The Indian Journal of Pediatrics

, Volume 85, Issue 6, pp 413–414 | Cite as

Severe Dengue: Developing a Universally Applicable Simple Prediction Model

  • Sunit C. SinghiEmail author

Globally dengue causes 50 million infections per year and an estimated 20,000 deaths annually, posing a large disease and economic burden. In 2009, World Health Organization (WHO) proposed a classification categorising the disease as dengue with or without warning signs and severe dengue, to enhance early recognition of severe dengue [1]. The 2009 classification suggests 7 clinical signs as warning signs for severe dengue based on a multicenter study in Southeast Asia and Latin American countries [2] and global expert consensus. WHO guidelines suggest that presence of any warning sign should lead to admission to a healthcare facility and intravenous fluid therapy [1]. A systematic review showed that sensitivity of 2009 classification to identify severe dengue ranged between 59 and 98% (88%/98%: prospective studies), and specificity between 41 and 99% (99%: prospective studies) [3]. Although the WHO 2009 guidelines’ system of early warning signs is easy to use and sensitive in...


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  1. 1.
    World Health Organization. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. New edition. Geneva: World Health Organization; 2009. Avaialble at: Accessed on 9th March 2018.
  2. 2.
    Alexander N, Balmaseda A, Coelho IC, et al; European Union, World Health Organization (WHO-TDR) supported DENCO Study Group. Multicentre prospective study on dengue classification in four south-east Asian and three Latin American countries. Tropical Med Int Health. 2011;16:936–48.Google Scholar
  3. 3.
    Horstick O, Jaenisch T, Martinez E, et al. Comparing the usefulness of the 1997 and 2009 WHO dengue case classification: a systematic literature review. Am J Trop Med Hyg. 2014;91:621–34.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Carrasco LR, Leo YS, Cook AR, et al. Predictive tools for severe dengue conforming to World Health Organization 2009 criteria. PLoS Negl Trop Dis. 2014;8:e2972.Google Scholar
  5. 5.
    Hadinegoro SR. The revised WHO dengue case classification: does the system need to be modified? Paediatr Int Child Health. 2012;32:33–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Sreenivasan P, Geetha S, Sasikala K. Development of a prognostic prediction model to determine severe dengue in children. Indian J Pediatr. 2018;
  7. 7.
    Zhang H, Zhou YP, Peng HJ, et al. Predictive symptoms and signs of severe dengue disease for patients with dengue fever: a meta-analysis. Biomed Res Int. 2014;2014:359308.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Branco Mdos R, Luna EJ, Braga Júnior LL, et al. Risk factors associated with death in Brazilian children with severe dengue: a case-control study. Clinics (Sao Paulo). 2014;69:55–60.CrossRefGoogle Scholar
  9. 9.
    Thanachartwet V, Oer-Areemitr N, Chamnanchanunt S, et al. Identification of clinical factors associated with severe dengue among Thai adults: a prospective study. BMC Infect Dis. 2015;15:420.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Tamibmaniam J, Hussin N, Cheah WK, Ng KS, Muninathan P. Proposal of a clinical decision tree algorithm using factors associated with severe dengue infection. PLoS One. 2016;11:e0161696.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Wakimoto MD, Camacho LA, Guaraldo L, Damasceno LS, Brasil P. Dengue in children: a systematic review of clinical and laboratory factors associated with severity. Expert Rev Anti-Infect Ther. 2015;13:1441–56.CrossRefPubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2018

Authors and Affiliations

  1. 1.Division of Pediatrics, Medanta, The MedicityGurugramIndia
  2. 2.Department of Pediatrics & Advanced Pediatrics CentrePost Graduate Institute of Medical Education and ResearchChandigarhIndia

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