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Clinical Characteristics and Outcomes Among Travelers With Severe Dengue: A GeoSentinel Analysis

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Clinical Characteristics and Outcomes Among Travelers With Severe Dengue: A GeoSentinel Analysis. / Huits, Ralph; Angelo, Kristina M; Amatya, Bhawana; Barkati, Sapha; Barnett, Elizabeth D; Bottieau, Emmanuel; Emetulu, Hannah; Epelboin, Loïc; Eperon, Gilles; Medebb, Line; Gobbi, Federico; Grobusch, Martin P; Itani, Oula; Jordan, Sabine; Kelly, Paul; Leder, Karin; Díaz-Menéndez, Marta; Okumura, Nobumasa; Rizwan, Aisha; Saio, Mauro; Waggoner, Jesse; Yoshimura, Yukihiro; Libman, Michael; Hamer, Davidson H; Schwartz, Eli.

in: ANN INTERN MED, Jahrgang 176, Nr. 7, 07.2023, S. 940-948.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Huits, R, Angelo, KM, Amatya, B, Barkati, S, Barnett, ED, Bottieau, E, Emetulu, H, Epelboin, L, Eperon, G, Medebb, L, Gobbi, F, Grobusch, MP, Itani, O, Jordan, S, Kelly, P, Leder, K, Díaz-Menéndez, M, Okumura, N, Rizwan, A, Saio, M, Waggoner, J, Yoshimura, Y, Libman, M, Hamer, DH & Schwartz, E 2023, 'Clinical Characteristics and Outcomes Among Travelers With Severe Dengue: A GeoSentinel Analysis', ANN INTERN MED, Jg. 176, Nr. 7, S. 940-948. https://doi.org/10.7326/M23-0721

APA

Huits, R., Angelo, K. M., Amatya, B., Barkati, S., Barnett, E. D., Bottieau, E., Emetulu, H., Epelboin, L., Eperon, G., Medebb, L., Gobbi, F., Grobusch, M. P., Itani, O., Jordan, S., Kelly, P., Leder, K., Díaz-Menéndez, M., Okumura, N., Rizwan, A., ... Schwartz, E. (2023). Clinical Characteristics and Outcomes Among Travelers With Severe Dengue: A GeoSentinel Analysis. ANN INTERN MED, 176(7), 940-948. https://doi.org/10.7326/M23-0721

Vancouver

Huits R, Angelo KM, Amatya B, Barkati S, Barnett ED, Bottieau E et al. Clinical Characteristics and Outcomes Among Travelers With Severe Dengue: A GeoSentinel Analysis. ANN INTERN MED. 2023 Jul;176(7):940-948. https://doi.org/10.7326/M23-0721

Bibtex

@article{e54f795cbf584a3da5671eaed9b052c7,
title = "Clinical Characteristics and Outcomes Among Travelers With Severe Dengue: A GeoSentinel Analysis",
abstract = "BACKGROUND: Dengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited.OBJECTIVE: To describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue).DESIGN: Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022.SETTING: 20 of 71 international GeoSentinel sites.PATIENTS: Returning travelers with complicated dengue.MEASUREMENTS: Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue.RESULTS: Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n = 27 [31%]) and Southeast Asia (n = 21 [24%]). Frequent reasons for travel were tourism (46%) and visiting friends and relatives (32%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n = 3), severe liver disease (n = 3), myocarditis (n = 2), and neurologic symptoms (n = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgM+/IgG-) and 12 as secondary (IgM-/IgG+) dengue.LIMITATIONS: Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited.CONCLUSION: Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study.PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention, International Society of Travel Medicine, Public Health Agency of Canada, and GeoSentinel Foundation.",
keywords = "Humans, Female, Adult, Male, Severe Dengue, Retrospective Studies, Travel, Prospective Studies, Immunoglobulin G, Immunoglobulin M",
author = "Ralph Huits and Angelo, {Kristina M} and Bhawana Amatya and Sapha Barkati and Barnett, {Elizabeth D} and Emmanuel Bottieau and Hannah Emetulu and Lo{\"i}c Epelboin and Gilles Eperon and Line Medebb and Federico Gobbi and Grobusch, {Martin P} and Oula Itani and Sabine Jordan and Paul Kelly and Karin Leder and Marta D{\'i}az-Men{\'e}ndez and Nobumasa Okumura and Aisha Rizwan and Mauro Saio and Jesse Waggoner and Yukihiro Yoshimura and Michael Libman and Hamer, {Davidson H} and Eli Schwartz",
year = "2023",
month = jul,
doi = "10.7326/M23-0721",
language = "English",
volume = "176",
pages = "940--948",
journal = "ANN INTERN MED",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "7",

