Guo Congcong, Zhou Zixing, Wen Zihao, Liu Yumei, Zeng Chengli, Xiao Di, Ou Meiling, Han Yajing, Huang Shiqi, Liu Dandan, Ye Xiaohong, Zou Xiaoqian, Wu Jing, Wang Huanyu, Zeng Eddy Y, Jing Chunxia, Yang Guang
Department of Epidemiology, School of Medicine, Jinan UniversityGuangzhou, China.
Department of Parasitology, School of Medicine, Jinan UniversityGuangzhou, China.
Front Cell Infect Microbiol. 2017 Jul 12;7:317. doi: 10.3389/fcimb.2017.00317. eCollection 2017.
Dengue is an arthropod-borne infectious disease caused by dengue virus (DENV) infection and transmitted by mosquitoes. Approximately 50-100 million people are infected with DENV each year, resulting in a high economic burden on both governments and individuals. Here, we conducted a systematic review and meta-analysis to summarize information regarding the epidemiology, clinical characteristics, and serotype distribution and risk factors for global dengue outbreaks occurring from 1990 to 2015. We searched the PubMed, Embase and Web of Science databases through December 2016 using the term "dengue outbreak." In total, 3,853 studies were identified, of which 243 studies describing 262 dengue outbreaks met our inclusion criteria. The majority of outbreak-associated dengue cases were reported in the Western Pacific Region, particularly after the year 2010; these cases were primarily identified in China, Singapore and Malaysia. The pooled mean age of dengue-infected individuals was 30.1 years; of the included patients, 54.5% were male, 23.2% had DHF, 62.0% had secondary infections, and 1.3% died. The mean age of dengue patients reported after 2010 was older than that of patients reported before 2010 (34.0 vs. 27.2 years); however, the proportions of patients who had DHF, had secondary infections and died significantly decreased after 2010. Fever, malaise, headache, and asthenia were the most frequently reported clinical symptoms and signs among dengue patients. In addition, among the identified clinical symptoms and signs, positive tourniquet test ( = 4.86), ascites ( = 13.91) and shock ( = 308.09) were identified as the best predictors of dengue infection, DHF and mortality, respectively (both < 0.05). The main risk factors for dengue infection, DHF and mortality were living with uncovered water container ( = 1.65), suffering from hypotension ( = 6.18) and suffering from diabetes mellitus ( = 2.53), respectively (all < 0.05). The serotype distribution varied with time and across WHO regions. Overall, co-infections were reported in 47.7% of the evaluated outbreaks, and the highest pooled mortality rate (2.0%) was identified in DENV-2 dominated outbreaks. Our study emphasizes the necessity of implementing programs focused on targeted prevention, early identification, and effective treatment.
登革热是一种由登革病毒（DENV）感染引起、通过蚊子传播的节肢动物传播性传染病。每年约有5000万至1亿人感染登革病毒，给政府和个人都带来了沉重的经济负担。在此，我们进行了一项系统综述和荟萃分析，以总结1990年至2015年全球登革热疫情的流行病学、临床特征、血清型分布及危险因素等信息。我们使用“登革热疫情”这一术语，在截至2016年12月的PubMed、Embase和科学网数据库中进行检索。总共识别出3853项研究，其中243项描述了262次登革热疫情的研究符合我们的纳入标准。与疫情相关的登革热病例大多报告于西太平洋地区，尤其是2010年之后；这些病例主要在中国、新加坡和马来西亚被识别出来。登革热感染个体的合并平均年龄为30.1岁；纳入的患者中，54.5%为男性，23.2%患有登革出血热（DHF），62.0%有二次感染，1.3%死亡。2010年后报告的登革热患者平均年龄高于2010年前报告的患者（34.0岁对27.2岁）；然而，2010年后患有登革出血热、有二次感染及死亡的患者比例显著下降。发热、不适、头痛和乏力是登革热患者中最常报告的临床症状和体征。此外，在识别出的临床症状和体征中，阳性束臂试验（比值比=4.86）、腹水（比值比=13.91）和休克（比值比=308.09）分别被确定为登革热感染、登革出血热和死亡率的最佳预测指标（均P<0.05）。登革热感染、登革出血热和死亡率的主要危险因素分别是生活在无盖储水容器附近（比值比=1.65）、患有低血压（比值比=6.18）和患有糖尿病（比值比=2.53）（均P<0.05）。血清型分布随时间和世界卫生组织各区域而有所不同。总体而言，在47.7%的评估疫情中报告了共同感染，在以DENV-2为主的疫情中确定了最高的合并死亡率（2.0%）。我们的研究强调了实施侧重于针对性预防、早期识别和有效治疗的项目的必要性。
