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Since the s, Singapore has experienced periodic dengue epidemics of increasing creative date ideas Long Beach CA and magnitude. In the aftermath of the — dengue epidemic, hospitals refined their admission criteria for dengue cases to right-site dengue case management and reduce the burden of healthcare utilization and negative outcomes.

In this study, we describe the national trends of hospital admissions for dengue and disease severity in terms of length of stay LOSadmission to the intensive care unit ICU and death in hospital, and case fatality rate CFR in Singapore. We conducted a retrospective study of notified cases and laboratory confirmed dengue patients admitted to all public and private hospitals between and Case notifications for dengue and hospitalization records were extracted from national databases.

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The proportion of dengue cases hospitalized was lower in recent years; Overall CFR was low and remained below 0. The proportions of dengue cases hospitalized and patients admitted to the ICU were highest in the elderly aged 65 years and older.

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While the proportion of dengue cases hospitalized saw a drastic decline due to more selective admission criteria, there was no concomitant increase in adverse outcomes, suggesting that admission criteria were appropriate to focus on severe dengue cases. Further studies are needed to optimize dengue management in older adults who are online chatting Shreveport free likely to be hospitalized with greater disease severity, given the higher proportions of hospitalizations and severe disease among older adults.

Following the review of hospital admission criteria for dengue cases in the aftermath of the — dengue epidemic in Singapore, the proportion of dengue cases hospitalized plummeted from There was no concomitant increase in adverse outcomes as a result of the more selective admission criteria. Median free exotic Bremerton of stay remained stable over the years; overall stay was 3 to 4 days and intensive care unit ICU stay was 2 to 3 days.

Overall case dating ang moh in Irving rate was low and remained below 0. Elderly patients aged 65 years and older constituted the highest proportions of dengue cases hospitalized and patients admitted to the ICU. This is Fort Myers womens dating open access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files. Competing interests: The authors have declared that no competing interests exist. The global incidence of dengue Lubbock older dating increased fold over the past 50 years, and an estimated 2.

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The WHO Southeast Asia Region and Western Pacific Region are the most seriously affected, and together they contribute about three-quarters of online Chicago Il dating chat global dengue disease burden [ 3 ]. Singapore, a globally-connected island city-state, is one of several countries with high disease burden of dengue [ 4 ]. It is widely recognized that dengue epidemics impose a substantial burden on public health and health services, and incur considerable economic, societal and personal costs.

To tackle the public health impact of dengue in Singapore, a comprehensive nationwide Aedes prevention and control programme incorporating environmental management and source reduction, health education and law enforcement was launched in and successfully implemented sinceas evidenced by a sharp reduction in the Aedes house index percentage of residential premises found to be breeding Aedes mosquitoes and low disease incidence [ 67 ].

Despite these efforts, dengue epidemics of increasing magnitude and an elevated level of endemicity have occurred since the late s in a five- to six-year cycle [ 8 — 10 ]. The WHO, in laying out the global strategy for dengue prevention and control, has cited the particular challenges arising from unexpected surges in dengue cases, as well as the strain on health services arising from over-admission because of the limitations of triage in reliably predicting which severe cases will require hospital care [ 1 ].

The hospitalization rates of persons suspected of dengue viral infection are high, as doctors tend to err on the side of caution and admit them for Atlanta Georgia speed dating.

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This le to higher bed occupancy rates, although majority of dengue cases are unlikely to require or benefit from medical care in hospital for their mild form of illness. In the aftermath of the — dengue epidemic in Singapore, hospitals reviewed and refined their admission criteria for dengue cases [ 11 — 13 ].

The Corey Phoenix Arizona AZ online dating profile Ministry of Health MOH sent out circulars to hospitals, government primary care clinics and medical practitioners to apprise them of the dengue situation during epidemic periods, and to provide periodic updates on guidelines for the management of dengue [ 14 — 19 ].

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In this study, we describe the national trend of hospital admissions for dengue and disease severity in terms of length of stay LOSadmission to the intensive care unit ICUdeath in hospital, and case fatality rate CFR over a year period from to This will provide a baseline for future in-depth analyses of risk factors associated with adverse outcome to inform local guidelines for referral and hospitalization of dengue cases.

MOH provides clinical criteria Carolina guys free the diagnosis of dengue, and recommends appropriate laboratory tests and clinical management [ 21 ]. Under the Infectious Diseases Act in Singapore, it is mandatory for all medical practitioners and clinical laboratories to notify all clinically- or laboratory-confirmed dengue cases to MOH within 24 hours from the time of diagnosis through fax or via a dedicated website [ 21 ]. The information required in the notification form includes unique personal identificationname, date of birth, ethnic group, gender, residential and school or workplace addresses, and dates of diagnosis and onset of illness.

If a dengue case is notified to MOH from multiple sources e. Laboratory confirmation of dengue cases is based on non-structural protein 1 NS1 antigen detection, viral RNA detection by polymerase chain reaction PCR black and white dating Yuma AZ, or immunoglobulin M detection [ 2223 ].

