Risk factors associated with dengue mortality in children under 15 years of age in Paraguay, 2010-2013

Abstract

Introduction: Dengue is the most important vector-borne disease in the Americas, and especially in Paraguay, with a sustained increase in outpatient cases, hospitalizations, and dengue deaths in the last 10 years, affecting all groups of the pediatric age group. Objective: To identify factors associated with mortality in children less than 15 years of age with diagnosis of dengue in the period 2010-2013. Materials and Methods: An observational, descriptive, retrospective study. The data were obtained from the weekly epidemiological bulletin of the Ministry of Public Health. Results: During the period 2010 to 2013, 57,483 children under the age of 15 years were diagnosed with dengue, requiring hospitalization in 12.2% (7,029 / 57,483). The mortality (number of deaths / number of total cases) in the study period was 0.055% (32 / 57,483), with a casefatality rate of 0.03%, 0.05%, 1.3% and 0.05%, respectively, in the years 2010 to 2013 respectively. The factors associated with increased mortality were age < 1 year (p < 0.001, RR = 6.22, 95% CI 3-12.9), hemorrhagic clinical manifestations (p < 0.01, RR 4.5, 95 % CI 1.6 -12.8), presence of dengue shock syndrome (p < 0.01, RR 83.5, 95% CI 40.6 172.1) and patients with baseline pathologies (p < 0.001, RR = 86.32, 95% CI 38.2-194.8). The highest frequency of hospitalization was observed in the age group < 1 year (591/3475, 17%), significantly higher compared to the groups of 1 to 4 years (6.5%) and 5 to 14 years (5687/42455. 13.4%) (p < 0.00001; RR = 2.51; 95% CI 2.3-2.7). Conclusions: Risk factors associated with increased mortality were age < 1 year, clinical manifestations of hemorrhagic fever, presence of shock syndrome due to dengue on admission, and underlying pathologies. The present study shows the great impact of dengue in Paraguay in terms of morbidity and mortality. The identification of factors associated with mortality may contribute to the timely detection of high-risk groups, seeking to reduce mortality.