The 2023 Dengue Outbreak in Bangladesh: Exploring the Epidemiology in Hospitalized Patients

Urby Saraf Anika Public Health and Research, Tropical Disease and Health Research Center, Dhaka, Bangladesh;

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Muna Islam Department of Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh;

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Fatema E Nur Mou Department of Radiology and Imaging, Mugda Medical College Hospital, Dhaka, Bangladesh;

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Mrinal Saha Department of Critical Care Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh;

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Aparna Deb Department of Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh;

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Rubaiya Rahman Tui Department of Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh;

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Joarder Rakeen Manzoor Department of Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh;

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Afroza Jesmin Department of Dermatology and Venerology, Mugda Medical College Hospital, Dhaka, Bangladesh

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Ayesha Martuja Department of Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh;

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Jannatul Fardous Public Health and Research, Tropical Disease and Health Research Center, Dhaka, Bangladesh;

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Mohiuddin Sharif Public Health and Research, Tropical Disease and Health Research Center, Dhaka, Bangladesh;

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Md. Abdur Rafi Public Health and Research, Tropical Disease and Health Research Center, Dhaka, Bangladesh;

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Mohammad Jahid Hasan Public Health and Research, Tropical Disease and Health Research Center, Dhaka, Bangladesh;

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ABSTRACT.

For the past two decades, Bangladesh has faced recurrent dengue outbreaks, with the most recent occurring in 2023. We investigated the socioeconomic, clinical, and laboratory aspects of patients diagnosed with dengue during this outbreak. This observational study was conducted from July to September 2023 at Dhaka Medical College Hospital and Chittagong Medical College Hospital, and included 450 confirmed cases of dengue. Sociodemographic information was collected via face-to-face interviews, clinical examinations, and laboratory testing, which was done within 24 hours of admission. Dengue severity was classified according to the 2009 WHO dengue guidelines. Notably, 17% of patients experienced severe dengue, and 89% of those with nonsevere cases exhibited at least one warning sign. Most patients were young adults (mean age, 33 years), with a nearly equal male-to-female ratio. Common clinical presentations included fever (95%), myalgia (62%), and headache (58%), whereas warning signs such as vomiting (54%) and abdominal pain (39%) were prevalent. Plasma leakage indicators, including ascites, pleural effusion, and edema, were found predominantly in severe cases. Laboratory findings revealed leukopenia, thrombocytopenia, and elevated hepatic enzymes (alanine aminotransferase and aspartate aminotransferase) in nearly half the patients. An elevated hematocrit level was associated with severe dengue. We report that a substantial number of patients developed severe dengue during the epidemic in 2023, and provide detailed clinical–epidemiological profiles of the patients, offering valuable insight into management of dengue cases.

Author Notes

Disclosures: The study protocol was reviewed and approved by the ethical review committee of Dhaka Medical College (ERC-DMC/ECC/2022/423). Informed written consent was obtained from each of the participating patients after informing them of the objectives of the study and their right to remain or opt out of the study if they felt uncomfortable. No human subjects were harmed and the procedures followed were in accordance with the ethical standards and regulations established by the Declaration of Helsinki of the World Medical Association. We used ChatGPT 3.5 for language editing and improved clarity of the manuscript.

Authors’ contributions: M. A. Rafi and M. J. Hasan conceptualized the study. F. E. N. Mou, M. Saha, A. Deb, R. R. Tui, and J. R. Manzoor provided resources. U. S. Anika, M. Islam, F. E. N. Mou, M. Saha, A. Deb, R. R. Tui, J. R. Manzoor, A. Jesmin, A. Martuja, J. Fardous, M. Sharif, M. A. Rafi, and M. J. Hasan conducted the investigation. U. S. Anika, M. Islam, M. A. Rafi, and M. J. Hasa conducted formal analyses. U. S. Anika, M. Islam, F. E. N. Mou, M. Saha, A. Deb, R. R. Tui, J. R. Manzoor, A. Jesmin, A. Martuja, J. Fardous, M. Sharif, M. A. Rafi, and M. J. Hasan created the methodology. A. Jesmin, A. Martuja, J. Fardous, M. Sharif, M. A. Rafi, and M. J. Hasan supervised. F. E. N. Mou, M. Saha, A. Deb, R. R. Tui, J. R. Manzoor, A. Jesmin, A. Martuja, J. Fardous, and M. Sharif wrote the first draft of the manuscript. U. S. Anika, M. Islam, F. E. N. Mou, M. Saha, A. Deb, R. R. Tui, J. R. Manzoor, A. Jesmin, A. Martuja, J. Fardous, M. Sharif, M. A. Rafi, and M. J. Hasan reviewed and edited the final manuscript.

