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Assessing the burden of dengue among household members in Alaminos, Laguna, the Philippines: a prospective cohort study

Maria Rosario Capeding
Maria Rosario Capeding
, 
Melanie de Boer
Melanie de Boer
, 
Silvia Damaso
Silvia Damaso
 et 
Adrienne Guignard
Adrienne Guignard
   | 29 oct. 2021
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Article Category: Original article
Publié en ligne: 29 oct. 2021
Pages: 213 - 222
DOI: https://doi.org/10.2478/abm-2021-0027
Mots clés
© 2021 GlaxoSmithKline Biologicals SA, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1

Schematic representation of the study design. *Blood samples were collected at Visit 2, but not analyzed due to early study termination. **Body temperature ≥ 38.0 °C within the past 8 days lasting from 36–48 h to 7 days, potentially accompanied by other signs of dengue that by the study investigator’s opinion could only be related to dengue; †SDCs confirmed by RT-qPCR or NS1. 1. Detailed clinical examination assessing the participant’s general condition, cardiac and respiratory rates, blood pressure, dengue-associated clinical signs, and symptoms. 2a. Used for ELISA to detect anti-DENV indirect IgG. 2b. Used for i. DENV RT-qPCR, ii. DENV isolation for sequencing purposes, iii. DENV sequence, iv. DENV NS1 rapid test (ICT) or ELISA, v. IgM/IgG rapid test (ICT) or SD Bioline Dengue Duo (dengue NS1 antigen and IgG/IgM). 3. Participants were advised to contact study investigators to report any sign or symptom they perceived as an SAE. All SAEs related to study procedures (blood collection) were recorded and evaluated by the study investigator along with related signs, symptoms, and relevant clinical information. 4. A. Warning signs. At least one of the following should be present: abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, liver enlargement, increase in hematocrit concurrent with a rapid decrease in platelet count, lethargy, restlessness. B. Criteria for severe dengue. Dengue with at least one of the following: severe plasma leakage leading to shock, fluid accumulation with respiratory distress, severe bleeding, severe organ involvement, failure of heart and other organs. DENV, dengue virus; ELISA, enzyme-linked immunosorbent assay; ICT, immunochromatographic assay; IgG, immunoglobulin G; IgM, immunoglobulin M; NS1, nonstructural protein 1; RT-qPCR, reverse-transcriptase quantitative polymerase chain reaction; SAE, serious adverse event; SDC, suspected dengue case.
Schematic representation of the study design. *Blood samples were collected at Visit 2, but not analyzed due to early study termination. **Body temperature ≥ 38.0 °C within the past 8 days lasting from 36–48 h to 7 days, potentially accompanied by other signs of dengue that by the study investigator’s opinion could only be related to dengue; †SDCs confirmed by RT-qPCR or NS1. 1. Detailed clinical examination assessing the participant’s general condition, cardiac and respiratory rates, blood pressure, dengue-associated clinical signs, and symptoms. 2a. Used for ELISA to detect anti-DENV indirect IgG. 2b. Used for i. DENV RT-qPCR, ii. DENV isolation for sequencing purposes, iii. DENV sequence, iv. DENV NS1 rapid test (ICT) or ELISA, v. IgM/IgG rapid test (ICT) or SD Bioline Dengue Duo (dengue NS1 antigen and IgG/IgM). 3. Participants were advised to contact study investigators to report any sign or symptom they perceived as an SAE. All SAEs related to study procedures (blood collection) were recorded and evaluated by the study investigator along with related signs, symptoms, and relevant clinical information. 4. A. Warning signs. At least one of the following should be present: abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, liver enlargement, increase in hematocrit concurrent with a rapid decrease in platelet count, lethargy, restlessness. B. Criteria for severe dengue. Dengue with at least one of the following: severe plasma leakage leading to shock, fluid accumulation with respiratory distress, severe bleeding, severe organ involvement, failure of heart and other organs. DENV, dengue virus; ELISA, enzyme-linked immunosorbent assay; ICT, immunochromatographic assay; IgG, immunoglobulin G; IgM, immunoglobulin M; NS1, nonstructural protein 1; RT-qPCR, reverse-transcriptase quantitative polymerase chain reaction; SAE, serious adverse event; SDC, suspected dengue case.

