2018 - 2019年美洲疫情激增期间牙买加住院儿童登革热的严重程度及预后
Severity and Outcomes of Dengue in Hospitalized Jamaican Children in 2018-2019 During an Epidemic Surge in the Americas.
作者信息
Lue Aileen May, Richards-Dawson Michelle-Ann Elizabeth Hue, Gordon-Strachan Georgiana Marie, Kodilinye Syed Matthew, Dunkley-Thompson Jacqueline Anne Theresa, James-Powell Tracia Dahlia, Pryce Curtis Alphonso, Mears Chadwic De'sean, Anzinger Joshua James, Webster-Kerr Karen, Christie Celia Dana Claire
机构信息
Bustamante Hospital for Children, Kingston, Jamaica.
Pediatric Residency Program, University of the West Indies, Kingston, Jamaica.
出版信息
Front Med (Lausanne). 2022 Jun 21;9:889998. doi: 10.3389/fmed.2022.889998. eCollection 2022.
OBJECTIVE
In 2019, dengue was among the "top-ten threats to global health," with 3.1 million cases reported from the Americas, the highest ever. Simultaneously, Jamaica reported its largest dengue outbreak in 40 years, following Chikungunya and Zika virus epidemics, in 2014 and 2016-2017, respectively. We describe dengue in children admitted to five hospitals in Jamaica during August 2018 through September 2019.
METHODS
Hospitalized children and adolescents aged 0 to 15 years with dengue were managed using PAHO/WHO criteria. Data were extracted from questionnaires, entered into a dataset on Microsoft Excel version 2016, exported to SPSS version 20 and analyzed. Groups were compared using Student's -test for normally distributed parametric data. Chi-square analysis, or Fisher's exact test was used for categorical variables. A value < 0.05 was considered statistically significant.
RESULTS
There were 339 children, 245 (72.3%) aged 1-10 years, males:females 1:1. Classification was "dengue without warning signs" 53 (15.3%), "dengue with warning signs" 218 (64.3%) and "severe dengue" 68 (20%). Co-morbidities were reported in 88 (26%). Hemoglobin SC disease was associated with severe dengue with hemorrhage ( = 0.005). Organ-system involvement occurred in 334 (98.5%) including gastrointestinal 317 (93.5%), hematologic 311 (91.7%) and musculoskeletal 180 (53.1%). Thirty-nine (11.5%) had 5-7 organ-systems involved. Metabolomics emphasized increased hepatic transaminases 245 (72.3%), lactate dehydrogenase 164 (48.4%) and creatine phosphokinase 84 (24.8%) approaching the high thousands (121,560 u/L), both were markers for severe disease ( < 0.002). Thirteen (3.8%) received intensive care. Dengue was laboratory-confirmed in 220 (78.9%): NS1 antigen-positive (218); RT-PCR-positive (23), with an overlap of NS1 antigen and RT-PCR positive (21); DENV-3 serotype (20). Seventeen (5%) died, 16 (94.1%) had severe dengue and 11 (64.7%) succumbed within 24 to 48 h of admission despite resuscitation and transfusion of blood products.
CONCLUSION
Severe dengue with increased attributable mortality occurred in hospitalized children after Jamaica's maiden Zika epidemic.
目的
2019年，登革热位列“全球健康十大威胁”之中，美洲地区报告了310万例病例，为有史以来最高纪录。与此同时，牙买加分别在2014年和2016 - 2017年经历基孔肯雅热和寨卡病毒疫情后，于2019年报告了其40年来最大规模的登革热疫情。我们描述了2018年8月至2019年9月期间在牙买加五家医院住院的儿童登革热情况。
方法
对0至15岁患登革热的住院儿童和青少年按照泛美卫生组织/世界卫生组织标准进行管理。数据从问卷中提取，录入2016版Microsoft Excel数据集，导出至SPSS 20版并进行分析。对于正态分布的参数数据，使用学生t检验比较各组。对于分类变量，使用卡方分析或费舍尔精确检验。P值<0.05被认为具有统计学意义。
结果
共有339名儿童，其中245名（72.3%）年龄在1至10岁，男女性别比为1:1。分类为“无警示体征的登革热”53例（15.3%），“有警示体征的登革热”218例（64.3%），“重症登革热”68例（20%）。88例（26%）报告有合并症。血红蛋白SC病与伴有出血的重症登革热相关（P = 0.005）。334例（98.5%）出现器官系统受累，包括胃肠道317例（93.5%）、血液系统311例（91.7%）和肌肉骨骼系统180例（53.1%）。39例（11.5%）涉及5至7个器官系统。代谢组学显示肝转氨酶升高245例（72.3%）、乳酸脱氢酶升高164例（48.4%）和肌酸磷酸激酶升高84例（24.8%），数值接近数千（高达121560 U/L），两者均为重症疾病的标志物（P < 0.002）。13例（3.8%）接受了重症监护。220例（78.9%）登革热经实验室确诊：NS1抗原阳性（218例）；逆转录聚合酶链反应（RT-PCR）阳性（23例），NS1抗原和RT-PCR均阳性（21例）；登革病毒3型（20例）。17例（5%）死亡，16例（94.1%）为重症登革热，11例（64.7%）在入院后24至48小时内尽管接受了复苏和输血制品仍死亡。
结论
牙买加首次出现寨卡疫情后，住院儿童中出现了重症登革热且归因死亡率增加。
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