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Background: Dengue is the most widespread aedes mosquito borne viral disease which infects more than 50 million people every year. The clinical symptoms of dengue may vary from mild fever to life-threatening incidents. Eltrombopag, a non-peptide, oral TPO-R agonist, small molecular weight is quandaries with the transmembrane domain of a TPO receptor and persuades the Janus Kinase/Signal transducer and activator of transcription pathway, with a significant rise in platelet production.Material & Methods:This study was a cross-sectional observational study which was conducted at Tairunnesa Memorial Medical College and Hospital (TMMCH), Gazipur and Shin Shin Japan Hospital, Uttara, Dhaka. The study was conducted in between July 2021- December 2021. The sample size for this study was 100.Results:The mean age in group 1 was 25� in group 2 29�and in control group 29� The mean Baseline PLT * 109 /L for group 1 was 57�, for group 2, 51� and for control group 54�. Mean of systolic baseline BP (mmHg) for group 1 was 103.55� 5.04 for group 2 was 105.38�.34 and for control group was 101.97�28 and followed by the mean of diastolic baseline BP (mmHg) was 72.83�56, 72.84�.93 and 71.97�75. AEs was found in 4(12.1%) cases of group 1 where in group 2 it was 2(5.9%) and in control group was 3(9.1%). In day 7, the recovery rate of group 1 was 93.9% and in group 2 the recovery rate was 94.1%.Conclusions:Dengue is a vector-borne viral disease which needs medical assistance because it may lead to life-threatening outcome. Eltrombopag can be considered as a therapeutic option to increase the PLT counts in DF and DHF patients in the management of thrombocytopenia.
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Background: Dengue fever has become a major public health concern in our country, causing significant morbidity and mortality. Because there is no definite drug or commercially available vaccine for dengue, prevention is the only option. As a result, early reporting of dengue cases is required in order to implement preventive measures before the disease spreads to epidemic proportions. Therefore, healthcare providers should notify every dengue incident to local authorities in the current format, including the District Health Officer or Chief Medical Officer of district concerned and the Municipal Health Officer of municipality concerned every week (daily during the transmission period). Materials and Methods: The data on dengue (2015-2021 till Oct.) was available at the National Vector Borne Disease Control Programme under the Ministry of Health & Family Welfare, Government of India, and has been used in this paper. Results and discussion: During the last two decades (2000-2009 and 2010-2019), significant geographical spread of the dengue has been experienced in India with the repeated outbreaks, and an 11 fold increase in number of cases. Despite an increase in the incidence of dengue fever, the case fatality rate in India has decreased from 3.3% in 1996 to 0.4% in 2010 to 0.1% in 2019. Early diagnosis and timely referral play a critical role in bringing down Case Fatality Rate (CFR). Conclusion: Dengue is a manifestation arising from the process of increasing vector density and adaptation to human habitation, as well as human lifestyle transformation, unplanned developmental activities exacerbated by climate change.
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Rationale: Dengue fever is a viral infection that is spread through the bites of infected female Aedes mosquitos. It can cause life threatening complications, including dengue haemorrhagic fever (DHF) and dengue shock syndrome. Patient concerns: A 15-year-old male presented with fever and petechiae and later developed hemoptysis. Diagnosis: Dengue fever with DHF with diffuse alveolar hemorrhage. Interventions: Invasive ventilation with high positive end expiratory pressure, multiple transfusions of packed red blood cells, fresh frozen plasma, single donor platelets and inotropic support Outcomes: The patient was stabilized and discharged on minimal supplemental oxygen. Lessons: Diffuse alveolar hemorrhage, although very rare, should be considered in a patient with dengue who presents with hemoptysis. The treatment is directed at providing respiratory and circulatory support, and preventing the progression of microcirculation damage.
