Clinical evaluation of dengue and identification of risks factors for severe disease in Bangladesh

Overview
The study on the clinical evaluation of dengue was headed by an internal consortium of three organisations: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), James P Grant School of Public Health, BRAC University (JPGSPH), and Shaheed Suhrawardy Medical College Hospital (ShSMCH). This study was part of a larger research initiative which is being conducted by the International Research Consortium on Dengue Risk Asses (IDAMS) formed by the University of Heidelberg, Oxford University Clinical Research Unit, and the Institute Pedro Kouri. This research initiative is taking place in six countries: Vietnam, Malaysia, Indonesia, Cambodia, El Salvador, and Brazil. To strengthen the inter and intra-regional collaboration, Bangladesh is participating in this global collaboration by a separate consortium formed by JPGSPH, icddr,b and ShSMCH.

The high burden of dengue fever in Dhaka, existing knowledge gaps, and wide pool of suspected patients provided Bangladesh with a unique opportunity to collaborate with IDAMS. JPGSPH endeavoured to address the knowledge gaps stated above, while simultaneously feeding the information pool of contextual dengue research in a highly prevalent zone (Dhaka).

The primary objectives of the study are:

  • To analyse clinical and/or simple laboratory parameters which differentiate between dengue and non-dengue illness within the first 72 hours of fever, predicting the likely progression to a more severe course of the disease, with the overall aim of developing a robust case definition for dengue.
  • To identify the virological correlates of severe dengue – in particular to assess plasma viremia and NS1 antigenemia within the first 72 hours of fever in patients with confirmed cases of dengue.
  • To identify early serological correlates of severe dengue, in order to characterise differences between severe and uncomplicated disease.

 To evaluate practical application of the original (WHO 1997) and the new dengue classification schemes (WHO 2009) across a series of clinical sites.
 To use the data to update the guidelines for dengue risk factors as proposed by the WHO.

Within the consortium, the research team collaborated with Shaheed Suhrawardy Medical Collage Hospital and conducted a hospital based study. Its catchment area is the north-western part of Dhaka which includes Mirpur, Mohammarpur, Dhanmondi, Pollobi, Bangaoun Union, and Savar.

Activities
Suspected patients from the Medicine and Paediatric Outpatient Department were enrolled after screening while, information about the study was disseminated beforehand to every department, so that suspected patients could be referred and enrolled in the study. A separate dengue cubicle was used for the enrolment of patients, taking their medical history, clinical assessment, and laboratory sample collection.

This was an 18 months long prospective observational study which included adults and children above five (>5 years) presenting with a febrile illness consistent with a diagnosis of dengue. To mitigate the risk of not achieving an adequate sample size, this study adopted a harmonised community mobilisation approach and an active follow up plan. Initially the focused community mobilisation effort was launched in the Mohammadpur and Agargaon area where most of the patients visited the Shaheed Suhrawardy Medical Collage Hospital. The risk of high dropout and incomplete follow-ups of enrolled patient were resolved by implementing the active follow up plan which traced the patients vigorously.

Partners/donor
Our development partners include the following:

  • International Centre for Diarrhoeal Disease Research Bangladesh,Icddr,b
  • Shaheed Suhrawardy medical College Hospital, ShSMC
  • International Research Consortium on Dengue Risk Asses (IDMAS) in University of Heidelberg, Germany

Highlights
From 21 -23 September, 2015 an expert meeting on dengue diagnosis and risk prediction, with a focus on improving clinical management and integration with IMCI/IMAI was held in Ho Chi Minh City, Vietnam. This meeting was convened on behalf of WHO-TDR, the EC-FP7 funded IDAMS Dengue Consortium, the Oxford University Clinical Research Unit, and the Hospital for Tropical Diseases in Ho Chi Minh City. Findings from Bangladesh were presented at this meeting to discuss the efforts required towards developing operational definitions for intermediate and severe dengue for the use in therapeutic intervention trials and clinical research.