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.