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In many parts of India, Dengue has become a major public health problem and Kalaburagi District in North Karnataka region was previously not known to be an endemic area for dengue. Three clinical syndromes, classic dengue fever, dengue haemorrhagic fever and dengue shock syndrome are seen with dengue virus infection. This present study was undertaken to find out whether platelet count really influences the outcome of dengue patients in a tertiary health care centre in Kalaburagi, Karnataka.METHODSAbout hundred patients admitted in our hospital with positive Dengue NS1 and Dengue IgM were selected. The follow up of patients is done from the onset of fever to up to twelve days or until their recovery according to discharge criteria of WHO whichever of them is earlier.RESULTSIn this study, 100 cases were studied, out of which Dengue fever was seen in 73 cases, Dengue Hemorrhagic Fever in 17 cases and Dengue Shock Syndrome in 10 cases was seen based on WHO criteria. In this study, 99 percent patients had fever. In this study 73 percent of patients were Dengue NS1 Positive and 27 percent of patients were Dengue IgM Positive. In present study, continuously increasing pattern of platelet count was seen in 55 percent cases; initial fall then rise of platelet count was seen in 38 percent cases and persistently low pattern of platelet count was seen in 7 percent cases. This study showed that 30 percent of patients had bleeding manifestations and bleeding manifestations were maximum in patients having low platelet counts. In the present study, 92% cases improved and 8% cases expired.CONCLUSIONSAmong the three clinical syndromes, Dengue fever was more common than dengue haemorrhagic fever and dengue shock syndrome. It was found that platelet count influenced the outcome of dengue patients. Management of dengue case is mainly supportive
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Background: Dengue fever caused by dengue virus is a self-limiting acute febrile illness transmitted by Aedes aegypti, a daytime biting mosquito. Dengue virus belongs to family of Flaviviridae and there are 4 serotypes. A fifth serotype DENV-5 was isolated in 2013 which was said to cause mild form of the disease. In 2019 total numbers of dengue cases are 10,524 in Karnataka which is 138% increase over 2018 (4,427 cases).Methods: A retrospective conducted in Yenepoya Medical College hospital from January 2017 to July 2019 for a period of 2' years. Medical records of children who were diagnosed with dengue fever were retrieved and analyzed. Clinical and laboratory findings were noted down. Clinical course and outcome were noted down from the case sheet and cases were classified as per WHO 2011 classification.Results: 97 children diagnosed with dengue fever were included in the study. Common age group was 5-15 years. 49.5% had dengue fever, 40.2% had dengue haemorrhagic fever (DHF) and 10.3% had expanded dengue syndrome. Fever was the main complaint. Children with dengue fever presented with vomiting, abdominal pain, myalgia, arthralgia in descending order of frequency. Children with DHF, petechiae were seen in 38% patients. Among bleeding manifestations, epistaxis was more common. Children with expanded dengue syndrome had atypical manifestations.Conclusions: Dengue fever like any other viral illness, presents with prodromal symptoms which should be picked up at the earliest with high index of suspicion in children coming from endemic area. Identification of atypical manifestations and co-infections at the earliest and prompt treatment avoids serious life-threatening complications.
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Background: Dengue fever has become one of the major public health problems in all developing countries. It is essential to create awareness among people as it can be prevented by simple practices. The study was conducted to find the awareness among the people thus determining the need to educate the people regarding the preventive measures of dengue fever.Methods: This was a cross-sectional community-based study conducted among the outpatients and their attenders visiting a Rural Health Training Center of private Medical College and Hospital, belonging to Alandur block in Kancheepuram district, Tamil Nadu during January 2019 to March 2019. 260 subjects within the age group of 18 to 82 years were selected by convenient sampling method. The data was collected by interviewing and by using questionnaires. Analysis of the structured data was done using SPSS software version 16.Results: The study included 260 respondents who gave their consent for the study. 60.8% of the study group were males. Mean age of the study group was 35.36 years. 58.1% of the individuals were educated more that 10th standard. Knowledge about the mode of transmission was correctly stated by 85.8%. Around 15% were not aware of breeding places of mosquitoes.Conclusions: From this study it was evident that there is a definite gap in understanding the various aspects of dengue fever. Thus, we conclude that regular awareness programs should be conducted in the form of campaigns and house visits to create awareness among all individuals.
