Differences in Mortality and Clinical Manifestations of Dengue Hemorrhagic Fever in Taiwan in Different Years: A Comparison for Cases in 2014 and 2015 Epidemics

Ko Chang Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung, Taiwan;
Department of Internal Medicine, Kaohsiung Medical University Kaohsiung, Taiwan;

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Chung-Hao Huang Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;

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Ing-Kit Lee Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan;

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Po-Liang Lu Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung, Taiwan;

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Chun-Yu Lin Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung, Taiwan;

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Tun-Chieh Chen Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung, Taiwan;
Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;

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Ping-Chang Lai Department of Internal Medicine, St. Joseph Hospital, Kaohsiung, Taiwan;

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Hsiao-Cheng Hsieh Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung, Taiwan;

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Hsin-Liang Yu Department of Internal Medicine, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan;

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Chih-Hsing Hung Department of Pediatric, Kaohsiung Medical University Kaohsiung, Taiwan;

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Meng-Chieh Wu Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
Department of Internal Medicine, Kaohsiung Medical University Kaohsiung, Taiwan;

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Yi-Ying Chin Department of Dermatology, Kaohsiung Medical University Kaohsiung, Taiwan;

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Chun-Chi Huang Department of laboratory Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;

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Deng-Chyang Wu Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University Kaohsiung, Taiwan;
Department of Dermatology, Kaohsiung Medical University Kaohsiung, Taiwan;

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Yen-Hsu Chen Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung, Taiwan;
School of Medicine, Graduate Institute of Medicine, Sepsis Research Institute, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;
Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan

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DOI:
https://doi.org/10.4269/ajtmh.16-1018
Volume/Issue:
Volume 97: Issue 2
Page(s):
361–368
Restricted access
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People in southern Taiwan experienced two major dengue outbreaks in 2014 and 2015. The mortality and clinical features were very different between these 2 years. Dengue virus serotype 1 (DENV-1) caused epidemic outbreak in 2014 and DENV-2 was predominant in 2015. The characteristics of dengue hemorrhagic fever (DHF) cases in the 2 years was analyzed. We conducted a retrospective chart review to analyze the clinical and laboratory features of 206 adult patients with DHF in southern Taiwan in 2014 and 2015. The mortality rate of DHF cases in 2015 was higher than that of cases in 2014 (38.7% versus 12.4%, P < 0.0001). Compared with cases in 2014, DHF cases in 2015 had more complications, such as gastrointestinal bleeding (78.5% versus 61.9%, P = 0.01), severe hepatitis (30.1% versus 8%, P < 0.0001), and myocarditis (14% versus 0.9%, P < 0.0001). Among the mortality cases, diabetes, chronic renal failure, proton-pump inhibitors using, platelet transfusion, and Charlson comorbidity index score (Charlson score) were also higher in 2015. Multivariate analysis for the mortality cases revealed that the risk factors were Charlson score ≥ 5 (P = 0.02, odds ratio [OR] = 4.07, 95% confidence interval [CI] = 1.244–13.307), severe hepatitis (P < 0.0001, OR = 11.97, 95% CI = 3.831–37.396), and acute renal failure (P < 0.0001, OR = 98.76, 95% CI = 10.847–899.22). DHF cases in 2015 had higher mortality and more complications, such as gastrointestinal bleeding, severe hepatitis, and myocarditis, than in 2014 in southern Taiwan. In the 2-year DHF case series, Charlson score ≥ 5, severe hepatitis, and acute renal failure were independent significant variables for mortality.

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Author Notes

Address correspondence to Yen-Hsu Chen, Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital; #100 Tzyou 1st Road, Kaohsiung, Taiwan. E-mail: d810070@kmu.edu.tw

Financial support: This work was supported by a grant from the foundation of Kaohsiung Municipal Hsiao-Kang Hospital (KMHK Proj-103-05), Department of Health, Taiwan, (DOH-106-0324 and MOHW105-TDU- M-212- 000006), and partly supported by a grant from the Research Center for Environmental Medicine, Kaohsiung Medical University (KMU-TP104A31, KMU-TP105A21), Kaohsiung, Taiwan.

Authors’ addresses: Ko Chang and Deng-Chyang Wu, Department of Internal Medicine, Kaohsiung Municipal Hsaio-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, E-mails: johnsonckk@yahoo.com.tw and dechwu@yahoo.com. Chung-Hao Huang, Po-Liang Lu, and Chun-Yu Lin, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taipei, Taiwan, E-mails: locusthao@gmail.com, idpaul@gmail.com, and infectionman@gmail.com. Ing-Kit Lee, Infectious Department, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, E-mail: leee@cgmh.org.tw. Tun-Chieh Chen, Division of Infectious Diseases, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, E-mail: idchen.tunchieh@gmail.com. Ping-Chang Lai, Department of Internal Medicine, St. Joseph Hospital, Kaohsiung, Taiwan, E-mail: pclai.tw@msa.hinet.net. Hsiao-Cheng Hsieh, Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung, Taiwan, E-mail: cheetah.hsieh@msa.hinet.net. Hsin-Liang Yu, Department of Internal Medicine, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan, E-mail: paulyu19571211@yahoo.com.tw. Chih-Hsing Hung, Department of Pediatric, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, E-mail: pedhung@gmail.com. Meng-Chieh Wu, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, E-mail: u8501078@ms47.hinet.net. Yi-Ying Chin, Department of Dermatology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, E-mail: ninakim515@yahoo.com.tw. Chun-Chi Huang, Laboratory Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, E-mail: 0870791@kmhk.kmu.edu.tw. Yen-Hsu Chen, Faculty of Medicine, Department of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan, E-mail: d810070@kmu.edu.tw.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2017
Received:
23 Dec 2016
|
Accepted:
25 Apr 2017
|
Published Online:
12 Jun 2017
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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