Age and regional differences in clinical presentation and risk of hospitalization for dengue in Brazil, 2000-2014.
Dengue cases range from asymptomatic to severe, eventually leading to hospitalization and death. Timely and appropriate management is critical to reduce morbidity. Since 1980, dengue has spread throughout Brazil, affecting an increasing number of individuals. This paper describes age and regional differences in dengue's clinical presentation and associated risk of hospitalization based on more than 5 million cases reported to the Brazilian Ministry of Health from 2000-2014.



We performed a retrospective analysis of ∼5,450,000 dengue cases, relating clinical manifestations and the risk of hospitalization to age, gender, previous infection by dengue, dengue virus serotype, years of formal education, delay to first attendance and the occurrence of dengue during outbreaks and in different Brazilian regions.



Complicated forms of dengue occurred more frequently among those younger than 10 years (3.12% vs 1.92%) and those with dengue virus 2 infection (7.65% vs 2.42%), with a delay to first attendance >2 days (3.18% vs 0.82%) and with ≤4 years of formal education (2.02% vs 1.46%). The risk of hospitalization was higher among those aged 6-10 years old (OR 4.57; 95% CI 1.43-29.96) and those who were infected by dengue virus 2 (OR 6.36; 95% CI 2.52-16.06), who lived in the Northeast region (OR 1.38; 95% CI 1.11-2.10) and who delayed first attendance by >5 days (composite OR 3.15; 95% CI 1.33-8.9).



In Brazil, the occurrence of severe dengue and related hospitalization is associated with being younger than 10 years old, being infected by dengue virus 2 or 3, living in the Northeast region (the poorest and the second most populated) and delaying first attendance for more than 2 days.
Faculdade de Medicina da Universidade de São Paulo, Divisão de Informática Médica, São Paulo/SP, Brazil.|Hospital São Paulo, Escola Paulista de Medicina, São Paulo/SP, Brazil.
Marcelo N
MN
Burattini
Faculdade de Medicina da Universidade de São Paulo, Divisão de Informática Médica, São Paulo/SP, Brazil.|CIARA, Florida International University, Miami, Florida, United States of America.
Luis F
LF
Lopez
Faculdade de Medicina da Universidade de São Paulo, Divisão de Informática Médica, São Paulo/SP, Brazil.
Francisco A B
FA
Coutinho
Universidade Federal de Goiás, Instituto Tropical de Patologia e Saúde Pública, Goiânia/GO, Brazil.
João B
JB
Siqueira
Sanofi Pasteur, São Paulo/SP, Brazil.
Sheila
S
Homsani
Sanofi Pasteur Latinoamerica, Mexico City, Mexico.
Elsa
E
Sarti
Faculdade de Medicina da Universidade de São Paulo, Divisão de Informática Médica, São Paulo/SP, Brazil.|London School of Hygiene and Tropical Medicine, London, UK.
Eduardo
E
Massad
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000150:complications / Q000453:epidemiology*; D003716:Dengue Virus; D058872:Epidemics; D005260:Female; D062305:Geographic Mapping; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult