title: Usefulness and applicability of the revised dengue case classification by disease: multi-centre study in 18 countries.
abstract: BACKGROUND
  In view of the long term discussion on the appropriateness of the dengue classification into dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS), the World Health Organization (WHO) has outlined in its new global dengue guidelines a revised classification into levels of severity: dengue fever with an intermediary group of "dengue fever with warning sings", and severe dengue. The objective of this paper was to compare the two classification systems regarding applicability in clinical practice and surveillance, as well as user-friendliness and acceptance by health staff.
  
  
  METHODS
  A mix of quantitative (prospective and retrospective review of medical charts by expert reviewers, formal staff interviews), semi-quantitative (open questions in staff interviews) and qualitative methods (focus group discussions) were used in 18 countries. Quality control of data collected was undertaken by external monitors.
  
  
  RESULTS
  The applicability of the DF/DHF/DSS classification was limited, even when strict DHF criteria were not applied (13.7% of dengue cases could not be classified using the DF/DHF/DSS classification by experienced reviewers, compared to only 1.6% with the revised classification). The fact that some severe dengue cases could not be classified in the DF/DHF/DSS system was of particular concern. Both acceptance and perceived user-friendliness of the revised system were high, particularly in relation to triage and case management. The applicability of the revised classification to retrospective data sets (of importance for dengue surveillance) was also favourable. However, the need for training, dissemination and further research on the warning signs was highlighted.
  
  
  CONCLUSIONS
  The revised dengue classification has a high potential for facilitating dengue case management and surveillance.
authors.affiliation: Section Clinical Tropical Medicine, Department for Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany. judit.barniol@urz.uni-heidelberg.de
authors.forename: Judit
authors.initials: J
authors.lastname: Barniol
authors.forename: Roger
authors.initials: R
authors.lastname: Gaczkowski
authors.forename: Eliana Vega
authors.initials: EV
authors.lastname: Barbato
authors.forename: Rivaldo V
authors.initials: RV
authors.lastname: da Cunha
authors.forename: Doris
authors.initials: D
authors.lastname: Salgado
authors.forename: Eric
authors.initials: E
authors.lastname: Martínez
authors.forename: Carmita Soria
authors.initials: CS
authors.lastname: Segarra
authors.forename: Ernesto B
authors.initials: EB
authors.lastname: Pleites Sandoval
authors.forename: Ajay
authors.initials: A
authors.lastname: Mishra
authors.forename: Ida Safitri
authors.initials: IS
authors.lastname: Laksono
authors.forename: Lucy C S
authors.initials: LC
authors.lastname: Lum
authors.forename: José G
authors.initials: JG
authors.lastname: Martínez
authors.forename: Andrea
authors.initials: A
authors.lastname: Núnez
authors.forename: Angel
authors.initials: A
authors.lastname: Balsameda
authors.forename: Ivan
authors.initials: I
authors.lastname: Allende
authors.forename: Gladys
authors.initials: G
authors.lastname: Ramírez
authors.forename: Efren
authors.initials: E
authors.lastname: Dimaano
authors.forename: Kay
authors.initials: K
authors.lastname: Thomacheck
authors.forename: Naeema A
authors.initials: NA
authors.lastname: Akbar
authors.forename: Eng E
authors.initials: EE
authors.lastname: Ooi
authors.forename: Elci
authors.initials: E
authors.lastname: Villegas
authors.forename: Tran T
authors.initials: TT
authors.lastname: Hien
authors.forename: Jeremy
authors.initials: J
authors.lastname: Farrar
authors.forename: Olaf
authors.initials: O
authors.lastname: Horstick
authors.forename: Axel
authors.initials: A
authors.lastname: Kroeger
authors.forename: Thomas
authors.initials: T
authors.lastname: Jaenisch
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult