title: Epidemiological assessment of the severity of dengue epidemics in French Guiana.
abstract: BACKGROUND
  Dengue fever is the most important arboviral infection that affects humans, particularly in tropical and subtropical regions. Here, we provide the first comprehensive overview of the severity of dengue epidemics in French Guiana.
  
  
  RESULTS
  We monitored hospitalized cases between 2008 and 2013. Detailed clinical features and biological parameters were collected on a daily basis from all cases. Among the 1,356 cases, 216 (16%) were classified according to the WHO 2009 classification as dengue without warning signs (WS), 926 (68%) were classified as dengue with WS and 214 (16%) were classified as severe dengue. The severity rates were similar between the three major epidemics that occurred during the study period, whereas the hospitalization rate was highest in 2013. Fluid accumulation, aspartate aminotransferase (ASAT) counts>193 IU/L and platelet counts<75,000 cells/mm3 were associated with dengue severity.
  
  
  CONCLUSIONS
  Our findings provide a recent epidemiological description of the severity of dengue epidemics in French Guiana. These results highlight the potential impacts and consequences of implementing the WHO 2009 classification on hospital activity. Future studies should include virological and immunological investigations of well-documented serum samples.
authors.affiliation: Institut Pasteur de la Guyane, Cayenne, French Guiana.
authors.forename: Claude
authors.identifier: http://orcid.org/0000-0002-8064-445X
authors.initials: C
authors.lastname: Flamand
authors.affiliation: Institut Pasteur de la Guyane, Cayenne, French Guiana.
authors.forename: Camille
authors.initials: C
authors.lastname: Fritzell
authors.affiliation: Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.
authors.forename: Christelle
authors.initials: C
authors.lastname: Prince
authors.affiliation: Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.
authors.forename: Philippe
authors.initials: P
authors.lastname: Abboud
authors.affiliation: Santé Publique France, Cayenne, French Guiana.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Ardillon
authors.affiliation: Santé Publique France, Cayenne, French Guiana.
authors.forename: Luisiane
authors.initials: L
authors.lastname: Carvalho
authors.affiliation: Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.
authors.forename: Magalie
authors.initials: M
authors.lastname: Demar
authors.affiliation: Centre Hospitalier de l'Ouest Guyanais, Saint-Laurent du Maroni, French Guiana.
authors.forename: Rachida
authors.initials: R
authors.lastname: Boukhari
authors.affiliation: Centre Médico-Chirurgical de Kourou, French Guiana.
authors.forename: Martine
authors.initials: M
authors.lastname: Papaix-Puech
authors.affiliation: Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.
authors.forename: Narcisse
authors.initials: N
authors.lastname: Elenga
authors.affiliation: Institut Pasteur de la Guyane, Cayenne, French Guiana.
authors.forename: Dominique
authors.initials: D
authors.lastname: Rousset
authors.affiliation: Institut Pasteur de la Guyane, Cayenne, French Guiana.
authors.forename: Séverine
authors.initials: S
authors.lastname: Matheus
authors.affiliation: Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Nacher
authors.affiliation: Institut Pasteur de la Guyane, Cayenne, French Guiana.|Inserm UMR 1085-IRSET Institut de Rechercheen Santé, Environnementet Travail, EHESP, Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Quenel
authors.affiliation: Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.
authors.forename: Félix
authors.initials: F
authors.lastname: Djossou
mesh_terms: D000293:Adolescent; D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003715:Dengue / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005616:French Guiana / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012720:Severity of Illness Index
chemical_list: D001219:Aspartate Aminotransferases