Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; National Mosquito-Borne Diseases Control Research Center, National Health Research Institutes, Miaoli County, Taiwan.
J Microbiol Immunol Infect. 2024 Oct;57(5):730-738. doi: 10.1016/j.jmii.2024.07.004. Epub 2024 Jul 11.
Dengue poses a significant public health concern. Secondary dengue infections with different dengue virus (DENV) serotypes have been linked to an increased risk of severe dengue. This study aimed to assess the risk of severe dengue during secondary infection in Taiwan.
A retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database to identify dengue cases with secondary dengue infection born after 1944 from 2014 to 2015. Ten matched patients with primary infection were selected as controls using propensity score matching for each secondary dengue infection case. The odds ratio (OR) for severe dengue in secondary versus primary infections was calculated using conditional logistic regression.
This study included 357 cases with secondary dengue infection and 3570 matched controls. The risk of severe dengue was found to be 7.8% in individuals with secondary infection, compared to 3.8% in those with primary dengue infection. Secondary infection significantly increased the risk of severe dengue (OR 2.13, 95% CI: 1.40-3.25, P = 0.0004). Notably, a significant association between secondary infection and severe dengue was observed only when the interval between the first and secondary infection was greater than two years (OR 3.19, 95% CI 2.04-5.00, P < 0.0001).
Secondary dengue infection significantly increases the risk of severe disease in Taiwan, particularly when the interval between infections is over two years. Healthcare professionals should maintain heightened vigilance for individuals with a history of previous dengue infection, particularly if their initial diagnosis was more than two years prior.
登革热是一个重大的公共卫生问题。不同登革热病毒（DENV）血清型的二次登革热感染与重症登革热风险增加有关。本研究旨在评估台湾二次登革热感染的重症登革热风险。
使用台湾全民健康保险研究数据库进行回顾性队列研究，确定 1944 年后出生于 2014 年至 2015 年的二次登革热感染病例。为每个二次登革热感染病例选择 10 名匹配的初次感染患者作为对照，使用倾向评分匹配。使用条件逻辑回归计算二次感染与初次感染相比重症登革热的比值比（OR）。
本研究共纳入 357 例二次登革热感染病例和 3570 例匹配对照。二次感染患者发生重症登革热的风险为 7.8%，而初次感染患者为 3.8%。二次感染显著增加了重症登革热的风险（OR 2.13，95%CI：1.40-3.25，P=0.0004）。值得注意的是，仅当第一次和第二次感染之间的间隔大于两年时，二次感染与重症登革热之间存在显著关联（OR 3.19，95%CI 2.04-5.00，P<0.0001）。
在台湾，二次登革热感染显著增加了重症疾病的风险，特别是当两次感染之间的间隔超过两年时。医疗保健专业人员应高度警惕有既往登革热感染史的个体，特别是如果他们的初次诊断是在两年多以前。
