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OėĎČĎēĆđ AėęĎĈđĊ

A descriptive study on dengue fever reported in

a Medical College Hospital
Jimmy Antony, T. M. Celine
Department of Community Medicine, Department of Community Medicine, M.O.S.C Medical College, Kolenchery,
Ernakulam District, Kerala State, India

A B S T R A C T
Background: Dengue fever is a serious public health problem in terms of its morbidity and mortality. It reports from almost all
countries and it is endemic in the tropical countries. Aim: The present hospital study aims to describe the frequency , distribution
and case fatality of dengue fever based on the variables such as age, sex and year. Settings and Design: It is a hospital-based
retrospective study of 5 years in tertiary care and teaching hospital in South India. Materials and Methods: The data were collected
from the medical records department of the hospital and analyzed by using Microsoft excel. Result: Out of 341 reported cases of
dengue, 60.70% were males and 39.29% were females. In both males and females, the high proportion of cases were reported in
adult age groups (>20 years). Case fatality rate of dengue fever is 1.2%, with 0.97% in males and 1.49% in females. Out of 341 cases,
333 (97.65%) were Classical Dengue Fever and remaining 8 cases (2.34%) were dengue hemorrhagic fever. Conclusion: More cases
of dengue fever were reported in the adult age group (20 years and above) and in males compared to low age groups (<20 years) and
females. It highlights the involvement of work component in the occurrence of disease. Community-based action program is required
for source reduction activities in the outdoor area for arresting the breeding and multiplication of Aedes mosquitoes and thereby to
reduce the morbidity and mortality of dengue fever.

Keywords: Age, case fatality, dengue fever, sex and year

INTRODUCTION include source reduction activities and also the personal

Dengue fever is an infectious mosquito-borne disease
caused by dengue virus. Its symptoms include fever,
head ache, muscle and joint pains and rash resembles
measles. The presence of muscle and joint paints
gives an alternative name to the dengue fever as ‘break
bone fever’.[1] Classical dengue fever cases sometimes
develop to more severe life-threatening stage of dengue
hemorrhagic fever or dengue hemorrhagic fever with
shock. The disease is transmitted by the bite of certain
species of female Aedes mosquito. Subsequent infection
with different serotypes increases the severity of this
fatal infection. The control measures of dengue fever
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prophylaxis measures. This study aimed for finding out
the frequency and distribution of dengue fever and its
case fatality based on the variables such as age and sex
during a time period of 5 years.
MATERIALS AND METHODS
It is a retrospective study of five years conducted
in the MOSC Medical College hospital, Kolenchery,
Kerala State in South India. The medical records
department follows the guidelines of WHO ICD 10 for
the classification of diseases. The data retrieved from
the medical records department with the permission of
institutional ethical committee and collected data were
analyzed using Microsoft excel.
RESULT

DOI: A total of 341 dengue cases were reported at the hospital

10.4103/1118-8561.140285 during the time period from April 2005 to March 2010.
Of 341 cases, 207 (60.70%) were males and 134 (39.29%)

Address for correspondence: Dr. Jimmy Antony, M.O.S.C Medical College, Kolenchery, Ernakulam, Kerala - 682 311, India.
E-mail: anjim2010@rediffmail.com

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Antony and Celine: A study on dengue fever in a tertiary care and teaching hospital