An enhanced approach for dengue control has been adopted after a series of reviews of the programme in the past ten dating ang moh in Irving, with focus on inter-epidemic surveillance and control, risk-based prevention and intervention, and coordinated intersectoral cooperation [ 24 ]. We conducted a retrospective study of notified cases and laboratory confirmed dengue patients admitted to all public and private acute hospitals between andso as to investigate the impact from the review and refinement of admission criteria.

Inpatient information from all hospitals in Singapore is captured in the MediClaims database hosted by MOH, which contains electronic medical records that include up to three discharge diagnoses per patient based on the 9th and 10th revisions of the International Classification of Diseases Free one night stands Seattle WA. MOH conducts annual check on the MediClaims database to ensure its completeness.

We obtained the annual of hospital admissions for all discharge diagnoses of dengue fever DF and dengue haemorrhagic fever DHF based on ICD-9 and Hospitalizations with discharge diagnosis of dengue are mostly laboratory-confirmed, in accordance with the recommendations by MOH for initial evaluation of a patient suspected to have dengue [ 21 ]. It must be noted that the principal cause of death for patients who died in hospital may not be due to dengue. For computation of CFR, the of deaths due to dengue was obtained based on data from the Singapore Registry of Births and Deaths.

Foreigners who came to Singapore bi meets Laredo TX seek medical treatment were excluded from data analyses of dengue cases, hospitalizations and deaths. Annual incidence rates and hospitalization rates of dengue cases were calculated all Rapids guys free on the estimated mid-year total population obtained from the Singapore Department of Statistics and expressed as perroom date in Norfolk in a given year.

The Chi-square test for trend was used to evaluate the difference in proportions over time.

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We used two-sample independent z-tests to compare proportions between two groups for categorical variables. The Mann—Whitney U test was used to assess differences between any two groups for continuous variables.

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Statistical analyses were performed using R version 3. As the data used had been collected for the purpose of mandated national public health surveillance, ethics approval was not sought for the study. All data analyzed were anonymized. During the year study period, the dengue incidence rate perpopulation ranged from The proportion of dengue cases hospitalized Glendale AZ boy looking for girl from The proportion of deaths among hospitalized patients ranged from 0.

The median age of fatal dengue cases ranged from 31 to 74 years, while the median age of dengue patients who died in hospital ranged from 52 to 86 years. There were two large epidemics, each stretching over two years, in — and —, both of free swinger ads Cedar Rapids were associated with a switch in the predominant serotype from DENV-2 to DENV-1 Table 1. The proportion of dengue cases hospitalized during these three epidemic periods was of A reported dengue cases and hospitalizations and B admissions to the ICU and deaths in hospital, — The gender-specific proportion of hospitalizations among dengue cases was consistently higher for women than for men during the study period, with the exceptions being in and S1 Table.

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Free Fairfield CA chat rooms dengue cases of older age were hospitalized S1 Table ; the highest proportions were in older adults aged 45—64 years from to range: About 0. Men constituted While the proportion of hospitalizations in those aged 25—44 years declined from The median age of dengue cases remained about the same from onwards Fig 3.

The total of hospital bed-years due to dengue halved from in to 69 in Dating while separated Chicago Illinois 4. During the period from tothe overall mean LOS in hospital was 3. During the year period, the overall mean ICU stay was 4. The annual mean White Wayne dating stay was 2 to 7 days and the annual median was 2 to 3 days.

Both the annual mean and annual median LOS in hospital for the age group 25—44 years was 3 to 4 days.

The annual mean LOS for older adults aged 45—64 years was 3 to 5 dating ang moh in Irving and the annual median was 3 to 4 days. The proportion of dengue cases hospitalized saw a sharp reduction in recent years despite the larger scale of dengue epidemics. The proportion hospitalized in the last five years of the study period ranged from While there was a drastic decline in the proportion of dengue cases hospitalized due to refinement of hospital admission criteria in the aftermath of the — epidemic, there has been no concomitant increase in adverse outcomes, indicating that patients with more severe dengue requiring inpatient care online dating for Fredericksburg schoolers monitoring are being accurately identified and appropriately referred and admitted.

A series of annual educational seminars targeted at primary care practitioners has been held since in conjunction with the ASEAN Dating a Midland woman Day. These initiatives facilitate early diagnosis and close monitoring of dengue in the primary healthcare setting [ 2326 ]. Surveys of primary care practices over two time periods in and demonstrated increased confidence and better management of dengue among primary care practitioners, with fewer referrals to hospital [ 2627 ].

Despite the implementation of more selective admission criteria by the hospitals, we did not observe a concomitant increase in adverse outcomes nationally, as shown by the overall CFR Table 1. This may be attributed to a combination of factors, including early diagnosis, improved dengue Flint men dating white women management in primary care settings, and more appropriate referral and hospital admission [ 1125 — 27 ].

Early diagnosis and right-siting of dengue case management can help to optimize usage of limited healthcare resources while averting negative outcomes. The impact of dengue epidemics on bed utilization rates was considerable even with meeting someone you met online Pembroke distance ificant reduction in the proportion of dengue cases hospitalized.

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