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Updated: May 2, 2026
Protocol for Dengue Infections in Mosquitoes A. aegypti and Infection Phenotype Determination
Published on: July 4, 2007
Prospective applicability study of the new dengue classification system for clinical management in children
Dolores Lovera1, Soraya Araya, Maria Jose Mesquita
1From the *Departamento de Pediatría, Institute of Tropical Medicine, Avda. Venezuela y Florida, Asunción; and †Universidad Nacional de Asunción, Barrio Villa Universitaria, San Lorenzo, Paraguay.
Insights
The 2009 World Health Organization (WHO) dengue classification system significantly improves early detection of severe dengue cases in children compared to the 1997 system. This revised system aids in timely intervention for better patient outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- The World Health Organization (WHO) revised its dengue classification system in 2009 to improve early detection of severe cases.
- The previous 1997 WHO criteria were less effective in identifying children requiring urgent medical intervention.
Purpose of the Study:
- To evaluate the efficacy of the 2009 WHO dengue classification system.
- To compare the diagnostic performance of the 2009 system against the 1997 WHO criteria for identifying dengue cases needing intervention.
Main Methods:
- A prospective study included 123 children under 15 years old admitted with dengue during Paraguay's 2011 outbreak.
- Cases were classified using both the 1997 and 2009 WHO dengue criteria.
- Patient management followed the 2009 revised recommendations.
Main Results:
- The 2009 classification identified 97% of cases as requiring intervention, versus 54% with the 1997 system (P < 0.001).
- Severe dengue cases were identified in 24% of patients using the 2009 criteria, compared to 10% with the 1997 criteria (P < 0.05).
Conclusions:
- The 2009 WHO dengue classification system demonstrates superior performance in detecting severe dengue in children.
- This revised system facilitates earlier identification and management of critical dengue cases, improving clinical outcomes.
Background:
To evaluate the efficacy of the 2009 revised dengue classification system proposed by the World Health Organization (WHO) for early detection of dengue cases requiring intervention.
Methods:
Children <15 years of age with dengue [confirmed by laboratory testing (IgM enzyme-linked immunosorbent assay, NS1 Ag or reverse transcriptase polymerase chain reaction) or by epidemiologic link] who were admitted to the Institute of Tropical Medicine during the 2011 dengue outbreak in Paraguay were prospectively included. Each case was classified according to the 1997 WHO dengue criteria and by the 2009 WHO revised criteria, which categorize dengue patients using a set of clinical finding into dengue with/without warning signs and severe dengue. The management of all cases followed the new recommendations.
Results:
During the 2011 dengue outbreak, 123 children were admitted with a mean age of 11 ± 3 years. By the 2009 classification system, 119 cases (97%) were classified as dengue requiring intervention [89 patients (75%) with warning signs and 30 patients (25%) with severe signs], whereas by the old system 67 patients (54%) were classified as dengue requiring intervention (P < 0.001). Further, by the 1997 classification, only 13 patients (10%) were classified as dengue hemorrhagic fever III/IV (severe cases), whereas with the 2009 classification 30 patients (24%) were considered as having severe dengue infection (P < 0.05) CONCLUSIONS:: This study confirms that the 2009 WHO dengue classification provides better detection of severe cases of dengue than the earlier 1997 WHO dengue system.
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