Kabilan L, Balasubramanian S, Keshava S M, Satyanarayana K
Centre for Research in Medical Entomology, Indian Council of Medical Research, Chennai, India.
Indian J Pediatr. 2005 Nov;72(11):919-23. doi: 10.1007/BF02731664.
Dengue is emerging as a serious public health problem in Tamil Nadu. The present surveillance system is unlikely to generate proper information on the epidemiology of the disease, which is essential for planning and development of relevant control/preventive measures against dengue.
Between November 2001 and January 2002, a descriptive study was undertaken on children with clinical dengue attending Kanchi Kamakoti Child Trust Hospital (KKCTH, a major private referral pediatric hospital in Tamil Nadu, India) to define the magnitude of dengue burden, the natural history of this disease in terms of clinical presentation, and outcome of the infections in hospitalized children (< 15) with clinical dengue.
The sera collected from patients analyzed for dengue specific IgM and IgG antibodies by IgM, IgG antibody capture enzyme linked immunosorbent assay (ELISA) using alternatively two commercial kits. World Health Organization clinical case definition was adopted to categorize the dengue confirmed children.
Dengue was diagnosed in 74.5% (143) of the 192 hospitalized children with clinical dengue. A considerable proportion (20%) of the total dengue infections were constituted by infants less than 1 yr of age. DF [dengue fever], DHF [dengue hemorrhagic fever] and DSS [dengue shock syndrome] were diagnosed in 65%, 11.2% and 23.8% of 143 dengue confirmed patients respectively. Though severe dengue (DSS + DHF) was present in 35% of the patients, the mortality rate was low during the study period due to timely diagnosis and clinical management of the patients.
In developing countries like India, building of laboratory capacity for diagnosis and combat-mode ready preparedness for the management of dengue cases in emergency situation may reduce dengue-related mortality. This can be achieved in a wider scale through an integrated approach through the community, professionals and the public health departments.
登革热在泰米尔纳德邦正成为一个严重的公共卫生问题。目前的监测系统不太可能生成关于该疾病流行病学的恰当信息,而这些信息对于规划和制定针对登革热的相关控制/预防措施至关重要。
2001年11月至2002年1月期间,对在甘地卡玛科蒂儿童信托医院(KKCTH,印度泰米尔纳德邦一家主要的私立转诊儿科医院)就诊的临床诊断为登革热的儿童进行了一项描述性研究,以确定登革热负担的程度、该疾病临床表现方面的自然史以及住院的临床诊断为登革热的儿童(<15岁)感染后的结局。
使用两种商用试剂盒,通过IgM、IgG抗体捕获酶联免疫吸附测定(ELISA)对患者采集的血清进行登革热特异性IgM和IgG抗体分析。采用世界卫生组织临床病例定义对确诊为登革热的儿童进行分类。
192名住院的临床诊断为登革热的儿童中,74.5%(143名)被诊断为登革热。在所有登革热感染病例中,相当大比例(20%)为1岁以下婴儿。在143例确诊为登革热的患者中,分别有65%、11.2%和23.8%被诊断为登革热发热(DF)、登革出血热(DHF)和登革休克综合征(DSS)。尽管35%的患者患有严重登革热(DSS + DHF),但由于对患者的及时诊断和临床管理,研究期间死亡率较低。
在印度这样的发展中国家,建立实验室诊断能力以及为紧急情况下登革热病例的管理做好战斗模式准备,可能会降低登革热相关的死亡率。这可以通过社区、专业人员和公共卫生部门的综合方法在更广泛的范围内实现。