Influence of demographics on clinical outcome of dengue: a cross-sectional study of 6703 confirmed cases in Vitória, Espírito Santo State, Brazil

Abstract

SUMMARYDengue presents a wide clinical spectrum of signs and symptoms, with characteristics of the host potentially influencing the disease evolution. Therefore, the purpose of this study was to evaluate the influence of gender and age on dengue clinical outcomes in a recent outbreak situation in Brazil, applying a cross-sectional design and including 6703 dengue cases with laboratory confirmation, occurring in Vitória, Espírito Santo State, Brazil, between 2007 and 2013. Data were obtained from the Information System for Notifiable Diseases. Overall, 11·3% of the sample presented with severe dengue, which affected 13·0% of males, 10·0% of females, 8·8% of children, 12·5% of adolescents, 10·5% of adults and 15·5% of the elderly. Age was higher in the severe dengue group (P = 0·03). Severe dengue was associated with males and the elderly (P < 0·01); however, considering only severe cases, children presented haemorrhage and plasma leakage more frequently than older age groups. The results emphasize the importance of a differentiated protocol for management of dengue cases, taking into consideration host factors like age. These findings also suggest the elderly and children as priority groups for immunization in a future implementation of a vaccine.

Dengue in the elderly: a review

“…Acute renal failure also occurred in higher frequency in individuals aged 65 and above with DHF as compared to those under 65 years of age (12.1% vs. 1.7%, P = 0.001) [33]. However, no significant difference in the prevalence of neurological and cardiac manifestations of dengue has been observed thus far [32].…”

“…Similarly, a large cross-sectional study of 6703 laboratory-confirmed cases of dengue in Vitória, Brazil, demonstrated that elderly adults, aged 60-88 years, had an adjusted odds ratio of 1.56 (1.23-1.99, 95% CI) as compared to younger adults, aged 20-59 years, of having severe dengue [32].…”

“…Elderly patients with dengue tend to have fewer hemorrhagic manifestations than their younger counterparts [28,32,41]. This difference is most stark in the context of mucosal bleeding, where it was found to be almost twice as common in the younger adults as compared to the elderly (41.1% vs. 21.7%, P = 0.003) [28].…”

“…A study of 17,666 dengue cases from Puerto Rico suggested that the elderly were more likely than youths or younger adults to manifest with plasma leakage [41]. However other studies from Singapore [28,30] and Brazil, did not find any difference in the occurrence of plasma leakage between the two groups [32].…”

“…Although the risk of bleeding manifestations has been shown to occur less frequently in the elderly [28,32,41], a study found that platelet transfusions were carried out more frequently in the elderly population (23% vs. 12%, P = 0.02) [30]. Based on current literature, transfusion of blood products is recommended only in the presence of severe bleeding or clinical suspicion of severe bleeding in a patient with unexplained hypotension [46].…”