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Improvement in Hospital Indicators after Changes in Dengue Case Management in Nicaragua

Dengue is a major problem worldwide, and improving case management is a significant priority. In consultation with colleagues in Thailand, changes in management of hospitalized dengue cases were introduced in Nicaragua, including oral rather than intravenous (IV) fluids upon admission, continuous monitoring of clinical and laboratory signs, and use of IV fluids principally during the critical phase and colloids in management of shock. Two periods were compared, before (2003) and after (2005) their implementation, to assess impact. In 2003, 182 hospitalized laboratory-confirmed dengue cases 0–14 years of age who presented 5 days post-symptom onset were included in the study; 46 were enrolled in 2005. Outcomes included significant reductions in days of IV fluid administration ( P = 0.0001), number of patients receiving IV fluids ( P < 0.0001), and duration of hospitalization ( P < 0.0001), and a non-significant reduction in the number of admissions to the intensive care unit from 8 in 2003 to 0 in 2005 ( P = 0.36). This study demonstrates concrete gains in dengue patient care and case management.

Received January 11, 2009. Accepted for publication May 20, 2009.

Acknowledgments: We thank Dr. Javier Silva, Dr. Federico Narvaez, and Andrea Nuñez for their excellent work in this study; the Pediatric Dengue Vaccine Initiative for providing the opportunity for our clinicians to visit colleagues in Bangkok, Thailand, to receive training in dengue case management; Dr. Siripen Kalayanarooj and Dr. Suchitra Nimmannitya (Queen Sirikit National Institute for Child Health) for providing excellent advice and training in management of severe dengue cases; the team of doctors and nurses at the Hospital Infantil Manuel de Jesús Rivera for using the new procedures; the personnel of the National Virology Laboratory of the CNDR for their invaluable work in conducting virologic and serologic samples and performing molecular biological assays; and the participants of the studies and their families.

^* Address correspondence to Eva Harris, Division of Infectious Diseases, School of Public Health, 1 Barker Hall, University of California, Berkeley, CA 94720-7354. E-mails: eharris{at}berkeley.edu or eharris{at}calmail.berkeley.edu

Authors’ addresses: Crisanta Rocha and Sheyla Silva, Hospital Infantil Manuel de Jesús Rivera, Barrio Ariel Darce, Distrito 5, Managua, Nicaragua. Aubree Gordon and Eva Harris, Division of Infectious Diseases, School of Public Health, 1 Barker Hall, University of California, Berkeley, CA 94720-7354. Samantha N. Hammond and Douglas Elizondo, Sustainable Sciences Institute, c/o Centro de Salud Sócrates Flores Vivas, Barrio Monseñor Lezcano, Managua, Nicaragua. Angel Balmaseda, Departamento de Virologia, Centro Nacional de Diagnóstico y Referencia, Ministerio de Salud, Complejo de Salud Dra. Concepcion Palacios, Primero de Mayo, Managua, Nicaragua.