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Background: As an arthropod-borne viral disease, dengue epidemics has created much public health hazards in tropical countries. In the national capital of India, there has been more than six epidemics. Dengue remains a notifiable disease in India. It is important that we understand the changing clinicopathological profile of this viral infection to prepare ourselves better for any impending future epidemic. This study done at a tertiary care center looks into the recent epidemics to understand the changing trends in the disease profile in two phases of three years each. Further, authors also assessed the utility of the tourniquet test in dengue syndrome.Methods: 260 serologically confirmed patients were recruited in two phases of the study. We evaluated them for clinical, epidemiological and pathological profile of dengue and trends in haematological, biochemical and radiological parameters during the course of the disease and its correlation with the severity of the disease.Results: Fever, headache, body ache, pharyngeal and conjunctival congestion, rhinitis, rash and diarrhea incidences were similar in both epidemics. Lymphadenopathy was seen in 18(18%) patients compared to 40(25%) in the second epidemic. More number of hemorrhagic manifestations with GI and retinal bleed was seen compared to earlier epidemics, which had higher liver involvement.Conclusions: Although the presentation of the disease has not shown a drastic change over the last decades, the severity varies depending on the predominant serotype. Patients with evidence of serositis, increased activated lymphocytes has a longer course in disease with poorer outcome. Early rising haematocrit, ALT/AST ratio, LDH and deranged coagulation parameters are important tools in triaging patients for priority of urgent care and hospitalization in a scenario of a future outbreak.
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Crimean-Congo Haemorrhagic Fever (CCHF) is caused by infection with a tick-borne virus (Nairovirus) in the family Bunyaviridae, causing severe and often fatal haemorrhagic fever in humans. CCHF is pervasive, now found in Europe, Asia, Africa, the Middle East and the Indian subcontinent. CCHF spreads to humans either by tick bites or by contact with blood and tissues from infected animals or humans. CCHF outbreaks constitute a threat to public health services because of its epidemic potential, its high case fatality ratio (10-40%), and its potential for nosocomial outbreaks and its quandaries in treatment and prevention. It is characterized by sudden onset with initial sign symptoms including fever, chills, agitations, myalgia, headaches, vomiting, abdominal pain, arthralgia, ecchymosis, melena, haematuria, nose bleeding, vaginal bleeding, bradycardia, thrombocytopenia. It is diagnosed by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) assay, ELISA test, antigen detection tests. Overall supportive therapy is the mainstay of patient management in CCHF. Seriously ill patients require intensive care. Ribavirin for the treatment of CCHF cases it is most effective, if administered very soon after the onset of clinical signs (e.g., during the first 48 hours). Prevention should be taken which reduce risk of tick to human transmission and human to human transmission.
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Background: Dengue fever is one of the major public health problems among all the vector born diseases. It is an emerging disease of tropical and sub-tropical regions, affecting urban, peri-urban and rural areas. Twenty five cases of dengue fever were reported in our hospital and other private hospitals from Undera village, which is in the peri urban area of Vadodara, so an investigation was carried out. The objective of this study is to find out the incidence and demographic details of people affected by fever during the outbreak and to find the environmental factors responsible for the outbreak.Methods: Community based, cross-sectional, direct interviewing of community members of Undera village in Vadodara district was carried out on 21st August 2017 and 23rd August 2017.Results: In this outbreak investigation, 219 fever cases were reported from 2930 population residing in 645 houses. There were 25 confirmed cases of dengue fever, out of which three deaths were reported. This included one pregnant woman during this outbreak. Seventy percent of fever cases were in the age group 0-30 years. Daily wagers were affected more than other occupations. At least one fever case was reported from 109 houses. Breeding places for mosquitoes were observed surrounding the houses from were fever cases reported.Conclusions: The dengue fever outbreak was confirmed through laboratory as well as clinico-epidemiological correlation with confirmed clinical picture and presence of breading places of Aedes mosquitoes. The fatality rate was 12% and there were three complicated deaths.
