Dengue is an infection that can be transmitted from mosquito to humans and can cause fever. Its occurrence is increasing worldwide. The mosquitoes that spread dengue already live in many popular tourist destinations and are spreading to other newer areas. Travellers returning to England from these places are at risk of dengue, with symptoms starting 3 to 14 days after first infection. Serious illness due to dengue can lead to hospitalisation due to, for example, bleeding or seizure.
We will use anonymised linked primary and secondary care health records as well as death records to determine how many people in England got dengue and were hospitalised as well as died within the last 14 years. We will also describe the amount of health service interactions and cost for dengue patients receiving care, including treatments.
This research will provide clinical and public health audiences with insight into dengue burden in England, which is currently not well defined, to help tackle this public health issue with the aim of advancing management of the illness as the number of people getting dengue increases worldwide.
The occurrence of dengue is increasing worldwide, with a 85.5% increase globally from 1990 to 2019. Dengue is a mosquito-borne viral disease transmitted by Aedes mosquitoes, populating endemic regions and popular tourist destinations in South East Asia, South Asia, Latin America and Africa. Ongoing geographical expansion of the Aedes mosquito increases dengue risk in non-endemic areas like France, Italy, Spain, Portugal, and Germany .
Dengue is now one of the most frequently diagnosed infections in travellers returning to England. Presentation of dengue in returning travellers is geographically dispersed, leaving healthcare professionals with low awareness of the infection and its consequences given their limited prior experience of treating patients with the infection. Dengue mostly presents as a mild febrile illness, however, severe illness can result in hospitalisation with complications like bleeding, seizure, encephalitis, Guillain-Barré syndrome and mononeuropathies.
There is a lack of published studies examining the clinical and economic burden of travel-related dengue in England. Understanding the burden of dengue on the healthcare system in England and its clinical presentation will facilitate awareness raising among healthcare professionals and travellers, and adopting preventative measures.
This research seeks to use routinely collected primary and secondary healthcare data from the Clinical Practice Research Datalink Aurum database, linked to the Hospital Episode Statistics and Office for National Statistics death registrations, to estimate the incidence and case fatality of hospitalised dengue and describe its trends between 2010 and 2023 stratified by year, age, ethnicity, and region. We will also describe the characteristics of people with hospitalised dengue, and the number and percentage of people with hospitalised dengue who have clinical complications and receive treatments. Associated healthcare resource use will be summarised (using means and medians). Additionally, this study will describe the setting of presentation for dengue, dengue tests performed in primary care, and dengue patient pathway.
Incidence of hospitalised dengue; Number of all-cause and dengue-related hospital admissions; Cost of all-cause and dengue-related hospital admissions; Length of stay for all-cause and dengue-related (i.e., specifically coded as dengue or complications related to dengue) hospital admissions; Number of all-cause and dengue-related intensive care unit (ICU) admissions; Cost of all-cause and dengue-related ICU admissions; Length of stay for all-cause and dengue-related ICU admissions; Number of all-cause and dengue-related outpatient appointments; Cost of all-cause and dengue-related outpatient appointments; Number of all-cause emergency care (EC) attendances; Cost of all-cause EC attendances; Number of all-cause and dengue-related primary care consultations; Cost of all-cause and dengue-related primary care consultations; Cost of all-cause and dengue-related total healthcare use (primary and secondary care); Number of patients with certified sickness in primary care; Baseline characterisation; Treatment of hospitalised dengue; Occurrence of complications after hospitalised dengue; Case fatality rate; Setting of first presentation for dengue; Time between primary and secondary care presentation; Number of tests for dengue; Incidence of primary suspected dengue with a negative test results or suspected dengue with subsequent positive result or diagnosed dengue; Referrals to secondary care; GP practices with patients with dengue
Jennifer Davidson - Chief Investigator - Health iQ Ltd ( UK ) t/a CorEvitas
Caitlin Winton - Corresponding Applicant - Health iQ Ltd ( UK ) t/a CorEvitas
Andre Ng - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
Bojana Milovanovic - Collaborator - Takeda Pharmaceuticals International AG
Caoimhe Rice - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
Hannah Brewer - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
Indraraj Umesh Doobaree - Collaborator - Takeda UK Limited
Rebecca Joseph - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
Sara Carvalho - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
Tracy Leong - Collaborator - Takeda Development Centre Europe Ltd. ( UK )
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation;CPRD Aurum Ethnicity Record