title: Severe dengue outbreak in Yunnan, China, 2013.
abstract: In recent decades, the impact of dengue has increased both geographically and in intensity, and this disease is now a threat to approximately half of the world's population. An unexpected large outbreak of dengue fever was reported in Xishuangbanna Dai Autonomous Prefecture, Yunnan Province, China, in 2013. This was the first autochthonous outbreak with a significant proportion of severe dengue cases in mainland China in a decade. According to the 2009 World Health Organization guidelines, half of the 136 laboratory confirmed cases during the epidemic were severe dengue. The clinical presentation included severe haemorrhage (such as massive vaginal and gastrointestinal bleeding), severe plasma leakage (such as pleural effusion, ascites, or hypoproteinaemia), and organ involvement (such as myocarditis and lung impairment); 21 cases eventually deteriorated to shock. During this outbreak, all severe cases occurred in adults, among whom about 43% had co-morbid conditions. Nucleic acid detection and virus isolation confirmed dengue virus serotype 3 (DENV-3) to be the pathogenic agent of this outbreak. Phylogenetic analyses of envelope gene sequences showed that these DENV-3 isolates belonged to genotype II. This finding is of great importance to understand the circulation of DENV and predict the risk of severe disease in mainland China. Here, we provide a brief report of the epidemiology, clinical manifestations, and aetiology of this dengue fever outbreak, and characterize DENV strains isolated from clinical specimens.
authors.affiliation: Guangzhou 8th People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China.
authors.forename: Fu-Chun
authors.initials: FC
authors.lastname: Zhang
authors.affiliation: Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Xishuangbanna Dai Autonomous Prefecture People's Hospital, Xishuangbanna, People's Republic of China.
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Li
authors.affiliation: Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Jiang
authors.affiliation: Guangzhou 8th People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China.
authors.forename: Wen-Xin
authors.initials: WX
authors.lastname: Hong
authors.affiliation: Guangzhou 8th People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Guangzhou 8th People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China.
authors.forename: Ling-Zhai
authors.initials: LZ
authors.lastname: Zhao
authors.affiliation: Guangzhou 8th People's Hospital, Guangzhou Medical University, Guangzhou, People's Republic of China; Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
authors.forename: Hui-Qin
authors.initials: HQ
authors.lastname: Yang
authors.affiliation: Xishuangbanna Dai Autonomous Prefecture People's Hospital, Xishuangbanna, People's Republic of China.
authors.forename: De-Hong
authors.initials: DH
authors.lastname: Ma
authors.affiliation: Xishuangbanna Dai Autonomous Prefecture People's Hospital, Xishuangbanna, People's Republic of China.
authors.forename: Chun-Hai
authors.initials: CH
authors.lastname: Bai
authors.affiliation: Xishuangbanna Dai Autonomous Prefecture People's Hospital, Xishuangbanna, People's Republic of China.
authors.forename: Xi-Yun
authors.initials: XY
authors.lastname: Shan
authors.affiliation: Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China.
authors.forename: Yong-Qiang
authors.initials: YQ
authors.lastname: Deng
authors.affiliation: Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, People's Republic of China. Electronic address: qincf@bmi.ac.cn.
authors.forename: Cheng-Feng
authors.initials: CF
authors.lastname: Qin
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D003715:Dengue / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D003716:Dengue Virus / Q000145:classification / Q000302:isolation & purification; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: China; Dengue; Dengue virus serotype 3; Severe dengue