Rigau-Pérez José G
Dengue Branch, Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, San Juan, PR, USA.
Lancet Infect Dis. 2006 May;6(5):297-302. doi: 10.1016/S1473-3099(06)70465-0.
Dengue fever imposes a societal burden that is difficult to measure because of the disease's non-specific symptoms and the lack of easily applied case definitions for its more severe manifestations. An efficacy trial of a tetravalent vaccine is expected in the near future, but only one of the severe dengue syndromes-the continuum of dengue haemorrhagic fever and dengue shock syndrome-is well defined. One of the results of the focus on dengue haemorrhagic fever is the false perception of low disease burden in the Americas, which is an obstacle to the mobilisation of political and economic resources to fight the disease. Three improvements are necessary to standardise the dengue haemorrhagic fever definition and to allow it to do well in different populations: (1) redefine the threshold for thrombocytopenia, (2) clarify the standard practice and value of the tourniquet test, and (3) incorporate a criterion to measure intravenous fluid replacement. In addition, for an accurate estimation of dengue burden, locally appropriate definitions of severe dengue must be devised and standardised so they will be considered valid in the global research community.
登革热给社会带来了难以衡量的负担，这是因为该疾病症状不具特异性，且对于其较为严重的表现形式缺乏易于应用的病例定义。预计在不久的将来会进行一项四价疫苗的疗效试验，但只有登革出血热和登革休克综合征这一严重登革热综合征连续体中的一种得到了明确界定。将重点放在登革出血热上的一个后果是在美洲地区对疾病负担产生了错误认知，这成为调动政治和经济资源抗击该疾病的障碍。为了使登革出血热的定义标准化并使其在不同人群中发挥良好作用，需要进行三项改进：（1）重新界定血小板减少症的阈值，（2）明确束臂试验的标准做法和数值，（3）纳入一项衡量静脉补液的标准。此外，为了准确估计登革热负担，必须制定并标准化适用于当地的严重登革热定义，以便在全球研究界被视为有效。
