Incidence and severity of dengue in pediatric patients higher in Southeast Asia versus Latin America


1. The disease burden and severity of virologically confirmed dengue appeared to be higher in Asian countries compared to Latin American countries 

Evidence Rating Level: 2 (Good)

Study Rundown: Dengue is an acute systemic viral infection with multiple strains that presents with variable symptomology. While the exact global distribution of both dengue disease burden and infection risk remains unclear, recent studies estimate approximately 100-390 million infections occur per year. In this prospective cohort study, researchers monitored acute febrile illness and virologically confirmed dengue (VCD) in two cohorts of children who served as the control group in a dengue vaccine phase 3 clinical trial in both Latin America (Brazil, Colombia, Honduras, Mexico and Puerto Rico) and Asian (Indonesia, Malaysia, Philippines, Thailand, Vietnam) countries. Overall, the incidence of both acute febrile episodes and VCD was higher in the Asian cohort compared to the Latin American cohort. However, across cohorts, all pediatric age groups were affected but the disease burden of dengue varied by geographic region. Generalization is limited due to the high estimated baseline levels of dengue in these countries, as well as the cohorts only including previously healthy participants involved in a vaccine clinical trial.

Click to read the study, published today in NEJM

Relevant Reading: The global distribution and burden of dengue

In-Depth [prospective cohort]: In this prospective cohort study, researchers evaluated the burden of symptomatic dengue and viral seropositivity in two pediatric control groups that were part of two phase 3 observer-blinded, randomized placebo-controlled clinical trials investigating the efficacy of a tetravalent dengue vaccine. The Asian cohort included 3214 previously healthy participants (2-14 years of age) and the Latin American cohort included 6939 previously healthy participants (9-16 years of age). Analyses were performed for acute febrile episodes, VCD and dengue hemorrhagic fever by country and age group. In the Asian cohort, 3109 febrile episodes were observed during 6934 person-years with 10.3% being VCD episodes, 19.1% of which required hospitalization. In the Latin American cohort, 3615 febrile episodes were observed during 13,527 person-years with 10.8% being VCD episodes, 11.1% of which required hospitalization. The incidence of hospitalization for VCD was 0.9 and 0.4 hospitalizations per 100 person-years in the Asian and Latin American cohorts, respectively. In a subgroup analysis, the researchers also assessed dengue seropositivity, and found 67.3% (1345/1999 participants) and 79.2% (1585/2000 participants) of the Asian and Latin American cohorts to be seropositive at baseline, respectively. 

Image: PD

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