Factors Associated With Severe Dengue During the 2019 Outbreak in Southern Colombia: Implications for Hyperendemic Regions.

INTRODUCTION: In 2019, Colombia reported over 127,000 dengue virus (DENV) infections, with Huila accounting for 20% of the national total of severe dengue (SD) cases. This highlights the need to identify the local determinants of severity. METHODS: We examined 5494 dengue and 251 SD cases with laboratory confirmation reported in Huila, southern Colombia, in 2019. Multiplex RT-qPCR was performed on 571 samples to determine viral serotypes. Multivariate logistic regression adjusted for age, sex, and comorbidities assessed epidemiological, clinical, and virological factors associated with SD. RESULTS: SD manifested as vascular leakage with or without shock (76%), organ involvement (13%), severe bleeding (2.7%), and multiple severe manifestations in 8.3%. A trend toward higher frequency of severity among vulnerable patients in the subsidized health insurance system was observed. DENV-1 was the most prevalent serotype, but DENV-2 was associated with severity. Age < 5 years (OR = 4; 95% CI: 2.3-6.8), 5-15 years (OR = 1.9; 95% CI: 1.1-3.1), diarrhea (OR = 2.1; 95% CI: 1.5-2.9), vomiting (OR = 1.8; 95% CI: 1.2-2.2), abdominal pain (OR = 3.2; 95% CI: 2.3-4.6), hepatomegaly (OR = 4.7; 95% CI: 3.4-6.7), platelet count < 100,000/μL (OR = 7.2; 95% CI: 5.2-10.1), and fluid accumulation (OR = 10.3; 95% CI: 6-17.8), were the main factors associated with SD. CONCLUSION: Young age, gastrointestinal manifestations, hepatomegaly, thrombocytopenia, fluid accumulation, and DENV-2 infection were associated with SD during the 2019 epidemic in southern Colombia.