Dengue Deaths in Puerto Rico: Lessons Learned from the 2007 Epidemic

Dengue is a major public health problem in the tropics and subtropics; an estimated 50 million cases occur annually and 40 percent of the world's population lives in areas with dengue virus (DENV) transmission. Dengue has a wide range of clinical presentations from an undifferentiated acute febrile illness, classic dengue fever, to severe dengue (i.e., dengue hemorrhagic fever or dengue shock syndrome). About 5% of patients develop severe dengue, which is more common with second or subsequent infections. No vaccines are available to prevent dengue, and there are no specific antiviral treatments for patients with dengue. However, early recognition of shock and intensive supportive therapy can reduce risk of death from ∼10% to less than 1% among severe dengue cases. Reviewing dengue deaths is one means to identify issues in clinical management. These findings can be used to develop healthcare provider education to minimize dengue morbidity and mortality

Laboratory Results for the Fatal Laboratory Positive Dengue Cases, 2007, Puerto Rico.

<p>DPO = day post onset of fever; DENV = dengue virus; RT-PCR = reverse transcriptase polymerase chain reaction; MAC-ELISA = IgM antibody capture enzyme linked immunosorbent assay; ELISA = enzyme linked immunosorbent assay; WNV = West Nile virus; PRNT = plaque reduction neutralization test; IgM Lepto = IgM ELISA ImmunoDOT assay for <i>Leptospira;</i> IHC = immunohistochemical microscopy; NEG = negative test result; POS = positive test result; N/A = not applicable for patient; QNS = quantity not sufficient to perform test indicated.</p>†<p>These samples where whole blood collected at time of death.</p

Clinical Features of the Fatal Laboratory-positive Dengue Cases at Time of Death or End of Hospital Stay, 2007, Puerto Rico.

<p>This table describes the clinical features of laboratory positive dengue case-patients at time of death or end of hospital stay.</p>†<p>DHF = dengue hemorrhagic fever; PLT = platelet; HCT = hematocrit; GI = gastrointestinal; ICH = intracranial hemorrhage; LOS = length of stay.</p>‡<p>DHF criteria as defined by World Health Organization in Dengue Hemorrhagic Fever: Diagnosis, Treatment, Prevention and Control. Second edition. Geneva: World Health Organization.</p