title: Serotype influences on dengue severity: a cross-sectional study on 485 confirmed dengue cases in Vitória, Brazil.
abstract: Dengue is caused by a RNA virus of the family Flaviviridae, which presents four serotypes (DENV-1 to DENV-4) capable of inducing hemorrhage. The purpose of this study was to evaluate the influence of serotype on the outcome of dengue.
  
  
  
  This cross-sectional study included data from dengue cases with serotyping results that occurred between 2009 and 2013 in Vitória, Espírito Santo, Brazil. Data were accessed through the Information System for Notifiable Diseases. Chi-square test, Fisher exact test, Mann-Whitney U test, and logistic regression were performed to assess associations between different serotypes and dengue severity, while considering gender and age.
  
  
  
  The sample consisted of 485 laboratory confirmed dengue cases, of which 46.4 % were females, with median age of 26 years. Regarding overall samples, 77.3 % were caused by DENV-1, 16.1 % by DENV-4, 6.4 % by DENV-2, and 0.2 % by DENV-3. Severe dengue affected 6.6 % of all cases, of which 32.3 % of the cases caused by DENV-2, 6.4 % of those caused by DENV-4, 4.5 % of those caused by DENV-1, and none of those caused by DENV-3. Severe dengue was found to be seven times more frequent among cases of DENV-2 than among those of the other serotypes.
  
  
  
  The present study found that cases of DENV-2 had a higher proportion of severe dengue than among those of DENV-1 and DENV-4. Consequently, early detection of serotypes circulating in the territory could be an important approach to prevent increasing numbers of severe outcomes during dengue outbreaks by predicting the health support needed for early diagnoses and treatment of dengue cases.
authors.affiliation: Center for International Health, Medical Center of the University of Munich, Leopoldstraße 7, 80802, Munich, Germany. Rachel.Vicente@lrz.uni-muenchen.de.
authors.forename: Creuza Rachel
authors.initials: CR
authors.lastname: Vicente
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Leopoldstraße 5, 80802, Munich, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Herbinger
authors.affiliation: Center for International Health, Medical Center of the University of Munich, Leopoldstraße 7, 80802, Munich, Germany.|Department of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Leopoldstraße 5, 80802, Munich, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Fröschl
authors.affiliation: Institute of Tropical Medicine, University of São Paulo, Avenida Eneas de Carvalho Aguiar 470, 05403-000, São Paulo, Brazil.
authors.forename: Camila
authors.initials: C
authors.lastname: Malta Romano
authors.affiliation: Coordination of Epidemiological Surveillance, Health Department of Vitória, Avenida Marechal Mascarenhas de Moraes 1185, 29017-010, Vitória, Brazil.
authors.forename: Aline
authors.initials: A
authors.lastname: de Souza Areias Cabidelle
authors.affiliation: Department of Social Medicine, Federal University of Espírito Santo, Avenida Marechal Campos 1468, 29040-090, Vitória, Brazil.
authors.forename: Crispim
authors.initials: C
authors.lastname: Cerutti Junior
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003715:Dengue / Q000145:classification / Q000453:epidemiology*; D003716:Dengue Virus / Q000235:genetics; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D065288:Serogroup; D012703:Serotyping; D019595:Severe Dengue / Q000453:epidemiology; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D055815:Young Adult
keywords: Dengue virus; Severe dengue; Signs and symptoms