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Contribution of Ecuador to the use of the who 2009 dengue classification

Abstract:

Introduction: dengue virus infection has had a dramatic increase, with a population at risk of 8 220 000 inhabitants in Ecuador. Objectives: determine the usefulness of the reclassification of cases of dengue fever, dengue hemorrhagic fever and dengue hemorrhagic fever/dengue shock syndrome, according to the WHO 2009 Dengue Clinical Guide, and identify the signs of alarm and their relationship to disease severity. Methods: a cross-sectional ambispective study was conducted between the years 2005 and 2006 (retrospective) and from April to November 2009 (prospective). The latter period followed a training intervention (WHO 2009 Guide). The study was conducted in primary and tertiary units based on randomly selected medical records. Results: fifty records were analyzed in the first period and 72 in the second, with a moderate (kappa= 0.51; CI 95% 0.18-0.85) and insignificant (kappa= 0.3; CI 95% 0-0.71) level of agreement, respectively, for the two classifications. Sensitivity of the 2009 classification for the detection of severe cases was 86.36% (CI 95% 71.9% 5-94.33%), and specificity was 83.3% (CI 95% 36.48%-99.12%). For both periods, sensitivity was 100% (CI 95% 61.0%-100%) and specificity was 59.09% (CI 434.4%-72.30%). Identification of alarm signs and their relationship to dengue severity showed a sensitivity of 100% (CI 95% 61.0%-100%) and a specificity of 59.09% (CI 434.4%-72.30%) in the first period, and a sensitivity of 100% (CI 95% 46.29% 5-98.13%) and a specificity of 46.27% (CI 95% 34.17%-58.80%) in the second. Conclusions: the WHO 2009 classification is useful for the timely, effective management of patients, with alarm signs that are good pbkp_redictors of shock.