WHO case definitions for dengue fever
Last reviewed 01/2018
WHO’s case definitions for dengue fever
The 1997 WHO guideline classified dengue into dengue fever (DF), dengue hemorrhagic
fever (DHF) (Grades 1 and 2) and dengue shock syndrome (DSS) (DHF Grades 3 and
4).
Several limitations of the 1997 definition led to a new WHO classification in
2009 which classifies dengue according to levels of severity:
- dengue without warning signs
- probable dengue
- live in/travel to dengue endemic area
- fever and 2 of the following criteria:
- nausea, vomiting
- rash
- aches and pain
- tourniquet test positive
- any warning sign
- laboratory confirmed dengue (important when no sign of plasma leakage)
- dengue with warning signs - requires strict observation and medical intervention
- dengue as defined above with any of the following:
- abdominal pain or tenderness
- persistent vomiting
- clinical fluid accumulation (ascites, pleural effusion)
- mucosal bleeding
- lethargy, restlessness
- liver enlargement >2 cm
- laboratory – increase in HCT concurrent with rapid decrease in platelet count
- severe dengue - dengue with at least one of the following criteria:
- severe plasma leakage leading into:
- shock (DSS)
- fluid accumulation with respiratory distress
- severe bleeding – as evaluated by clinician
- severe organ involvement
- liver: AST or ALT ≥ 1000
- CNS: impaired consciousness
- failure of heart and other organs (1,2)
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