Clinical and Virological Study of Dengue Cases and the Members of Their Households: The Multinational DENFRAME Project
Clinical and Virological Study of Dengue Cases and the Members of Their Households: The Multinational DENFRAME Project
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DOI：
10.1371/journal.pntd.0001482
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发表时间：
2012-01-01
影响因子：
3.8
通讯作者：
da Costa Vasconcelos, Pedro Fernando
中科院分区：
文献类型：
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作者：
Dussart, Philippe;Baril, Laurence;da Costa Vasconcelos, Pedro Fernando
背景：登革热已成为热带地区最重要的媒介传播病毒性疾病。由于经常缺乏实验室确认和对更严重病例的强烈选择偏见，对登革热疾病的负担和严重程度的评估受到阻碍。方法：在东南亚（SEA）和拉丁美洲（LA）进行了一项多国前瞻性临床研究，以确定发热登革热病例家庭中隐性登革热感染的比例，并比较临床数据和生物标志物 患有各种登革热疾病模式的受试者。在急性期，通过病毒分离和基因组检测，实验室确认了登革热感染。四个参与参考实验室使用标准化方法。 主要发现：在 215 名发热登革热受试者中，其中 114 名来自 SEA，101 名来自 LA-28 (13.0%)，根据 WHO 的定义被诊断为严重登革热（仅来自 SEA）。对 177 名发热受试者进行了入户调查。首次家访时，家庭成员中发现 39 例急性登革热感染病例，其中 29 例为隐性感染。另外 62 例登革热病例被分类为早期康复期。因此，408名家庭成员中发现101例登革热感染者。将这些病例与 177 例登革热指数病例相加，研究参与者中登革热感染的总体比例估计为 47.5% (278/585；95% CI 43.5-51.6)。隐性登革热受试者和有症状登革热受试者之间的淋巴细胞计数和 NS1 抗原检测存在显着差异；隐性病例中淋巴细胞计数正常，仅 20% NS1 抗原阳性。原发性登革热感染和特定登革热病毒血清型与有症状的登革热感染无关。结论：家庭调查显示，家庭成员登革热感染阳性的比例很高，包括一些隐性病例，东南亚的登革热感染频率高于洛杉矶。
Background: Dengue has emerged as the most important vector-borne viral disease in tropical areas. Evaluations of the burden and severity of dengue disease have been hindered by the frequent lack of laboratory confirmation and strong selection bias toward more severe cases.Methodology: A multinational, prospective clinical study was carried out in South-East Asia (SEA) and Latin America (LA), to ascertain the proportion of inapparent dengue infections in households of febrile dengue cases, and to compare clinical data and biological markers from subjects with various dengue disease patterns. Dengue infection was laboratory-confirmed during the acute phase, by virus isolation and detection of the genome. The four participating reference laboratories used standardized methods.Principal Findings: Among 215 febrile dengue subjects-114 in SEA and 101 in LA-28 (13.0%) were diagnosed with severe dengue (from SEA only) using the WHO definition. Household investigations were carried out for 177 febrile subjects. Among household members at the time of the first home visit, 39 acute dengue infections were detected of which 29 were inapparent. A further 62 dengue cases were classified at early convalescent phase. Therefore, 101 dengue infections were found among the 408 household members. Adding these together with the 177 Dengue Index Cases, the overall proportion of dengue infections among the study participants was estimated at 47.5% (278/585; 95% CI 43.5-51.6). Lymphocyte counts and detection of the NS1 antigen differed significantly between inapparent and symptomatic dengue subjects; among inapparent cases lymphocyte counts were normal and only 20% were positive for NS1 antigen. Primary dengue infection and a specific dengue virus serotype were not associated with symptomatic dengue infection.Conclusion: Household investigation demonstrated a high proportion of household members positive for dengue infection, including a number of inapparent cases, the frequency of which was higher in SEA than in LA.