Dengue in travellers: Applicability of the 1975-1997 and the 2009 WHO classification system of dengue fever

Rosanne W. Wieten, Wytze Vlietstra, Abraham Goorhuis, Michèle van Vugt, Caspar J. Hodiamont, Tjalling Leenstra, Peter J. de Vries, Saskia Janssen, Pieter P. van Thiel, Kees Stijnis, Martin P. Grobusch

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objectives The aim of this study was to assess the applicability and benefits of the new WHO dengue fever guidelines in clinical practice, for returning travellers. Methods We compared differences in specificity and sensitivity between the old and the new guidelines for diagnosing dengue and assessed the usefulness in predicting the clinical course of the disease. Also, we investigated whether hypertension, diabetes or allergies, ethnicity or high age influenced the course of disease. Results In our setting, the old classification, compared with the new, had a marginally higher sensitivity for diagnosing dengue. The new classification had a slightly higher specificity and was less rigid. Patients with dengue who had warning signs as postulated in the new classification were admitted more often than those who had no warning signs (RR, 8.09 [1.80-35.48]). We did not find ethnicity, age, hypertension, diabetes mellitus or allergies to be predictive of the clinical course. Conclusions In our cohort of returned travellers, the new classification system did not differ in sensitivity and specificity from the old system to a clinically relevant degree. The guidelines did not improve identification of severe disease.

Original languageEnglish
Pages (from-to)1023-1030
Number of pages8
JournalTropical Medicine and International Health
Issue number8
StatePublished - Aug 2012


  • Classification system
  • Dengue
  • Dengue haemorrhagic fever
  • Disease severity
  • Travellers
  • WHO classification system


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