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Introduction: Dengue fever is the most common mosquitoborne viral illness in humans. Study was done to determinethe serum levels of pro -inflammatory cytokines (IL-6,IFgamma and TNF alpha) in patients with dengue infection andto determine the correlation of level of cytokine with diseaseseverity, platelet count and SGOT values.Material and methods: Preserved samples of patients withthe clinical features compatible with dengue infection andNSI antigen positivity admitted during the month of Mayand June 2016 in Pushpagiri Institute of Medical science andResearch Centre, Thiruvalla were analysed for levels of pro-inflammatory cytokines (IL-6, IF gamma, and TNF alpha).Disease severity of Dengue patients was assessed from theclinical details obtained from medical records. Total samplesused in this study were 80 of which 49 were patients withdengue fever,11 were patients with severe dengue,10 werepatients with other febrile illness and 10 are from healthyindividuals.Results: The levels of all three cytokines were found to beelevated in the infected groups (dengue and severe dengue)when compared to the control groups (healthy and nondengue). The level of interleukin 6 and TNF alpha were foundto be significantly elevated (p value <0.05) in the severe formof dengue. However no statistically significant difference(p value <0.05) between the infected and control group wasfound in Interferon gamma although it showed an elevation inthe infected group. It was observed that all the three cytokinesshowed a negative correlation with platelet count.Conclusions: IL6 and TNF alpha correlated with diseaseseverity suggesting that these cytokines can be used as amarker to predict the severity of the disease. Thus, necessarytreatments and precaution can be taken in advance. TNFalpha correlated with the degree of thrombocytopenia and IL6correlated with level of SGOT.
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Introduction: Dengue fever is the most common mosquitoborne viral illness in humans. Study was done to determinethe serum levels of pro -inflammatory cytokines (IL-6, IFNgamma and TNF alpha) in patients with dengue infectionand to determine the correlation of level of cytokine withdisease severity, platelet count and SGOT values.Material and methods: Preserved samples of patients withthe clinical features compatible with dengue infection andNSI antigen positivity admitted during the month of Mayand June 2016 in Pushpagiri Institute of Medical science andResearch Centre, Thiruvalla were analysed for levels of pro-inflammatory cytokines (IL-6, IFN gamma, and TNF alpha).Disease severity of Dengue patients was assessed from theclinical details obtained from medical records. Total samplesused in this study were 80 of which 49 were patients withdengue fever,11 were patients with severe dengue,10 werepatients with other febrile illness and 10 are from healthyindividuals.Results: The levels of all three cytokines were found to beelevated in the infected groups (dengue and severe dengue)when compared to the control groups (healthy and nondengue). The level of interleukin 6 and TNF alpha were foundto be significantly elevated (p value <0.05) in the severe formof dengue. However no statistically significant difference(p value <0.05) between the infected and control group wasfound in Interferon gamma although it showed an elevation inthe infected group. It was observed that all the three cytokinesshowed a negative correlation with platelet count.Conclusions: IL6 and TNF alpha correlated with diseaseseverity suggesting that these cytokines can be used as amarker to predict the severity of the disease. Thus, necessarytreatments and precaution can be taken in advance. TNFalpha correlated with the degree of thrombocytopenia and IL6correlated with level of SGOT.