Data availability: Data and other necessary details are available and will be provided upon reasonable request to the corresponding authors.

Authors’ addresses: Urby Saraf Anika, Jannatul Fardous, Mohiuddin Sharif, Md. Abdur Rafi, and Mohammad Jahid Hasan, Public Health and Research, Tropical Disease and Health Research Center, Dhaka, Bangladesh, E-mails: urby.anika@gmail.com, jannatulfardous888@gmail.com, mohiuddinsharif.fmc@gmail.com, abdurrafi007@gmail.com, and jahid.hasan@tdhrc.org. Muna Islam, Aparna Deb, and Ayesha Martuja, Department of Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh, E-mails: drmunaislam@gmail.com, deb.aparna84@gmail.com, and ayeshamartujassmc@gmail.com. Fatema E Nur Mou, Department of Radiology and Imaging, Mugda Medical College Hospital, Dhaka, Bangladesh, E-mail: mou07smu@gmail.com. Mrinal Saha, Department of Critical Care Medicine, Chittagong Medical College Hospital, Chattogram, Bangladesh, E-mail: drmrinalsaha82@gmail.com. Rubaiya Rahman Tui and Joarder Rakeen Manzoor, Department of Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh, E-mails: rubaiya9326@gmail.com and rakeen.1632@gmail.com. Afroza Jesmin, Department of Dermatology and Venerology, Mugda Medical College Hospital, Dhaka, Bangladesh, E-mail: dr.afrozajesmin@gmail.com.

Address correspondence to Mohammad Jahid Hasan or Urby Saraf Anika, Public Health and Research, Tropical Disease and Health Research Center, Dhaka-1205, Bangladesh. E-mail: jahid.hasan@tdhrc.org or urby.anika@gmail.com
  • 1.

    Yang X , Quam MBM , Zhang T , Sang S , 2021. Global burden for dengue and the evolving pattern in the past 30 years. J Travel Med 28: taab146.

  • 2.

    Messina JP et al., 2019. The current and future global distribution and population at risk of dengue. Nat Microbiol 4: 15081515.

  • 3.

    Stanaway JD et al., 2016. The global burden of dengue: An analysis from the Global Burden of Disease Study 2013. Lancet Infect Dis 16: 712723.

  • 4.

    Karim MN , Munshi SU , Anwar N , Alam MS , 2012. Climatic factors influencing dengue cases in Dhaka city: A model for dengue prediction. Indian J Med Res 136: 3239.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Sharmin S , Viennet E , Glass K , Harley D , 2015. The emergence of dengue in Bangladesh: Epidemiology, challenges and future disease risk. Trans R Soc Trop Med Hyg 109: 619627.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Hasan MJ , Tabassum T , Sharif M , Khan MAS , Bipasha AR , Basher A , Islam MR , Amin MR , Gozal D , 2021. Clinico-epidemiologic characteristics of the 2019 dengue outbreak in Bangladesh. Trans R Soc Trop Med Hyg 115: 733740.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Amin MR , Islam MR , Bhuiyan M , Islam MS , Islam F , Tuli HJ , Nawar A , Tabassum T , Fardous J , Hasan MJ , 2022. Sketch of 2018 dengue outbreak in a megacity, Bangladesh. Trop Med Health 50: 80.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Islam S , Hasan MN , Kalam SB , Islam MS , Hasan MJ , Sami CA , Chowdhury FR , 2022. Clinical profile, severity spectrum, and hospital outcome of patients with dengue in a tertiary care hospital in Dhaka city. Cureus 14: e28843.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Hossain MS , Noman AA , Mamun SMAA , Mosabbir AA , 2023. Twenty-two years of dengue outbreaks in Bangladesh: Epidemiology, clinical spectrum, serotypes, and future disease risks. Trop Med Health 51: 37.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Dengue Press Releases , 2023. IEDCR. Available at: https://old.dghs.gov.bd/index.php/bd/home/5200-daily-dengue-status-report. Accessed March 8, 2024.

