title: Laboratory-confirmed Dengue in Children in Three Regional Hospitals in the Philippines in 2009-2010.
abstract: BACKGROUND
  The burden of dengue is high in the Philippines but the prevalence of confirmed cases is unknown, and the disease is subject to underreporting because surveillance of suspected cases is passive. We conducted a prospective epidemiological study to estimate the proportion of laboratory-confirmed dengue among clinically suspected hospitalized cases in the pediatric wards of 3 regional hospitals in the Philippines and to describe the clinical and laboratory features, age distributions, case fatality rates and serotype distributions of these hospitalized cases.
  
  
  METHODS
  Patients ≤18 years and hospitalized for suspected dengue were included if they had an axillary temperature ≥38°C for 2-7 days and 2 or more dengue-associated symptoms. Dengue infection was confirmed in acute blood samples by serotype-specific reverse transcription-polymerase chain reaction and IgM immunoassay.
  
  
  RESULTS
  We confirmed dengue infection in 1809 (86.1%) cases of 2103 suspected cases between November 2009 and November 2010. The 6- to 10-year-old age group had the highest proportion of cases overall (36.7%). Fever, anorexia, myalgia, abdominal pain and headache were the most common symptoms at admission. Hemorrhagic manifestations, signs of plasma leakage, thrombocytopenia and leucopenia were all significantly more common in confirmed than in nonconfirmed cases. Most cases (76.5%) developed dengue hemorrhagic fever or dengue shock syndrome, and the overall case fatality rate was 0.94%. Distributions of all 4 virus serotypes varied at each hospital.
  
  
  CONCLUSIONS
  The clinical burden of pediatric dengue continues to be substantial in the Philippines. Most hospitalized cases of suspected pediatric dengue can be laboratory confirmed and most develop severe disease.
authors.affiliation: From the *Department of Health, Research Institute for Tropical Medicine, Muntinlupa City, Philippines; †Global Epidemiology, Sanofi Pasteur, Lyon, France; ‡Southern Philippines Medical Center (formerly Davao Medical Center), Davao City, Mindanao, Philippines; §Western Visayas Medical Center, Iloilo City, Visayas, Philippines; ¶José B. Lingad Memorial Regional Hospital, San Fernando City, Luzon, Philippines; and ‖Department of Health, National Epidemiology Center, Manila, Metropolitan Manila, Philippines.
authors.forename: Maria Rosario Z
authors.initials: MR
authors.lastname: Capeding
authors.forename: Maïna
authors.initials: M
authors.lastname: L'Azou
authors.forename: Michael
authors.initials: M
authors.lastname: Manalaysay
authors.forename: Cristina R
authors.initials: CR
authors.lastname: Vince-Woo
authors.forename: Religaya G
authors.initials: RG
authors.lastname: Rivera
authors.forename: Ava
authors.initials: A
authors.lastname: Kristy Sy
authors.forename: Edelwisa Segubre
authors.initials: ES
authors.lastname: Mercado
authors.forename: Marianette T
authors.initials: MT
authors.lastname: Inobaya
authors.forename: Enrique G
authors.initials: EG
authors.lastname: Tayag
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D003716:Dengue Virus / Q000276:immunology; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010679:Philippines / Q000453:epidemiology; D011446:Prospective Studies
chemical_list: D000914:Antibodies, Viral