were females. The proportion of male cases was higher
than females. High proportion of dengue cases were in
20 to 39 years (42.02%) in males while females showing
high proportion of cases in the 40 to 59 years (41.04%).
Dengue fever in both males and females in different age
groups has been shown in Table 1. Case fatality rate of
dengue fever is 1.2%; with 0.97% in males and 1.49%
in females. Out of 341 cases, 333 (97.65%) were due to
classical dengue fever and remaining 8 cases (2.34%)
were due to dengue hemorrhagic fever. The trend of
case fatality of dengue fever in males and females from
2005 to 2010 has been given in Figure 1.
DISCUSSION
Dengue fever reports from many parts of the world including
Africa, America, Eastern Mediterranean, Western pacific
and South East Asia[2] (WHO). The last decade witnessed
this pandemic in different countries of the world such as
Bangladesh in 2000,[3] Hawaii in 2001,[4] Rio de Janeiro of
Brazil in 2002,[5] Texas[6] and Singapore[7] in 2005, India[8]
and Pakistan[9] in 2006, Paraguay in 2007,[10] Cairns in the
Queensland state of Australia in 2008,[11] Bolivia[12] and
Argentina[13] in 2009, Florida[14] in 2010, Latin America[15]
in 2012 and Brazil[16] in 2013. As far as India is concerned
the dengue fever cases reporting from all states of the
country such as Rajasthan,[17] Punjab,[18] Uttar Pradesh,[19]
Madhya Pradesh,[20] Maharashtra,[21] Andhra Pradesh,[22]
West Bengal,[23] Assam and Nagaland,[24] Karnataka,[25]
Tamil Nadu,[26] and Kerala.[27]
In the present study 341 confirmed dengue cases were
reported at the medical college hospital during the time
period. Out of 341 cases, 4 deaths reported with a case
fatality rate of 1.17%; it is 0.97% in males and 1.49%
in females. The case fatality rate of dengue fever in
the present study is higher than in Jakarta[28] (0.04%)
and West Bengal[29] (0.54%) and less than a study
conducted (1.5%) in India[29] and 3.2% of other South
Indian study in 2005.[30] In the present study, case
fatality rate of classical dengue fever is 0.90% and
the dengue hemorrhagic fever is 12.5%. Dengue
hemorrhagic fever reports high case fatality rate in the
study area compared to the other regions, 0.76% in
Jakarta,[28] 1.4% in Indonesia, 2.8% in West Java and
8.5% in West Bengal.[29]
Studies show that dengue fever report more in adult
age group (>20 years) compared to the low age
group (<20 years). In the present study also dengue
fever is higher in adult age groups (>20 years) than the
low age groups (<20 years) in both males and females.
A study conducted by Chia-Hsien Lin et al. in Taiwan[31]
reports that dengue fever is higher in adult age groups
compared to lower age groups. Another study conducted
by Adriana et al. in Brazil[32] also reveals that adult age
group shows the predominance in dengue fever. Studies
conducted by Ooi et al.,[33] and Yew et al. in Singapore,[34]
Anker et al. in six Asian countries,[35] Qureshi et al.
in Pakistan,[36] Lin et al. in Taiwan[37] also proves the
same. Study reports from England, Wales and Northern
Island[35] also support this fact in their studies as dengue
fever reports higher in the adult population (>20 years).
This predominance of adults may be due to involvement
of adult groups in outdoor works compared to low
age group as they have the more chances of exposing
infected mosquitoes than the low age groups.

In the present study, the proportion of male cases is

higher than the female cases. In males, it is 60.70%
Figure 1: Trend of case fatality of dengue fever in males and females from
and in females it is 39.29% of total dengue fever cases.
2005 to 2010 A study conducted by Eong[38] in Singapore supports

Table 1: Case infection of dengue fever: Age and sex wise distribution
Age Sex
(years) Male Female
Classical Dengue Total Classical Dengue Total (%)
dengue fever haemorrhagic fever dengue fever haemorrhagic fever
<20 52 2 54 (26%) 27 1 28 (20.89)
20-39 82 5 87 (42.02%) 37 0 37 (27.61)
40-59 57 0 57 (27.5%) 55 0 55 (41.04)
60-79 8 0 8 (3.86%) 11 0 11 (8.20)
80 and above 1 0 1 (0.48%) 3 0 3 (2.23)
Total 200 7 207 133 1 134

