title: Evaluation of the WHO classification of dengue disease severity during an epidemic in 2011 in the state of Ceará, Brazil.
abstract: In 2009, the World Health Organization (WHO) issued a new guideline that stratifies dengue-affected patients into severe (SD) and non-severe dengue (NSD) (with or without warning signs). To evaluate the new recommendations, we completed a retrospective cross-sectional study of the dengue haemorrhagic fever (DHF) cases reported during an outbreak in 2011 in northeastern Brazil. We investigated 84 suspected DHF patients, including 45 (53.6%) males and 39 (46.4%) females. The ages of the patients ranged from five-83 years and the median age was 29. According to the DHF/dengue shock syndrome classification, 53 (63.1%) patients were classified as having dengue fever and 31 (36.9%) as having DHF. According to the 2009 WHO classification, 32 (38.1%) patients were grouped as having NSD [4 (4.8%) without warning signs and 28 (33.3%) with warning signs] and 52 (61.9%) as having SD. A better performance of the revised classification in the detection of severe clinical manifestations allows for an improved detection of patients with SD and may reduce deaths. The revised classification will not only facilitate effective screening and patient management, but will also enable the collection of standardised surveillance data for future epidemiological and clinical studies.
authors.affiliation: Departamento de Saúde Comunitária, Universidade Federal do Ceará, FortalezaCE, Brasil, Departamento de Saúde Comunitária , Universidade Federal do Ceará , Fortaleza , CE , Brasil.
authors.forename: Luciano Pamplona de Góes
authors.initials: LP
authors.lastname: Cavalcanti
authors.affiliation: Faculdade de Medicina, Centro Universitário Christus, FortalezaCE, Brasil, Faculdade de Medicina , Centro Universitário Christus , Fortaleza , CE , Brasil.
authors.forename: Lia Alves Martins
authors.initials: LA
authors.lastname: Mota
authors.affiliation: Faculdade de Medicina, Centro Universitário Christus, FortalezaCE, Brasil, Faculdade de Medicina , Centro Universitário Christus , Fortaleza , CE , Brasil.
authors.forename: Gustavo Porto
authors.initials: GP
authors.lastname: Lustosa
authors.affiliation: Faculdade de Medicina, Centro Universitário Christus, FortalezaCE, Brasil, Faculdade de Medicina , Centro Universitário Christus , Fortaleza , CE , Brasil.
authors.forename: Mayara Carvalho
authors.initials: MC
authors.lastname: Fortes
authors.affiliation: Faculdade de Medicina, Universidade Federal do Ceará, FortalezaCE, Brasil, Faculdade de Medicina , Universidade Federal do Ceará , Fortaleza , CE , Brasil.
authors.forename: Davi Alves Martins
authors.initials: DA
authors.lastname: Mota
authors.affiliation: Hospital São José de Doenças Infecciosas, FortalezaCE, Brasil, Hospital São José de Doenças Infecciosas , Fortaleza , CE , Brasil.
authors.forename: Antônio Afonso Bezerra
authors.initials: AA
authors.lastname: Lima
authors.affiliation: Núcleo de Medicina Tropical Prof JE Alencar, Universidade Federal do Ceará, FortalezaCE, Brasil, Núcleo de Medicina Tropical Prof JE Alencar , Universidade Federal do Ceará , Fortaleza , CE , Brasil.
authors.forename: Ivo Castelo Branco
authors.initials: IC
authors.lastname: Coelho
authors.affiliation: Fundação de Medicina Tropical Dr Heitor Vieira Dourado, ManausAM, Brasil, Fundação de Medicina Tropical Dr Heitor Vieira Dourado , Manaus , AM , Brasil.
authors.forename: Maria Paula Gomes
authors.initials: MP
authors.lastname: Mourão
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003715:Dengue / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology; D018563:Disease Notification / Q000706:statistics & numerical data; D058872:Epidemics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019595:Severe Dengue / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology*; D012720:Severity of Illness Index; D063189:Symptom Assessment; D014944:World Health Organization; D055815:Young Adult