity has mainly been found in Kaohsiung city. 3 The co-circulation of two or even four dengue serotypes (DENV-1–4) has been reported in Kaohsiung city. 4 …”

mentioning

confidence: 99%

Consecutive large dengue outbreaks in Taiwan in 2014–2015

Wang

Chang

Loh

et al. 2016

Emerging Microbes & Infections

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Dengue Outbreaks in High-Income Area, Kaohsiung City, Taiwan, 2003–2009

Abstract: Cases distribute in a clustered pattern, and elderly persons have the highest risk for illness and death.

Cited by 53 publications

References 27 publications

Challenges in Dengue Fever in the Elderly: Atypical Presentation and Risk of Severe Dengue and Hospita-Acquired Infection

Challenges in Dengue Fever in the Elderly: Atypical Presentation and Risk of Severe Dengue and Hospita-Acquired Infection

Evaluation of the National Notifiable Diseases Surveillance System for Dengue Fever in Taiwan, 2010–2012

Consecutive large dengue outbreaks in Taiwan in 2014–2015

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