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. 2011 Jan;84(1):127-34.
doi: 10.4269/ajtmh.2011.10-0476.

Epidemiological factors associated with dengue shock syndrome and mortality in hospitalized dengue patients in Ho Chi Minh City, Vietnam

Affiliations

Epidemiological factors associated with dengue shock syndrome and mortality in hospitalized dengue patients in Ho Chi Minh City, Vietnam

Katherine L Anders et al. Am J Trop Med Hyg. 2011 Jan.

Abstract

Understanding trends in dengue disease burden and risk factors for severe disease can inform health service allocation, clinical management, and planning for vaccines and therapeutics. Dengue admissions at three tertiary hospitals in Ho Chi Minh City, Vietnam, increased between 1996 and 2009, peaking at 22,860 in 2008. Children aged 6-10 years had highest risk of dengue shock syndrome (DSS); however, mortality was highest in younger children and decreased with increasing age (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.36-0.75 in 6- to 10- year-old children and OR = 0.27, 95% CI = 0.16-0.44 in 11- to 15-year-old children compared with 1- to 5-year-old children). Males were overrepresented among dengue cases; however, girls had higher risk of DSS (OR = 1.19, 95% CI = 1.14-1.24) and death (OR = 1.57, 95% CI = 1.14-2.17). Young children with dengue had greatest risk of death and should be targeted in dengue vaccine and drug trials. The increased risk of severe outcomes in girls warrants further attention in studies of pathogenesis, health-seeking behavior, and clinical care.

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Figures

Figure 1.
Figure 1.
Temporal trends in dengue admissions in Ho Chi Minh City, Vietnam, from 1996 to 2008. (A) Bars show the number of in-patients with clinically diagnosed dengue each year at each of the three study hospitals. Lines show the number of dengue cases in children aged 15 years or less (triangles) and adults over the age of 15 (circles) combined across the study sites. (B) Shown for comparison is the annual incidence of hospitalized dengue per 100,000 people in the southern 20 provinces of Vietnam derived from cases reported through the southern Vietnam dengue surveillance system. Data collated by and reproduced with permission from the Pasteur Institute HCMC. This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
Age distribution of hospitalized dengue cases. (A) Circles show the median and lines show the interquartile range of the age of pediatric dengue patients admitted to Children's Hospitals 1 and 2 (CH1 and CH2) and the Hospital for Tropical Disease (HTD) each year from 2000 to 2009. In 2000, there was no data from HTD. The solid line indicates the total number of pediatric admissions for dengue (≤ 15 years) across the three hospitals each year. (B) Circles show the median and lines show the interquartile range of the age of adult dengue patients admitted to HTD each year from 2001 to 2009. The solid line indicates the total number of adult admissions for dengue (> 15 years) at HTD each year. This figure appears in color at www.ajtmh.org.
Figure 3.
Figure 3.
Male to female ratio of dengue patients and total hospital admissions. Points indicate the male to female ratio each year for (A) total dengue admissions, (B) cases of dengue shock syndrome, and (C) all-cause admissions by hospital: Children's Hospital Number 1 (CH1; circles), Children's Hospital Number 2 (CH2; squares), and Hospital for Tropical Diseases (HTD; triangles). The dashed line indicates an equal ratio of males and females. This figure appears in color at www.ajtmh.org.
Figure 4.
Figure 4.
Disease severity and mortality among dengue patients. (A) Bars show the number of dengue patients admitted to the three study hospitals each year from 1996 to 2009 by disease severity. Red bars show pediatric DF/DHF (striped) and DSS (solid) cases. White and blue bars show adult DF/DHF (white) and DSS (blue) cases. Note that 1996 to 1999 excludes data from Children's Hospital Number 2, because figures on disease severity were not available. (B) Lines show the case fatality rate among all pediatric (≤ 15 years; solid line) and adult (> 15 years; dotted line) dengue patients admitted to the three study hospitals each year from 1996 to 2009. This figure appears in color at www.ajtmh.org.
Figure 5.
Figure 5.
District-level minimum incidence of dengue shock syndrome in HCMC. Maps showing the estimated minimum incidence of DSS per 100,000 children in each district of HCMC in (A) 2008 and (B) 2009 based on DSS cases hospitalized at one of the three study hospitals and district-level population data. The locations of the three study hospitals are also shown: Hospital for Tropical Diseases (HTD ★), Children's Hospital Number 1 (CH1 ▪), and Children's Hospital Number 2 (CH2 ▴). This figure appears in color at www.ajtmh.org.

References

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