Figure 2

SDCs. *SDCs confirmed by RT-qPCR or NS1. To be classified with a SDC a study participant should have a body temperature of ≥38.0 °C within the past 8 days lasting from 36–48 h to 7 days, potentially accompanied by other signs of dengue that by the study investigator’s opinion could only be related to dengue; †SDCs not classified as confirmed virologically or probable. Warning signs. At least one of the following should be present: abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, liver enlargement, increase in hematocrit concurrent with a rapid decrease in platelet count, lethargy, restlessness. Criteria for severe dengue. Dengue with at least one of the following: severe plasma leakage leading to shock, fluid accumulation with respiratory distress, severe bleeding, severe organ involvement, failure of heart and other organs. DENV, dengue virus; ELISA, enzyme-linked immunosorbent assay; ICT, immunochromatographic assay; IgG, immunoglobulin G; IgM, immunoglobulin M; na, not available; NS1, nonstructural protein 1; RT-qPCR, reverse-transcriptase quantitative polymerase chain reaction; SDC, suspected dengue case.
SDCs. *SDCs confirmed by RT-qPCR or NS1. To be classified with a SDC a study participant should have a body temperature of ≥38.0 °C within the past 8 days lasting from 36–48 h to 7 days, potentially accompanied by other signs of dengue that by the study investigator’s opinion could only be related to dengue; †SDCs not classified as confirmed virologically or probable. Warning signs. At least one of the following should be present: abdominal pain or tenderness, persistent vomiting, clinical fluid accumulation, mucosal bleeding, liver enlargement, increase in hematocrit concurrent with a rapid decrease in platelet count, lethargy, restlessness. Criteria for severe dengue. Dengue with at least one of the following: severe plasma leakage leading to shock, fluid accumulation with respiratory distress, severe bleeding, severe organ involvement, failure of heart and other organs. DENV, dengue virus; ELISA, enzyme-linked immunosorbent assay; ICT, immunochromatographic assay; IgG, immunoglobulin G; IgM, immunoglobulin M; na, not available; NS1, nonstructural protein 1; RT-qPCR, reverse-transcriptase quantitative polymerase chain reaction; SDC, suspected dengue case.

Figure 3

Plain language summary.
Plain language summary.

Clinical evaluation of patients with cases of dengue confirmed virologically and other SDCs

Clinical symptoms Virologically confirmed dengue cases* n = 4 Other SDC† n = 5 Total n = 9
At first visit for SDC
Axillary body temperature, n (°C)
  <38.0 2 5 7
  ≥38.0 2 0 2
Symptoms recorded during the SDC episode, n
Lasting fever‡ 4 5 9
Cough 2 3 5
Headache 2 2 4
Nausea or vomiting 1 2 3
Abdominal pain 2 0 2
Nasal congestion 0 2 2
Retroorbital pain (eye pain) 1 0 1
Sore throat 1 0 1
Petechia 1 0 1
Other 3 2 5

Proportion of DENV IgG+ participants by ELISA at Visit 1

n Positive dengue (%) Estimated GEE (%)* 95%CI†
Overall 494 377 (76.3) 76.2 71.9–80.0
Age group
  6 months to <12 months1 12 1 (8.3) 8.3 1.2–41.3
  12 months–4 years 74 23 (31.1) 31.2 21.7–42.7
  5–8 years 85 44 (51.8) 51.5 40.8–62.0
  9–17 years 173 160 (92.5) 92.0 86.4–95.4
  18–50 years 150 149 (99.3) 99.3 95.4–99.99

Sociodemographic characteristics of the participants

Characteristics N = 500
Households, number 352
Sex, female, n (%) 272 (54.4)
Age (years)
  Mean (SD) 15.6 (12.6)
  Median 12.0
  Range 0.5–50
Age groups, n (%)
  6 months to <12 months 12 (2.4)
  12 months–4 years 75 (15.0)
  5–8 years 88 (17.6)
  9–17 years 175 (35.0)
  18–50 years 150 (30.0)
Number of participants enrolled per household, n′ (%)
  1 204 (58.0)
  2 148 (42.0)
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