Comparing the Usefulness of the 1997 and 2009 WHO Dengue Case Classification: A Systematic Literature Review
Olaf Horsticka b, Thomas Jaenischa b, Eric Martineza b c, Axel Kroegerb d, Lucy Lum Chai Seeb, Jeremy Farrarb e, Silvia Runge Ranzingerb e
- aInstitute of Public Health , University of Heidelberg , Heidelberg , Germany
- bLiverpool School of Tropical Medicine, Liverpool, United Kingdom
- cInstitute of Public Health , University of Heidelberg , 69120 Heidelberg , Germany
- dLiverpool School of Tropical Medicine , Liverpool , United Kingdom
- eInstituto de Medicina Tropical , Pedro Kuori , La Habana , Cuba
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Abstract
The 1997 and 2009 WHO dengue case classifications were compared in a systematic review with 12 eligible studies (4 prospective). Ten expert opinion articles were used for discussion. For the 2009 WHO classification studies show: when determining severe dengue sensitivity ranges between 59-98% (88%/98%: prospective studies), specificity between 41-99% (99%: prospective study) - comparing the 1997 WHO classification: sensitivity 24.8-89.9% (24.8%/74%: prospective studies), specificity: 25%/100% (100%: prospective study). The application of the 2009 WHO classification is easy, however for (non-severe) dengue there may be a risk of monitoring increased case numbers. Warning signs validation studies are needed. For epidemiological/pathogenesis research use of the 2009 WHO classification, opinion papers show that ease of application, increased sensitivity (severe dengue) and international comparability are advantageous; 3 severe dengue criteria (severe plasma leakage, severe bleeding, severe organ manifestation) are useful research endpoints. The 2009 WHO classification has clear advantages for clinical use, use in epidemiology is promising and research use may at least not be a disadvantage.