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Background: The global incidence of dengue has grown dramatically in recent decade. Half of world’s population is now at risk. India represents significantly a larger burden, accounting for nearly 34% of the global burden of dengue infection. Dengue infection needs to be addressed as a single disease with different clinical presentations ranging from asymptomatic conditions to severe clinical courses that may lead to high morbidity and mortality.Method: This was retrospective observational study carried out during period of July 2017 to April 2018, to study clinical profile and laboratory parameters in dengue fever patients. Confirmed dengue cases having NS1 positive or IgM positive or having both NS1 and IgM positive or dengue ELISA reactive, having minimum one CBC reports done and not having other confounding factor such as co-infection, bone marrow diseases etc. that may altered clinical and laboratory results are included in study. Statistical analysis was done by SPSS software version 18.0.Results: Out of 48 confirmed dengue cases maximum patients 58.33% was from young age group (21 to 40 years) with M:F ratio was 2.43:1. Fever was found in 100% patients, in order of frequency followed by headache, bodyache, abdominal pain, weakness, retro-orbital pain, anorexia, dry cough, back pain, nausea, diarrhoea, vomiting, rash, joint pain, itching and malena.NS1was positive in 41.67% cases, dengue ELISA in 31.25%, IgM was positive in 20.83% cases, and both NS1 and IgM positive were in 4.17% cases. TLC count was low 35.42%, high in 12.50% of cases and remaining had normal TLC count. Platelet count was ranged between normal platelet counts to thrombocytopenia. One case had platelet count less than 20000. Out of 48 patients, 2 (4.17%) had malena.Conclusion: In this study, fever was found in all patients, and headache, body ache and weakness were common symptoms, but significant number of patients also had gastroentstinal and respiratory symptoms like abdominal pain, nausea, diarrhea, vomiting and dry cough. TLC count ranging from normal TLC, leukopenia to leucocytosis. Large number of patients had low platelet count that shows dengue fever had varied clinical presentation.
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Background: Dengue fever is the most rapidly spreading mosquito-borne viral disease in the world.Incidence has increased 230-fold with increasing geographic expansion with potential for further spread. The rapidly expanding global footprint of dengue is a public health challenge with an economic burden. This study's objective is to assess the outbreak of epidemic of dengue fever in a tertiary care children hospital and to describe their socio-demographic, clinical outcome and serological profile.Methods: It is an observational descriptive study conducted for a period of 1 year in less than 12 years old children in a tertiary care hospital at Southern Tamil Nadu.Results: Among the 360 children admitted with dengue fever, there were 198 boys (55%) and 162 (45%) were girls. Maximum incidence of dengue incidence was seen in infants less than 1 year (25%). The highest number of cases were admitted during September and October. The most common affected age group was less than 3 years with 179 (49%). Among the cases, 297 (82%) were of severe dengue which constitute dengue haemorrhagic fever-183(38%) and Dengue shock syndrome 114 (62%). Serological analysis showed NS1 Ag was positive in 144 children (40%), Dengue IgM was positive in 54 children (15%), both IgM and IgG positive in 126 children (35%) and IgG was positive in 36 children (10%). Out of the total children admitted with dengue fever, the case fatality was 0.5% (2 children).Conclusions: This study highlights the importance of WHO clinical criteria for early diagnosis of severe dengue. Moreover, the early and intensive management reduces the mortality significantly.
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Background: Dengue is the most rapidly spreading mosquito-borne viral disease in the world. A number of Dengue Haemorrhagic Fever (DHF) risk factors had been suggested. However, these risk factors may not be generalized to all populations and epidemics for screening and clinical management of patients at risk of developing DHF/ Dengue shock syndrome (DSS).Methods: A hospital based prospective case control study was done by taking 40 cases each of dengue fever with diabetes mellitus, hypertension, diabetes and hypertension and 30 cases of dengue with asthma/COPD and these patients were compared with controls of 100 patients with dengue fever but no comorbidities. All patients had Dengue serology NS1 or IgM positive.Results: Patients admitted with dengue fever with comorbidities had increased duration of hospitalization with P value of 0.012. The clinical outcome of the 250 patients. In the subgroup of dengue fever patients with DM and Dengue fever with DM and HTN, they were noted to have a 2.69 and 3.06 times increased risk effect of DHF.Conclusions: Dengue fever with DM or DM with HTN have a higher risk of developing DHF when compared with patients with dengue fever with no comorbidities. This finding helps us in triaging patients with comorbidities who develop dengue fever for specialized care and closer clinical monitoring.