}

RIS

TY - JOUR

T1 - Clinical Characteristics and Outcomes Among Travelers With Severe Dengue: A GeoSentinel Analysis

AU - Huits, Ralph

AU - Angelo, Kristina M

AU - Amatya, Bhawana

AU - Barkati, Sapha

AU - Barnett, Elizabeth D

AU - Bottieau, Emmanuel

AU - Emetulu, Hannah

AU - Epelboin, Loïc

AU - Eperon, Gilles

AU - Medebb, Line

AU - Gobbi, Federico

AU - Grobusch, Martin P

AU - Itani, Oula

AU - Jordan, Sabine

AU - Kelly, Paul

AU - Leder, Karin

AU - Díaz-Menéndez, Marta

AU - Okumura, Nobumasa

AU - Rizwan, Aisha

AU - Saio, Mauro

AU - Waggoner, Jesse

AU - Yoshimura, Yukihiro

AU - Libman, Michael

AU - Hamer, Davidson H

AU - Schwartz, Eli

PY - 2023/7

Y1 - 2023/7

N2 - BACKGROUND: Dengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited.OBJECTIVE: To describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue).DESIGN: Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022.SETTING: 20 of 71 international GeoSentinel sites.PATIENTS: Returning travelers with complicated dengue.MEASUREMENTS: Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue.RESULTS: Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n = 27 [31%]) and Southeast Asia (n = 21 [24%]). Frequent reasons for travel were tourism (46%) and visiting friends and relatives (32%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n = 3), severe liver disease (n = 3), myocarditis (n = 2), and neurologic symptoms (n = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgM+/IgG-) and 12 as secondary (IgM-/IgG+) dengue.LIMITATIONS: Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited.CONCLUSION: Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study.PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention, International Society of Travel Medicine, Public Health Agency of Canada, and GeoSentinel Foundation.

AB - BACKGROUND: Dengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited.OBJECTIVE: To describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue).DESIGN: Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022.SETTING: 20 of 71 international GeoSentinel sites.PATIENTS: Returning travelers with complicated dengue.MEASUREMENTS: Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue.RESULTS: Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n = 27 [31%]) and Southeast Asia (n = 21 [24%]). Frequent reasons for travel were tourism (46%) and visiting friends and relatives (32%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n = 3), severe liver disease (n = 3), myocarditis (n = 2), and neurologic symptoms (n = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgM+/IgG-) and 12 as secondary (IgM-/IgG+) dengue.LIMITATIONS: Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited.CONCLUSION: Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study.PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention, International Society of Travel Medicine, Public Health Agency of Canada, and GeoSentinel Foundation.

KW - Humans

KW - Female

KW - Adult

KW - Male

KW - Severe Dengue

KW - Retrospective Studies

KW - Travel

KW - Prospective Studies

KW - Immunoglobulin G

KW - Immunoglobulin M

U2 - 10.7326/M23-0721

DO - 10.7326/M23-0721

M3 - SCORING: Journal article

C2 - 37335991

VL - 176

SP - 940

EP - 948

JO - ANN INTERN MED

JF - ANN INTERN MED

SN - 0003-4819

IS - 7

ER -