Chen-Yu Wei, Chun-Yu Lin, Yen-Hsu Chen, Yu-Yao Chiu, Chung-Hao Huang, Min-Han Hsieh, Tzu-Chao Lin, Wen-Hung Wang, Ko Chang, Po-Liang Lu, Yu-Te Tsai
In conclusion, manifestations of dengue patients during the 2023 outbreak in southern Taiwan might be less severe, compatible with our clinical observation. The different clinical and laboratory features in 2023 included a lower frequency of warning signs-particularly mucosal bleeding-as well as a platelet nadir occurring 1 day later, and serum AST levels peaking 3 days later. These findings suggest that dengue manifestations differ between outbreak periods in Taiwan and may reform patient management during future outbreaks. Further research is warranted to verify these findings and to elucidate the underlying mechanisms.
BACKGROUND: Dengue is a mosquito-borne disease that caused a large outbreak in Taiwan in 2023. Some published studies about this outbreak suggest higher disease severity while we observed the opposite epidemiological trend in the southern part of Taiwan. Therefore, we conducted comparative analysis for clinical manifestation and disease severity between two outbreak periods.
METHODS: We retrospectively analyzed 4009 cases diagnosed at one medical center and two regional hospitals in Taiwan, including 3588 cases from 2014 to 2015 and 421 cases from 2023. Moderate-to-severe dengue was defined as dengue with warning signs or severe dengue by World Health Organization (WHO) definitions. The factors associated with dengue severity were assessed by multivariate logistic regression.
RESULTS: The proportion of moderate-to-severe dengue was significantly lower in 2023 (P < 0.001), even after adjusting for covariates (adjusted odds ratio 0.259, P < 0.001). In 2023, patients were generally less symptomatic and exhibited fewer warning signs, particularly mucosal bleeding. Compared with the 2014-2015 outbreak, the 2023 outbreak was characterized by a lower white blood cell nadir, platelet nadir occurring 1 day later (7 vs. 6 days after symptom onset), and aspartate aminotransferase (AST) levels peaking 3 days later.
CONCLUSIONS: In conclusion, manifestations of dengue patients during the 2023 outbreak in southern Taiwan might be less severe, compatible with our clinical observation. The different clinical and laboratory features in 2023 included a lower frequency of warning signs-particularly mucosal bleeding-as well as a platelet nadir occurring 1 day later, and serum AST levels peaking 3 days later. These findings suggest that dengue manifestations differ between outbreak periods in Taiwan and may reform patient management during future outbreaks. Further research is warranted to verify these findings and to elucidate the underlying mechanisms.