Experts propose simplified system of dengue classification

TDR news item, 2 October 2008

A TDR and WHO cosponsored meeting has proposed a revised and

simplified categorization for dengue case classification – in a move to help
doctors and nurses rapidly identify and adequately treat the most severe, life-
threatening form of the disease and to simplify case reporting and
surveillance.

The proposed system will now be tested and validated in studies in dengue-
endemic regions over the coming 12 months. Following the evaluation, the
revised system will be formally assessed to see whether it should be adopted
and implemented at the regional and country level.

The revisions are based upon a review of clinical data from recently
completed studies in seven countries across South-East Asia, Western
Pacific and Latin America, which was supported by TDR and WHO with
funding by the European Union and the Wellcome Trust.

The multi-centre study known as "DENCO" (DENgue COntrol) concluded

that by using clinical and simple laboratory tests, it is possible to classify
dengue patients more simply into two general levels of severity, with certain
subclassifications, and that this has potential operational advantages.

The review of dengue classification is among a number of recent initiatives

being taken by WHO and its global partners to respond to the alarming
worldwide resurgence of dengue virus infection. The initiatives come at a
time when the impact of dengue in several regions is being compared to that
of diseases like tuberculosis and malaria.

Revision of the current case classification, which has been in place for over
30 years, could help emergency health services better cope with explosive
dengue outbreaks that have become an increasingly frequent occurrence in
many developing world cities.

"Rapid identification of severe disease can help health staff decide whether
to hospitalize patients or treat in outpatient clinics," said TDR director Robert
Ridley. "Better categorization will also help to improve reporting, surveillance
and early detection of outbreaks from what is today one of the developing
world's fastest growing infectious diseases," he added.

The global dengue burden has increased more than fourfold in the last 30
years, making it now the most common mosquito-borne viral disease in the
world. South-East Asia, the Western Pacific and the Americas are most
seriously affected; it is endemic in all these as well as in the Eastern
Mediterranean and African regions (see Fig. 1). The most serious forms of
dengue can lead to bleeding, plasma leakage (fluid loss) and death,
particularly in children.

The three day meeting of experts, which concluded 1 October, was

convened by TDR and WHO's Departments of Neglected Tropical Diseases
and of Endemic and Pandemic Alert and Response. It was cosponsored by
the Wellcome Trust.

The proposed new dengue classification system is much simpler than the
present system of five disease categories. The new system groups dengue
cases into just two major categories of severity – dengue (with or without
warning signals) and severe dengue.

"The consensus was that this new model could offer major advantages.
However, before it is implemented, we want to assess how it performs in
practice," said Professor Jeremy Farrar, of Oxford University Clinical
Research Unit, Viet Nam, who chaired the meeting.

As there is currently no specific treatment for dengue, case management

relies solely on careful supportive clinical care, making the method of case
classification critical for identifying patients with a high risk for severe
disease. A simplified method of case classification can also be of great
assistance for disease surveillance.

In back-to -back sessions with the dengue classification meeting, TDR and
WHO also held an informal discussion with clinical and public health experts,
representatives from drug regulatory authorities and drug developers to
discuss the product profiles for sought-after new dengue drugs, as well as
the evaluation of commercial dengue diagnostics.

Take frome: http://apps.who.int/tdr/svc/news-events/news/dengue-

classification