Singaporean adults diagnosed with dengue fever face a significantly elevated risk of hospitalization and long-term disability for up to two years post-infection, according to a new study published this week in JAMA Network Open. Researchers analyzing national health data found that dengue infection was associated with increased risks of cardiovascular, neuropsychiatric, autoimmune, kidney, endocrine and gastrointestinal conditions.
The retrospective cohort study, led by Chow JY and colleagues, included 68,145 individuals with a first-time dengue diagnosis between January 1, 2013, and June 30, 2022. These cases were meticulously matched with over 2.8 million controls who had no recorded dengue infection. The analysis employed overlap weighting to ensure a balanced comparison between the groups.
The study revealed a higher risk of all-cause hospitalization over the two-year follow-up period for those infected with dengue. Beyond hospitalization, investigators quantified the disability burden using disability-adjusted life years (DALYs), estimating 1,670 excess DALYs attributable to post-acute sequelae. This translates to 2.52 DALYs per 100 dengue infections. Neuropsychiatric sequelae were the largest contributor to this burden, followed by endocrine, kidney, and gastrointestinal complications.
While risks for several organ system outcomes diminished during the second year of follow-up, elevated risks persisted for all-cause hospitalization and specific complications, including neuropsychiatric, kidney, and gastrointestinal issues. The burden of these long-term effects was particularly pronounced among older adults, individuals with pre-existing comorbidities, and those residing in public housing.
The findings underscore the lasting health consequences of dengue fever, even beyond the acute phase of the illness. Singapore has experienced significant dengue outbreaks in recent years, including a peak of over 20,000 cases in 2013 and a substantial surge in 2022, with over 31,892 reported infections, according to the National Environment Agency (NEA). The 2013 outbreak saw 22,170 cases and 8 deaths, surpassing previous records at the time. A more recent study published in 2023 highlighted the challenges of managing dengue outbreaks amidst the COVID-19 pandemic.
The researchers noted that the circulation of the DENV-3 strain of the dengue virus in 2022, a serotype to which the population had lower immunity, contributed to the increased case numbers. The seasonal pattern of dengue infection in Singapore typically peaks in July, coinciding with the onset of the Southwest Monsoon season, according to research published in ScienceDirect.
The study’s authors did not offer immediate recommendations for clinical practice or public health intervention. The NEA has not yet released a statement responding to the findings.
