title: Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil.
abstract: BACKGROUND
  The dengue classification proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic.
  
  
  METHODS
  This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations.
  
  
  RESULTS
  The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121) of the cases were classified as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121) of the cases were classified as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF.
  
  
  CONCLUSIONS
  The WHO 2009 classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue.
authors.affiliation: Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Luciano Pamplona de Góes
authors.initials: LP
authors.lastname: Cavalcanti
authors.affiliation: Departamento de Patologia, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Deborah Nunes de Melo
authors.initials: DN
authors.lastname: Braga
authors.affiliation: Departamento de Patologia, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Margarida Maria de Lima
authors.initials: MM
authors.lastname: Pompeu
authors.affiliation: Hospital São Jose de Doenças Infecciosas, Fortaleza, Ceará, Brazil.
authors.forename: Antônio Afonso Bezerra
authors.initials: AA
authors.lastname: Lima
authors.affiliation: Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Ceará, Brazil.
authors.forename: Lívia Maria Alexandre da
authors.initials: LM
authors.lastname: Silva
authors.affiliation: Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Ceará, Brazil.
authors.forename: Marina Gondim
authors.initials: MG
authors.lastname: Aguiar
authors.affiliation: Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Ceará, Brazil.
authors.forename: Mariana
authors.initials: M
authors.lastname: Castiglioni
authors.affiliation: Laboratório Central de Saúde Pública do Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Fernanda Montenegro de Carvalho
authors.initials: FM
authors.lastname: Araújo
authors.affiliation: Universidade de Fortaleza, Fortaleza, Ceará, Brazil.
authors.forename: Daniele Lima
authors.initials: DL
authors.lastname: Malta
authors.affiliation: Departamento de Patologia, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil.
authors.forename: Anastácio
authors.initials: A
authors.lastname: Queiroz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000145:classification* / Q000453:epidemiology; D058872:Epidemics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019595:Severe Dengue / Q000453:epidemiology; D012720:Severity of Illness Index; D063189:Symptom Assessment / Q000592:standards; D014944:World Health Organization; D055815:Young Adult