Dengue in travellers: applicability of the 1975-1997 and the 2009 WHO classification system of dengue fever.
OBJECTIVE
The aim of this study was to assess the applicability and benefits of the new WHO dengue fever guidelines in clinical practice, for returning travellers.


METHODS
We compared differences in specificity and sensitivity between the old and the new guidelines for diagnosing dengue and assessed the usefulness in predicting the clinical course of the disease. Also, we investigated whether hypertension, diabetes or allergies, ethnicity or high age influenced the course of disease.


RESULTS
In our setting, the old classification, compared with the new, had a marginally higher sensitivity for diagnosing dengue. The new classification had a slightly higher specificity and was less rigid. Patients with dengue who had warning signs as postulated in the new classification were admitted more often than those who had no warning signs (RR, 8.09 [1.80-35.48]). We did not find ethnicity, age, hypertension, diabetes mellitus or allergies to be predictive of the clinical course.


CONCLUSIONS
In our cohort of returned travellers, the new classification system did not differ in sensitivity and specificity from the old system to a clinically relevant degree. The guidelines did not improve identification of severe disease.
Center for Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam, The Netherlands.
Rosanne W
RW
Wieten
Wytze
W
Vlietstra
Abraham
A
Goorhuis
Michèle
M
van Vugt
Caspar J
CJ
Hodiamont
Tjalling
T
Leenstra
Peter J
PJ
de Vries
Saskia
S
Janssen
Pieter P
PP
van Thiel
Kees
K
Stijnis
Martin P
MP
Grobusch
D000328:Adult; D000367:Age Factors; D015897:Comorbidity; D003715:Dengue / Q000175:diagnosis* / Q000208:ethnology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D014195:Travel; D044465:White People; D014944:World Health Organization