Clinical characteristics and outcomes among travelers with severe dengue: a geoSentinel analysis

Ralph Huits, Kristina M Angelo, Bhawana Amatya, Sapha Barkati, Elizabeth D Barnett, Emmanuel Bottieau, Hannah Emetulu, Loïc Epelboin, Gilles Eperon, Line Medebb, Federico Gobbi, Martin P Grobusch, Oula Itani, Sabine Jordan, Paul Kelly, Karin Leder, Marta Díaz-Menéndez, Nobumasa Okumura, Aisha Rizwan, Camilla RotheMauro Saio, Jesse Waggoner, Yukihiro Yoshimura, Michael Libman, Davidson H Hamer, Eli Schwartz

Research output: Contribution to journalA1: Web of Science-articlepeer-review


BACKGROUND: Dengue virus is a flavivirus transmitted by Aedes mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited.

OBJECTIVE: To describe the epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue).

DESIGN: Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022.

SETTING: 20 of 71 international GeoSentinel sites.

PATIENTS: Returning travelers with complicated dengue.

MEASUREMENTS: Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue.

RESULTS: Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (n = 27 [31%]) and Southeast Asia (n = 21 [24%]). Frequent reasons for travel were tourism (46%) and visiting friends and relatives (32%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (n = 3), severe liver disease (n = 3), myocarditis (n = 2), and neurologic symptoms (n = 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgM+/IgG-) and 12 as secondary (IgM-/IgG+) dengue.

LIMITATIONS: Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited.

CONCLUSION: Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study.

PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention, International Society of Travel Medicine, Public Health Agency of Canada, and GeoSentinel Foundation.

Original languageEnglish
JournalAnnals of Internal Medicine
Issue number7
Pages (from-to)940-948
Number of pages9
Publication statusPublished - 2023


  • Adult
  • Female
  • Humans
  • Immunoglobulin G
  • Immunoglobulin M
  • Male
  • Prospective Studies
  • Retrospective Studies
  • Severe Dengue
  • Travel


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