‘Dengue, the past present and future- Exploring opportunities for outpatient case management’

This oration is based on three dengue studies conducted at the Southern province of Sri Lanka. The studies landmark three distinct points in the timeline of dengue.: before the onset of nationwide epidemics (2007), during large epidemics (2011/2012) and when rapid tests, ultrasonography and guidelines improved management (2017/2018). 

Three studies consecutively enrolled patients from the largest tertiary care hospital in the southern province. Dengue was serologically and virologically confirmed. According to 2007 study results, among 859 hospitalized with acute fever, dengue was a less common etiology (6.3%). Overall, 54% were seropositive indicating previous dengue exposure. In 2011/2012 study, 40% of a cohort of 976 with acute fever were dengue.  Dengue was mostly unrecognized by the clinicians in 2007, sensitivity of clinical diagnosis was 14% which improved to 58% in 2011/2012. The WHO classification had better sensitivity for diagnosis (76%), but overestimated disease severity.

2017/2018 study enrolled 1064 patients with dengue and platelets below100,000/μL, the threshold for hospitalization in Sri Lanka. Here ultrasonography helped identifying plasma leak. Majority of children (80%) and 55% adults developed DHF, 8.6% children and 2% adults developed DSS. About 14.% children and 11% adults developed severe dengue, two died (0.2%). Although majority progressed to DHF, only a small minority developed severe diseasee. Developing algorithms for triaging adults and children separately for ambulatory versus inpatient management should be the future goal to optimize utilization of healthcare resources. Based on above findings our future work is geared to identify host gene signatures that predict severe disease to contribute to the advances in dengue management.