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To investigate age-related differences in dengue severity, 114 infants, 1,211 children, and 346 adults with laboratory-confirmed dengue virus (DEN) infections presenting to three hospitals in major urban centers in Nicaragua were recruited from 1999 to 2001. The age distribution of dengue cases and the circulating serotype (predominantly DEN2) were representative of national data. Similar results were obtained when either dengue hemorrhagic fever/dengue shock syndrome or its principal manifestations (vascular permeability, internal hemorrhage, marked thrombocytopenia, and/or shock) were analyzed in relation to age and immune status. The burden of disease and of severe dengue was found predominantly in infants 4–9 months of age and in children 5–9 years old, and secondary DEN infection was a risk factor for severity in children. Age-related differences were identified in the prevalence of specific clinical manifestations as well as in their association with a confirmed DEN diagnosis. This represents one of the few comprehensive studies to analyze characteristics of dengue in infants, children, and adults in the same population and highlights age-related differences in dengue severity.
Received May 6, 2005. Accepted for publication August 20, 2005.
Acknowledgments: We would like to thank Juan José Amador for his continuous support and Stephen Waterman for editorial comments. This work was supported by grant TW-0095 from the Fogarty International Center (NIH).
These two authors contributed equally to this study.
* Address correspondence to Eva Harris, Division of Infectious Diseases, School of Public Health, 140 Warren Hall, University of California, Berkeley, CA 94720-7360. E-mail: eharris{at}berkeley.edu
Authors’ addresses: Angel Balmaseda, Leonel Pérez, Yolanda Tellez, Saira Indira Saborío, and Juan Carlos Mercado, Departamento de Virología, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Complejo de Salud Dra. Concepcion Palacios, Primero de Mayo, Managua, Nicaragua, Telephone/Fax: 011-505-289-7723. Samantha Nadia Hammond and Eva Harris, Division of Infectious Diseases, School of Public Health, 140 Warren Hall, University of California, Berkeley, CA 94720-7360, Telehone: 510-642-4845, Fax: 510-642-6350. Maria Angeles Pérez, Sheyla Silva, and Crisanta Rocha, Infectious Diseases Unit, Hospital Infantil Manuel de Jesus Rivera, Barrio Ariel Darce, Distrito no. 5, Managua, Nicaragua, Telephone: 011-505-289-7702, Fax: 011-505-289-7408. Ricardo Cuadro and Julio Rocha, Hospital Escuela Dr. Oscar Danilo Rosales Arguello (HEODRA), Iglesia Catedral 1 cuadra al sur, León, Nicaragua., Telephone/Fax: 011-505-311-5939.
Reprint requests: Eva Harris, Division of Infectious Diseases, School of Public Health, University of California, Berkeley, 140 Warren Hall, Berkeley, CA 94720-7360. E-mail: eharris{at}berkeley.edu
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