Session: Oral Abstract Session: Laboratory and Clinical Virology
Saturday, October 5, 2013: 11:30 AM
Room: The Moscone Center: 300
Background: In Puerto Rico, fatal dengue cases are thought to be under-recognized.

Methods: To estimate the dengue death rate, an enhanced fatal case surveillance system was implemented in 2010 by CDC Dengue Branch, Institute of Forensic Sciences of Puerto Rico (IFSPR), and CDC Infectious Diseases Pathology Branch. Deaths with a dengue-like, acute febrile illness were identified via 1) disease surveillance, 2) death certificate review, 3) autopsies, and 4) calls to hospitals. Serum was tested by RT-PCR and immunodiagnostic methods for dengue virus (DENV); tissue was tested using immunohistochemistry and RT-PCR. Medical records from dengue laboratory-positive (DLP) case-patients were reviewed.

Results: From 2010-2012, 247 suspect dengue fatal cases were identified; most (66%) had autopsy tissues available. Fifty-six cases were dengue DLP, 149 were laboratory-negative, 34 laboratory-indeterminate (acute sample negative and no convalescent sample), and 8 had no specimen; the 2010 incidence rate was 0.1 dengue deaths per 10,000 residents and case-fatality rate was 28 DLP deaths per 10,000 surveillance reported DLP cases.  The majority (61%) of DLP case-patients were female and the median age was 45 years (range: 6 months to 89 years) in contrast to only 42% of non-fatal surveillance reported DLP cases being female, with a median age of 18 years.  Most case-patients (77%, 43) had one or more chronic medical conditions including 24 with hypertension, 20 with diabetes mellitus type II, and 12 with asthma.  Forty (71%) DLP case-patients were admitted to a hospital; 13 died in ER before admission and 3 died at home. Management issues identified included incorrect type of IV fluid usage (14, 25%) and fluid overload (16, 29%). Of 53 case-patients who died in a healthcare facility, 25 (47%) died at night or a weekend. Dengue was listed on the death certificate in only 25 of 54 DLP cases with a death certificate.

Conclusion: Our findings suggest that the sex and age distribution of DLP fatal cases differs from DLP cases reported to dengue surveillance. Reasons for these differences are being investigated.

Kay Tomashek, MD, MPH, Dengue Branch, CDC, San Juan, PR


K. Tomashek, None

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