    • PubMed
    • Export Citation
  • 11.

    Avrami S , Hoffman T , Meltzer E , Lustig Y , Schwartz E , 2023. Comparison of clinical and laboratory parameters of primary vs. secondary dengue fever in travelers. J Travel Med 30: taad129.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Alam H , 2023. Dengue “DEN-3” Variant More Prominent Now. Dhaka, Bangladesh: The Daily Star. Available at: https://www.thedailystar.net/news/bangladesh/news/dengue-den-2-variant-more-prominent-now-3350001. Accessed September 2, 2023.

    • PubMed
    • Export Citation
  • 13.

    World Health Organization , 2009. Dengue Guidelines For Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland: WHO.

  • 14.

    Yuan K , Chen Y , Zhong M , Lin Y , Liu L , 2022. Risk and predictive factors for severe dengue infection: A systematic review and meta-analysis. PLoS One 17: e0267186.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Tsheten T , Clements ACA , Gray DJ , Adhikary RK , Furuya-Kanamori L , Wangdi K , 2021. Clinical predictors of severe dengue: A systematic review and meta-analysis. Infect Dis Poverty 10: 123.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Thach TQ et al., 2021. Predictive markers for the early prognosis of dengue severity: A systematic review and meta-analysis. PLoS Negl Trop Dis 15: e0009808.

  • 17.

    Yesmin S , Ahammad AM , Sarmin S , Rafi MA , Islam S , Hasan MJ , 2023. Clinical profile of pediatric cases of dengue during the 2019 epidemic in Bangladesh: A multicenter cross-sectional study. Mymensingh Med J 32: 502509.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Hasan MJ , Tabassum T , Sharif M , Khan MAS , Bipasha AR , Basher A , Islam MR , Amin MR , 2021. Comparison of clinical manifestation of dengue fever in Bangladesh: An observation over a decade. BMC Infect Dis 21: 1113.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Shirin T, et al., 2019. Largest dengue outbreak of the decade with high fatality may be due to reemergence of DEN-3 serotype in Dhaka, Bangladesh, necessitating immediate public health attention. New Microbes New Infect 29: 100511.

    • PubMed
    • Export Citation
  • 20.

    Ahsan A, Haider N, Kock R, Benfield C. 2020. Possible drivers of the 2019 dengue outbreak in Bangladesh: The need for a robust community-level surveillance system. J Med Entomol 58: 37–39.

    • PubMed
    • Export Citation
  • 21.

    Rafi A, Mousumi AN, Ahmed R, Chowdhury RH, Wadood A, Hossain G, 2020. Dengue epidemic in a non-endemic zone of Bangladesh: Clinical and laboratory profiles of patients. PLoS Negl Trop Dis 14: e0008567.

    • PubMed
    • Export Citation
  • 22.

    Islam S, Khan MAS, Badal MFA, Khan MZI, Gozal D, Hasan MJ, 2022. Clinical and hematological profiles of children with dengue residing in a non-endemic zone of Bangladesh. PLoS Negl Trop Dis 16: e0010847.

    • PubMed
    • Export Citation
  • 23.

    Carrasco LR, et al., 2014. Predictive tools for severe dengue conforming to World Health Organization 2009 Criteria. PLoS Negl Trop Dis 8: e2972.

    • PubMed
    • Export Citation
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