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Antony and Celine: A study on dengue fever in a tertiary care and teaching hospital
that proportion of males was higher than females
in their study. Ruel Perez[39] also support that in his
study in Manila, Philippines, males are more prone to
dengue fever than females. But a South American study
conducted by Kaplan et al.[40] reports in their study
that more cases were in females compared to males.
Study reports from Asian countries such as Cambodia,
Malaysia, Sri Lanka, Singapore and Philippines[35] and
India[41] reveal the high preponderance of males in
dengue fever and pointing out the fact that it may be due
to the outdoor work habit of men compared to females.
A majority of the studies points out the fact that males
have more outdoor work habits compared to females.
They are more exposed to the mosquito bite during
their day time work or while travelling to the work site
in the early morning or returning from the work site in
the late evening. Study reports from Pakistan by Qureshi
et al.,[36] an Indian study by Vijayakumar et al.,[42] and
Thailand study by Tharava et al.[43] uniformly support
that the male preponderance in the dengue fever and
it is mainly due to the outdoor work nature of males
compared to females. So the high number of infected
dengue cases in adult age groups and in males is strongly
indicating the involvement of work component in this
infection because children and women are spending
much time in indoors and less exposed to the vectors of
dengue infection.[44] Thus, more infection in the adult age
groups and males compared to the low age groups and
females in the present study highlights the possibility
of occupational exposure of the dengue infection. While
dengue fever vectors show much outdoor habitats, the
people work in the outdoors are high risk groups and
much emphasize to be given for personal prophylaxis
and also for source reduction activities to control the
breeding and multiplication of Aedes mosquitoes.
CONCLUSION
As the prevention of dengue fever lacks proper vaccine,
the main preventive strategy is the awareness building in
the community regarding the source reduction process
by emptying the man made containers or dispose those
in a systematic or in a proper way. Much efforts to be
taken to promote the participation of the community in
the action program for eliminating vector-breeding sites.
REFERENCE
1. Chen LH, Wilson ME. Dengue and chikungunya infections in
travelers. Curr Opin Infect Dis 2010;23:438-44.
2. Global strategy for dengue prevention and control. Geneva: World
Health Organization; 2012. p. 16-7.
Sahel Medical Journal / July-September 2014 / Vol 17 | Issue 3
3. Rahman M, Rahman M, Rahman K, Siddque AK, Shoma S,
Kamal AH, et al. First outbreak of dengue hemorrhagic fever,
Bangladesh. Emerg Infect Dis 2002;8:738-40.
4. Smith CE, Tom T, Sasaki J, Ayers T, Effler PV. Dengue risk
among visitors to Hawaii during an outbreak. Emerg Infect Dis
2005;11:750-6.
5. Oliveira MF, Galvao Araujo JM, Ferreira OC Jr, Ferreira DF, Lima DB,
et al. Two Lineales of Dengue virus type 2, Brazil. Emerg Infect Dis
2010;16:576-8.
6. Adalja AA, Sell TK, Bouri N, Franco C. Lessons learned during
dengue outbreaks in the United States, 2001-2011. Emerg Infect
Dis 2012;18:608-14.
7. Koh BK, Ng LC, Kita Y, Tang CS, Ang LW, Wong KY, et al. The
2005 dengue epidemic in Singapore: Epidemiology, prevention and
control. Ann Acad Med Singapore 2008;37:538-45.
