title: WHO dengue case classification 2009 and its usefulness in practice: an expert consensus in the Americas.
abstract: BACKGROUND
  In 2009, the new World Health Organization (WHO) dengue case classification - dengue/severe dengue (D/SD) - was introduced, replacing the 1997 WHO dengue case classification: dengue fever/dengue haemorrhagic fever/dengue shock syndrome (DF/DHF/DSS).
  
  
  METHODS
  A 2-day expert consensus meeting in La Habana/Cuba aimed to (1) share the experiences from Pan American Health Organization (PAHO) member states when applying D/SD, (2) present national and local data using D/SD, and (3) agree with the presented evidence on a list of recommendations for or against the use of D/SD for PAHO, and also globally.
  
  
  RESULTS
  Eight key questions were discussed, concluding: (1) D/SD is useful describing disease progression because it considers the dynamic nature of the disease, (2) D/SD helps defining dengue cases correctly for clinical studies, because it defines more precisely disease severity and allows evaluating dynamically the progression of cases, (3) D/SD describes correctly all clinical forms of severe dengue. Further standards need to be developed regionally, especially related to severe organ involvement, (4) D/SD allows for pathophysiological research identifying - in a sequential manner - the clinical manifestations of dengue related to pathophysiological events, (5) the warning signs help identifying early cases at risk of shock (children and adults), pathophysiology of the warning signs deserves further studies, (6) D/SD helps treating individual dengue cases and also the reorganization of health-care services for outbreak management, (7) D/SD helps diagnosing dengue, in presumptive diagnosis and follow-up of the disease, because of its high sensitivity and high negative predictive value (NPV), and (8) there is currently no update of the International Disease Classification10 (ICD10) to include the new classification of dengue (D/SD); therefore, there are not enough experiences of epidemiological reporting. Once D/SD has been implemented in epidemiological surveillance, D/SD allows to (1) identify severity of dengue cases in real time, for any decision-making on actions, (2) measure and compare morbidity and mortality in countries, and also globally, and (3) trigger contingency plans early, not only based on the number of reported cases but also on the reported severity of cases.
  
  
  CONCLUSIONS
  The expert panel recommends to (1) update ICD10, (2) include D/SD in country epidemiological reports, and (3) implement studies improving sensitivity/specificity of the dengue case definition.
authors: Olaf
authors: O
authors: Horstick
authors: Eric
authors: E
authors: Martinez
authors: Maria Guadalupe
authors: MG
authors: Guzman
authors: Jose Luis San
authors: JL
authors: Martin
authors: Silvia Runge
authors: SR
authors: Ranzinger
mesh_terms: D000569:Americas / Q000453:epidemiology; D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D018450:Disease Progression; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D014944:World Health Organization
keywords: Dengue case classification,; Expert consensus; WHO 1997 dengue case classification,; WHO 2009 dengue case classification,
references: J Med Virol. 2014 Aug;86(8):1437-47
references: 24170344
references: Am J Trop Med Hyg. 2014 Sep;91(3):621-34
references: 24957540
references: Mem Inst Oswaldo Cruz. 2014 Feb;109(1):93-8
references: 24626308
references: Clinics (Sao Paulo). 2013 Oct;68(10):1299-304
references: 24212835
references: J Microbiol Immunol Infect. 2013 Aug;46(4):271-81
references: 23022142
references: Infection. 2013 Aug;41(4):775-82
references: 23381875
references: PLoS One. 2013;8(4):e60946
references: 23573291
references: Cytokine. 2013 Mar;61(3):766-71
references: 23357301
references: BMJ. 1995 Aug 5;311(7001):376-80
references: 7640549
references: Trop Med Int Health. 2006 Aug;11(8):1238-55
references: 16903887
references: Lancet Infect Dis. 2007 Jan;7(1):21-31
references: 17182341
references: Rev Panam Salud Publica. 2009 Jan;25(1):16-23
references: 19341519
references: Southeast Asian J Trop Med Public Health. 2010 Sep;41(5):1088-94
references: 21073029
references: Am J Trop Med Hyg. 2011 Feb;84(2):224-8
references: 21292888
references: Pediatr Infect Dis J. 2011 May;30(5):449-50
references: 21490492
references: BMC Infect Dis. 2011;11:106
references: 21510901
references: PLoS Negl Trop Dis. 2011 Nov;5(11):e1397
references: 22087348
references: Am J Trop Med Hyg. 2012 Jan;86(1):166-70
references: 22232468
references: Trop Med Int Health. 2011 Aug;16(8):936-48
references: 21624014
references: BMC Res Notes. 2012;5:645
references: 23167997
references: PLoS Negl Trop Dis. 2013;7(1):e2023
references: 23350013