Background:Severe dengue is a life-threatening complication;rapid identifcation of these cases,followed by adequate management is crucial to improve the clinical prognosis.Therefore,this study aimed to identify risk f...Background:Severe dengue is a life-threatening complication;rapid identifcation of these cases,followed by adequate management is crucial to improve the clinical prognosis.Therefore,this study aimed to identify risk factors and predictors of severe dengue.Methods:A literature search for studies reporting risk factors of severe dengue among individuals with dengue virus infection was conducted in PubMed,Scopus and Web of Science database from inception to December 31,2020.Pooled odds ratios(ORs)for patients’demographic characteristics,co-morbidities,and warning signs were estimated using an inverse variance heterogeneity model.Results:We included 143 articles in the meta-analysis from a total of 13090 articles retrieved from the literature search.The risk factors of severe dengue were:being a child[OR=1.96;95%confdence interval(CI):1.22–3.13],secondary infection(OR=3.23;95%CI:2.28–4.57),and patients with pre-existing diabetes(OR=2.88;95%CI:1.72–4.81)and renal disease(OR=4.54;95%CI:1.55–13.31).Warning signs strongly associated with severe disease were increased haematocrit with a concurrent decrease in platelet count(OR=5.13;95%CI:1.61–16.34),abdominal pain(OR=2.00;95%CI:1.49–2.68),lethargy(OR=2.73;95%CI:1.05–7.10),vomiting(OR=1.80;95%CI:1.43–2.26),hepa‑tomegaly(OR=5.92;95%CI:3.29–10.66),ascites(OR=6.30;95%CI:3.75–10.60),pleural efusion(OR=5.72;95%CI:3.24–10.10)and melena(OR=4.05;95%CI:1.64–10.00).Conclusions:Our meta-analysis identifed children,secondary infection,diabetes and renal disease(s)as important predictors of severe dengue.Our fnding also supports the predictive ability of the WHO warning signs to iden‑tify severe dengue.These fndings are useful for clinicians to identify severe dengue for management and timely interventions.展开更多
Bhutan has reported a total of 2596 COVID-19 cases and three deaths as of September 15,2021.With support from India,the United States,Denmark,the People’s Republic of China,Croatia and other countries,Bhutan was able...Bhutan has reported a total of 2596 COVID-19 cases and three deaths as of September 15,2021.With support from India,the United States,Denmark,the People’s Republic of China,Croatia and other countries,Bhutan was able to conduct two rounds of nationwide vaccination campaign.While many countries struggle to overcome vaccine refusal or hesitancy due to complacency,a lack of trust,inconvenience and fear,escalated in some countries by anti-vaccine groups,Bhutan managed to inoculate more than 95%of its eligible populations in two rounds of vaccination campaign.Enabling factors of this successful vaccination campaign were strong national leadership,a well-coordinated national preparedness plan,and high acceptability of vaccine due to effective mass communication and social engagement led by religious figures,volunteers and local leaders.In this short report,we described the national strategic plan and enabling factors that led to the success of this historical vaccination campaign.展开更多
文摘Background:Severe dengue is a life-threatening complication;rapid identifcation of these cases,followed by adequate management is crucial to improve the clinical prognosis.Therefore,this study aimed to identify risk factors and predictors of severe dengue.Methods:A literature search for studies reporting risk factors of severe dengue among individuals with dengue virus infection was conducted in PubMed,Scopus and Web of Science database from inception to December 31,2020.Pooled odds ratios(ORs)for patients’demographic characteristics,co-morbidities,and warning signs were estimated using an inverse variance heterogeneity model.Results:We included 143 articles in the meta-analysis from a total of 13090 articles retrieved from the literature search.The risk factors of severe dengue were:being a child[OR=1.96;95%confdence interval(CI):1.22–3.13],secondary infection(OR=3.23;95%CI:2.28–4.57),and patients with pre-existing diabetes(OR=2.88;95%CI:1.72–4.81)and renal disease(OR=4.54;95%CI:1.55–13.31).Warning signs strongly associated with severe disease were increased haematocrit with a concurrent decrease in platelet count(OR=5.13;95%CI:1.61–16.34),abdominal pain(OR=2.00;95%CI:1.49–2.68),lethargy(OR=2.73;95%CI:1.05–7.10),vomiting(OR=1.80;95%CI:1.43–2.26),hepa‑tomegaly(OR=5.92;95%CI:3.29–10.66),ascites(OR=6.30;95%CI:3.75–10.60),pleural efusion(OR=5.72;95%CI:3.24–10.10)and melena(OR=4.05;95%CI:1.64–10.00).Conclusions:Our meta-analysis identifed children,secondary infection,diabetes and renal disease(s)as important predictors of severe dengue.Our fnding also supports the predictive ability of the WHO warning signs to iden‑tify severe dengue.These fndings are useful for clinicians to identify severe dengue for management and timely interventions.
文摘Bhutan has reported a total of 2596 COVID-19 cases and three deaths as of September 15,2021.With support from India,the United States,Denmark,the People’s Republic of China,Croatia and other countries,Bhutan was able to conduct two rounds of nationwide vaccination campaign.While many countries struggle to overcome vaccine refusal or hesitancy due to complacency,a lack of trust,inconvenience and fear,escalated in some countries by anti-vaccine groups,Bhutan managed to inoculate more than 95%of its eligible populations in two rounds of vaccination campaign.Enabling factors of this successful vaccination campaign were strong national leadership,a well-coordinated national preparedness plan,and high acceptability of vaccine due to effective mass communication and social engagement led by religious figures,volunteers and local leaders.In this short report,we described the national strategic plan and enabling factors that led to the success of this historical vaccination campaign.