8. Sinha N, Gupta N, Jhamb R, Gulati S, Kulkarni Ajit V. The 2006
dengue outbreak in Delhi, India. J Commun Dis 2008;40:243-8.
9. Khan E, Siddiqui J, Shakoor S, Mehraj V, Jamil B, Hasan R. Out
break in Karachi, Pakisthan, 2006: Experience at a tertiary care
centre. Trans R Soc Trop Med Hyg 2007;101:1114-9.
10. Kim Knowlton, Gina soloman, Miriam Rotkin- Ellman. Fever
pitch, Mosquito –Borne dengue fever threat spreading in the
Americas-NRDC Issue paper July 2009.
11. Dengue outbreak cases increase rapidly in Cairns. Media release
12th December, 2008, Queensland health.
12. ‘Dengue fever worsens in Bolivia’ BBC 2009-02-26. Archieved from
the original on 1st March, 2009.
13. Bernardini Zambrini DA. Neglected lessons from the 2009 dengue
epidemic in Argentina. Rev Saude Publica 2011;45:428-31.
14. Radke EG, Gregory CJ, Kintziger KW, Sauber-Schatz EK,
Hunsperger EA, Gallagher GR, et al. Dengue outbreak in Key West,
Florida, USA, 2009. Emerg Infect Dis 202;18:135-7.
15. Hoen AG, Keller M, Verma AD, Buckeridge DL, Brownstein JS.
Brownstein. Electronic Event-based surveillance for monitoring
dengue, Latin America. Emerg Infect Dis 2012;18:1147-50.
16. Brazilian city declares Health emerging due to Dengue fever outbreak.
Kaiser Dailey Global Health Policy Report, January 23, 2013.
17. Dengue cases on the rise in Rajasthan, Hindusthan Times; Accessed
9th October, 2006.www.thefullwiki.org/2006_dengue_outbreak_in_
india.
18. Kaur H, Prabhakar H, Mathew P, Marshalla R, Arya M. Dengue
haemorrhagic fever out break in October- November 1996 in
Ludhiana, Punjab, India. Indian J Med Res 1997;106:1-3.
19. More dengue Chikungunya cases reported, NDTV, Webversion,
Accessed 9th October, 2006.wpedia.goo.ne.jp/enwiki/2006_dengue_
outbreak_in_india.
20. Rodrigues FM, Pavri KM, Dandawate CN, Banerjee K, Bhatt PN. An
investigation of the aetiology of the 1996 Out break of febrile illness
in Jabalpur, Madhyapradesh. Indian J med Res 1973;61:1462-70.
21. Shah I, Deshpande GC, Tardeja PN. Outbreak of dengue in Mumbai
and predictive markers for dengue shock syndrome. J Trop Paediatr
2004;50:301-5.
22. Krishnamurthy K, Kasturi TE, Chittipantulu G. Clinical and
Pathological Studies of an oubreak of dengue like illness in
Visakhapatnam. Indian J Med Res 1965;53:800-12.
23. Mukherjee KK, Chakravarti SK, Dey PN, Dey S, Chakraborthy MS.
Out break of febrile illness due to dengue virus type 3 in Calcutta
during 1983. Trans R Soc Trop Med Hyg 1987;81:1008-10.
24. Barua HC, Mahanta J. Serological evidence of Den-2 activity in
Assam and Nagaland. J Communi Dis 1996;28:56-8.
25. Padbidri VS, Adhikari P, Thakre JP, Ilkal MA, Joshi GD, Pereira P,
et al. The 1993 epidemic of dengue fever in Mangalore Karnataka
State, India. Southeast Asian J Trop Med Public Health
1995;26:699-704.
85
[Downloaded free from http://www.smjonline.org on Wednesday, September 28, 2016, IP: 158.181.64.173]
Antony and Celine: A study on dengue fever in a tertiary care and teaching hospital
26. Paramasivan R, Dhananjeyan KJ, Leo SV, Muniaraj M, Thenmozhi V,
Rajendran R, et al. Dengue fever caused by dengue virus
serotype-3 (Subtype-111) in a rural area of Mudurai district,
Tamilnadu. Indian J Med Res 2010;132:339-42.
27. Anoop M, Issac A, Mathew T, Philip S, Kareem NA, Unnikrishnan R,
et al. Genetic characterization of dengue virus serotypes causing
concurrent infection in an outbreak in Ernakulam, Kerala, South
India. Indian J Exp Biol 2010;48:849-57.
