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Occurrence and Correlates of Symptom Persistence Following Acute Dengue Fever in Peru

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  • Virology Department, United States Naval Medical Research Unit No. 6, Lima and Iquitos, Peru; Dirección Regional de Salud de Piura, Ministerio de Salud, Piura, Peru; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Dengue virus (DENV) infection causes an acute febrile illness generally considered to result in either complete recovery or death. Some reviews describe persistent symptoms after the febrile phase, although empirical data supporting this phenomenon is scarce. We evaluated symptom persistence in acute febrile DENV-infected and DENV-negative (controls) individuals from Peru. Self-reported solicited symptoms were evaluated at an acute and a follow-up visit, occurring 10–60 days after symptom onset. Rate of persistence of at least one symptom was 7.7% and 10.5% for DENV infected and control subjects, respectively (P < 0.01). The DENV-infected individuals had lower rates of persistent respiratory symptoms, gastrointestinal symptoms, headache, and fatigue, but higher rates of persistent rash compared with controls. Older age and female gender were positively associated with symptom persistence. As dengue cases continue to increase annually, even a relatively low frequency of persistent symptoms may represent a considerable worldwide morbidity burden.

Author Notes

* Address correspondence to Eric S. Halsey, Unit 3230, Box 0345, DPO AA, 34031-0345. E-mail: erichalsey2000@gmail.com

Financial support: This work was supported by the Armed Forces Health Surveillance Center Global Emerging Infections Systems Research Program [847705.82000.25GB.B0016] and the National Cancer Institute at the National Institutes of Health, T32 post-doctoral training fellowship in Cancer Prevention, Etiology and Control at the Johns Hopkins Bloomberg School of Public Health [http://www.cancer.gov/researchandfunding/cancertraining/atnci/programs; 5T32CA009314-28 to MM]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright Statement: Authors Eric S. Halsey and Maya Williams are military service members and V. Alberto Laguna-Torres, Stalin Vilcarromero, and Tadeusz J. Kochel are employees of the U.S. Government. This work was prepared as part of their official duties. Title 17 U.S.C. § 105 provides that ‘Copyright protection under this title is not available for any work of the United States Government’. Title 17 U.S.C. § 101 defines a U.S. Government work as a work prepared by military service members or employees of the U.S. Government as part of those persons' official duties.

Authors' addresses: Eric S. Halsey, Maya Williams, V. Alberto Laguna-Torres, and Stalin Vilcarromero, United States Naval Medical Research Unit No. 6, Lima and Iquitos, Peru, E-mails: erichalsey2000@gmail.com, maya.williams@med.navy.mil, alberto.laguna@med.navy.mil, and stalinf@yahoo.com. Victor Ocaña, Dirección Regional de Salud de Piura, Ministerio de Salud, Piura, Peru, E-mail: vocanag01@yahoo.es. Tadeusz J. Kochel, National Biodefense Analysis and Countermeasures Center, Fort Detrick, MD, E-mail: tadeusz.kochel@nbacc.dhs.gov. Morgan A. Marks, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: mmarks@jhsph.edu.

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