Related Experiment Video
Updated: Jul 18, 2026
Protocol for Dengue Infections in Mosquitoes (A. aegypti) and Infection Phenotype Determination
Published on: July 4, 2007
Early Dengue infection and outcome study (EDEN) - study design and preliminary findings
Jenny G H Low1, Eng-Eong Ooi, Thomas Tolfvenstam
1Department of Infectious Diseases, Communicable Disease Centre, Tock Seng Hospital, Singapore. jenny.low@sgh.com.sg
Insights
Adult dengue infections in Singapore present unique challenges, with prolonged symptoms in 9% of cases. This study highlights the need for better early prognostic markers for adult dengue management.
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- Dengue poses a significant public health challenge in Singapore, disproportionately affecting young adults.
- Current World Health Organization (WHO) guidelines, based on pediatric data, may not adequately address adult dengue infections.
Purpose of the Study:
- To investigate epidemiological, clinical, and viral features of early adult dengue infections.
- To identify potential early markers for prognostication in adult dengue cases.
Main Methods:
- The Early DENgue (EDEN) infection and outcome study is a longitudinal investigation of adult patients with early undifferentiated fever.
- An interim analysis focused on identifying early indicators of severe dengue disease.
Main Results:
- 133 out of 455 febrile patients were confirmed with acute dengue via PCR.
- Nine percent of dengue cases experienced prolonged symptoms (over 3 weeks) including fatigue and loss of appetite.
- Viral load (Ct value) correlated with symptom duration; over half of dengue cases required hospitalization.
Conclusions:
- Adult dengue illness burden differs from non-dengue febrile illnesses, characterized by prolonged symptom duration in a subset of patients.
- There is a critical need for early prognostic markers to guide the management of adult dengue infections.
Introduction:
Dengue is a major public health problem in Singapore. Age-specific dengue morbidity rates are highest in the young adult population, unlike in many other Southeast Asian countries where dengue is mainly a paediatric disease. Hence, the World Health Organization (WHO) guidelines on dengue diagnosis and management which were developed using the paediatric experiences, may not be suitable for the management of adult dengue infections.
Materials And Methods:
The Early DENgue (EDEN) infection and outcome study is a collaborative longitudinal study to investigate epidemiological, clinical, viral and host-specific features of early dengue-infected adults, in an effort to identify new early markers for prognostication. Patients presenting with early undifferentiated fever were included in the study. We carried out an interim analysis to look for early indicators of severe disease.
Results:
During the period of this interim study analysis, 455 febrile patients were recruited. Of these, 133 were confirmed as acute dengue cases based on dengue-specific polymerase chain reaction (PCR) results. There were significant clinical and epidemiological differences between dengue and febrile non-dengue cases. Nine per cent of the dengue cases experienced persistent tiredness, drowsiness and loss of appetite beyond 3 weeks of illness. Quantitation of viral loads using the crossover (Ct) value of real-time RT-PCR correlated with the duration of symptoms. More than half of both primary and secondary dengue cases were hospitalised. There was no dengue-related mortality in this study.
Conclusion:
The duration of illness and prolonged symptom duration in 9% of the subjects indicate that the burden of dengue illness is substantially different from other non-dengue febrile illness in our study cohort. Our study also highlights the paucity of early prognostic markers for dengue fever in adults.
