|Year : 2021 | Volume
| Issue : 4 | Page : 175-176
Morbidity and mortality in dengue fever: Does it too change periodically?
Satheesh Ponnarmeni, Govind Benakatti
Department of Pediatric Intensive Care, Mediclinic Airport Road Hospital, Abu Dhabi, UAE
|Date of Submission||15-Jun-2021|
|Date of Acceptance||19-Jun-2021|
|Date of Web Publication||10-Jul-2021|
Dr. Satheesh Ponnarmeni
Mediclinic Airport Road Hospital, Abu Dhabi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ponnarmeni S, Benakatti G. Morbidity and mortality in dengue fever: Does it too change periodically?. J Pediatr Crit Care 2021;8:175-6
|How to cite this URL:|
Ponnarmeni S, Benakatti G. Morbidity and mortality in dengue fever: Does it too change periodically?. J Pediatr Crit Care [serial online] 2021 [cited 2021 Sep 19];8:175-6. Available from: http://www.jpcc.org.in/text.asp?2021/8/4/175/321106
Dengue, a vector borne viral hemorrhagic fever transmitted via female mosquitoes (Aedes aegypti and to a lesser extent, Ae. Albopictus) is a disease of grave concern to global health. Dengue occurs all over the world. However, Asia accounts for 70% of the global burden. The incidence of dengue has increased alarmingly - 8 fold in past two decades and so are the reported deaths. In India, it's endemic (transmission occurring year-round) all-over and hyperendmic in certain regions with seasonal variation in incidence — peaks during rainy season, humid weather, etc. India had the highest number of outbreaks amongst WHO regions since 2000 and 13 million estimated number of infections annually. In 2017, highest seroprevalence was seen in southern regions (76.9%), followed by western (62.3%), and northern (60.3%) regions and higher in urban (70.9% vs 42.3%) areas. Dengue is known to cause wide spectrum of disease, mostly subclinical or mild illness to severe/lethal disease, i.e., dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Overall mortality is 0.5 - 2.0%. which may reach 20% in DSS (in-ICU/in-hospital mortality). It's known that patient age distributions, DHF or severe disease rates, secondary infections and mortality rates often differs between outbreaks. In intensive care requiring patients, variations are seen between outbreaks in terms of organ dysfunction profile, hyperinflammation, immuno-pathology, life threatening hemorrhages, etc. And so, the mortality and its immediate cause/s. The serotype distribution has shown to vary with time and across geography. All four serotypes with district epidemiological patterns circulate in India causing outbreaks. It is not known whether these epidemiological shifts and clinical variations correlate with serotype (atleast dominant serotype) causing the outbreak. However, the longitudinal trend since 2000 shows co-infection with all four serotypes dominated the outbreaks in India with predominant serotype being serotype 3 followed by serotype 2 and least common being serotype 4. In contrast, of the global outbreaks between 1990-2015, serotype 2 was the predominant before 2000, serotype 3 between 2000 - 2009 and serotype 1 after 2010. Coinfection with more than one serotype was reported in nearly half of the outbreaks. This study also showed decreased rates of DHF, secondary infection and mortality in outbreaks occurring after 2010 suggesting somewhat decreased severity in global dengue. This is unlike in India in terms of serotypes as well as disease severity. Moreover, it's possible that certain serotype/s and co-infection are associated with varied disease severity, laboratory abnormalities, outcomes, etc., A study from Tamil Nadu, India, during 2017 outbreak, found association of serotype 4 with elevated liver enzymes. During 2019 outbreak, a study from Karnataka, India, found higher number of patients with HLH syndrome had serotype 3 infection (8 out of 9 cases). Similarly, thrombocytopenia, haemorrhagic manifestations and atypical presentations were found most commonly in serotype 3 infected patients and co-infections were associated with a more serious clinical profile.
In the current issue of Journal of Pediatric Critical care, the study by Sugunan S, et al. describes the changing epidemiology of the disease severity and causes of mortality between 2013 to 2017. This is in accordance with the varied reports on cause of death and severity of disease across geography and between outbreaks, suggesting dynamic epidemics. However, refractory hypotension, multi-organ failure, massive haemorrhage and encephalitis are commonly reported causes of deaths in dengue. Bleeding or massive haemorrhage as primary cause of death were reported less common all over. Efforts have been made with several clinical and laboratory markers to correlate with mortality and poor outcome, recent being elevated liver enzymes and hyperleveated ferritin. However these lack uniformity and cut off levels, which need to be defined and validated.
In our opinion, more sample sized, longitudinal, serotype studies across Indian geography may help to answer whether particular serotype/s and co-infection patterns are associated with varied spectrum of the disease in terms of clinical manifestations, severity, laboratory abnormalities, and mortality rate. This may in-turn aid in improved identification, prediction and prognostication.
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