VARIATIONS IN THE CLINICAL FEATURES OF DENGUE CASES BETWEEN CHILDREN AND ADULTS IN BRUNEI DARUSSALAM.
OTHMAN NN1, HTIKE NL2, CHAW L1.
1PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jalan Tungku Link Gadong, BE1410, Brunei Darussalam.
2Disease Control Division, Public Health Services, Ministry of Health, Brunei Darussalam.
Background: Dengue is a common vector-borne disease in Brunei Darussalam. Early recognition of its signs and symptoms is essential for early detection and treatment. Brunei is currently using both 1997 and 2009 WHO dengue case classifications interchangeably. This study aims to describe and compare the clinical features of laboratory-confirmed cases of dengue between children (<15 years old) and adults in Brunei. Methods: Data on the socio-demographic, clinical symptoms and signs, presence of co-morbidities and duration of hospitalisation for laboratory-confirmed dengue cases was collected from January-December 2015. Incidence rate for dengue cases for 2015 was derived. Chi-square or Fisher’s Exact tests were used to compare differences in clinical variables between children and adults. Results: In 2015, there was a total of 317 laboratory-confirmed dengue cases, giving an incidence rate of 76.9 per 100,000 population. Thirteen cases were excluded due to missing data and the remaining 304, consisting of 35 children (11.5%) and 269 adults (88.5%) were analysed. The median age for the children and adult cases were 10 years (IQR = 6.5) and 39 years (IQR = 25), respectively. There were proportionally more males in both children (54.3%) and adult (61.0%) groups. Higher proportions of hospitalisation were observed for both children (57.5%) and adults (66.2%). The most common clinical features among both children and adults were fever, rash, and vomiting but nausea (p=0.037) and headaches (p=0.042) were significantly more common in adults than children. The leading warning signs reported were thrombocytopenia, raised hematocrit and abdominal pain. The presence of any warning signs were significantly more in adults than in children (p=0.011), particularly thrombocytopenia (p=0.008). The proportion of respiratory symptoms recorded however was significantly more among children than adults (p=0.005), especially cough (p=0.002). Conclusion: There are significant differences in clinical presentation and presence of warning signs between adults and children, with adults more likely to report of headaches and nausea and have thrombocytopenia as a warning signs than children. However, children tend to present more with respiratory symptoms such as cough than adults. These differences in clinical symptoms and signs as well as warning signs could serve as a reference for general practitioners to facilitate early detection and treatment for dengue.
Keywords: Dengue, Children, Adult, Classification, Severe Dengue, Signs and symptoms.
Corresponding author: Liling Chaw, PhD, Lecturer, PAPRSB Institute of Health Science, Universiti Brunei Darussalam, Jalan Tungku Link Gadong, BE1410, Brunei Darussalam.
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Brunei Int Med J. 2020;16:92-99