28. Sungkars, Sari Fadli, Sukmaningsih A. Trend of Dengue Hemorrhagic
fever in North Jakarta. J Indonesian Med Assoc 2011;61: 394-9.
29. Suman Kanungo Ananda Amarasingh, Dipika Sur, Byomkesh Manna,
Shyamalendu Chatterjee, Provash Sadhukhan, Shanta Dutta, Mark E
Beatty, Sekhar Chakrabarty. Surveillance for dengue fever in eastern
Kolkata, West Bengal, India: preliminary results. International meeting
on emerging diseases and surveillance, Abstract presented at IMED
Vienna, Austria. Feb 13-16, 2009. Abstract no: 18.037, p. 148.
30. Rachel Daniel, Rajamohanan and Aby Zachariah Philip. A Study
of clinical profile of Dengue fever in Kollam, Kerala, India. Dengue
Bulletin 2005; 29:197-202.
31. Lin CH, Schiøler KL, Jepsen MR, Ho CK, Li SH, Konradsen F. Dengue
outbreaks in high income area, Kaohsiung city, Taiwan, 2003-2009.
Emerg Infect Dis 2012;18:1063-11.
32. Guilarde AO1, Turchi MD, Siqueira JB Jr, Feres VC, Rocha B,
Levi JE, et al. Dengue and Dengue Haemorrhagic Fever among
adults. Clinical outcomes related to Viremia, Serotypes and Antibody
response. J Infect Dis 2008;197:817-24.
33. Ooi EE, Goh KT, Gubler DJ. Dengue prevention and 35 year of
vector control in Singapore. Emerg infect Dis 2006;12:887-93.
34. Yew YW, Ye T, Ang LW, Ng LC, Yap G, James L, et al.
Sero-epidemiology of dengue virus infection among adults in
Singapore. Ann Acad Med 2009;38:667-75.
35. Anker M, Arima Y. Male female difference in the number of reported
incident dengue fever cases in Six Asian countries. Western Pac
Surveill Response J 2011;2:17-23.
86 Sahel Medical Journal / July-September 2014 / Vol 17 | Issue 3
36. Qureshi JA, Notta NJ, Salabuddin N, Zaman V, Khan JA. An Epidemic
of Dengue fever in Karachi: Associated clinical manifestations. J Pak
Med Assoc 1997;47:178-81.
37. Lin CC, Huang YH, Shu PY, Wu HS, Lin YS, Yeh TM, et al.
Characteristics of dengue disease in Taiwan 2002-2007. Am J Trop
Med Hyg 2010;82:731-9.
38. Eong OE. Changing pattern of dengue transmission in Singapore.
Dengue Bull 2001;25:40-44. Available from: http://209.61.208.233/
Linkfiles/dengue_bulletin__volume_25_ch7.pdf [Last accessed on
2013 Jan 13].
39. Ruel Perex. Males more prone to dengue than females-DOH. Inquirer
news. inquirer.net September 6th, 2011.
40. Kaplan JE, Eliason DA, Moore M, Sather GE, Schonberger LB,
Cabrera-Coello L, et al. Epidemiologic investigations of dengue
infection in Mexico, 1980. Am J Epidemol 1983;117;335-43.
41. Agarwal R, Kapoor S, Nagar R, Misra A, Tandon R, Mathur A, et al.
A Clinical study of the patients with denue hemorrhagic fever during
the epidemic of 1996 at Lucknow, India. Southeast Asian J Trop Med
Public Health 1999;30:735-40.
42. Vijayakumar TS, Chandy S, Satish N, Abraham M, Abraham P,
Sridhavan G. Is dengue emerging as a major public health problem?
Indian J Med Res 2005;121:100-7.
43. Thavara U, Tawatsin A, Chansang C, Kong-ngamsuk W,
Paosriwong S, Boon-Long J, et al. Larval occurance ovi position
behaviour and biting activity of potential mosquito vectors of dengue
on Samui Island, Thailand. J Vector Eco 2001;26:172-80.
44. Goh KT, Ng SK, Chan YC, Lim SJ, Chua EC. Epidemiological
aspects of an outbreak of dengue fever/dengue haemorrhagic
fever in Singapore. Southeast Asian J Trop Med Public Health
1987;18:295-302.
Cite this article as: Antony J, Celine TM. A descriptive study on dengue fever
reported in a Medical College Hospital. Sahel Med J 2014;17:83-6.
Source of Support: Nil. Conflict of Interest: None declared.