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Background: Dengue fever is a benign syndrome caused by an arthropod-borne virus and is characterized by Biphasic fever, myalgia, and arthralgia, rash, leucopenia, and lymphadenopathy. Dengue hemorrhagic fever and dengue shock syndrome are a severe, often fatal febrile disease caused by 1 of 4 dengue virus. It is characterized by increased capillary permeability, abnormalities of hemostasis and protein-losing shock syndrome. The aim of this study was to assess the clinical profile, complications and outcome of dengue infection in children.Methods: All children attending the hospital with symptoms and signs suggestive of dengue fever were tested for NS1 antigen and IgM/ IgG dengue antibody serology (depending on the day of fever) by enzyme-linked immunosorbent assay (ELISA) technique.Results: Of the 174-dengue serology positive children, fever was the most common major symptom (97.7%) followed by vomiting (85.6%), loss of appetite (81.6%), abdominal pain (77%), body pain/leg pain (62.6%). Severe dengue as per WHO criteria was seen in 29 (16.7%) children. Thrombocytopenia (platelet count less 1,00,000) was observed in 82 children (47%), Platelet count less than 20,000 in 8 children (4.5%). Dengue shock syndrome was seen it 26 children (15%). Mortality was nil.Conclusions: In children, if symptoms like fever, vomiting, loss of appetite, abdominal pain and body pain are present, a strong possibility of dengue fever is present especially in an epidemic setting. Early suspicion and effective management can reduce the severity.
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Ebola virus disease (EVD) is associated with haemorrhagic fever in humans and nonhuman primates, with a high rate of fatality (up to 90%). Some outbreaks in human history have proven the lethality of EVD. The recent epidemic of 2014 and 2015 in West Africa was the deadliest of all time (11 284 deaths). To understand the transmission dynamics, we have reviewed the epidemiology of EVD to date. The absence of any licensed vaccines or approved drugs against Ebola virus (EBOV) further highlights the severity and crisis level of EVD. Some organizations (public and private) are making considerable efforts to develop novel therapeutic approaches or vaccines to contain the outbreak of EBOV shortly. Here, we summarized the various potential drugs and vaccines (undergoing multiple phases of clinical trials) that have arisen as an alternative against EBOV, and we highlighted the numerous issues and limitations hindering this process. Alternatively, an increasing focus on strengthening the medical and civic health structure could provide speedy benefits in containing the spread of EVD, as well as offer a resilient foundation for the deployment of novel drugs and vaccines to the affected countries, once such drugs and vaccines become available.
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Ebola virus disease (EVD) is associated with haemorrhagic fever in humans and nonhuman primates, with a high rate of fatality (up to 90%). Some outbreaks in human history have proven the lethality of EVD. The recent epidemic of 2014 and 2015 in West Africa was the deadliest of all time (11 284 deaths). To understand the transmission dynamics, we have reviewed the epidemiology of EVD to date. The absence of any licensed vaccines or approved drugs against Ebola virus (EBOV) further highlights the severity and crisis level of EVD. Some organizations (public and private) are making considerable efforts to develop novel therapeutic approaches or vaccines to contain the outbreak of EBOV shortly. Here, we summarized the various potential drugs and vaccines (undergoing multiple phases of clinical trials) that have arisen as an alternative against EBOV, and we highlighted the numerous issues and limitations hindering this process. Alternatively, an increasing focus on strengthening the medical and civic health structure could provide speedy benefits in containing the spread of EVD, as well as offer a resilient foundation for the deployment of novel drugs and vaccines to the affected countries, once such drugs and vaccines become available.
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Crimean-Congo Hemorrhagic Fever (CCHF) is a disease affecting domestic livestock and wild animals which can spread to humans. It is caused by infection with a tick- borne virus (Nairovirus) in the family Bunyaviridae or by contacting with infected tissues or from animal blood. CCHF cases were recorded from published data from 2013 to 2018 in different geographic regions of Pakistan. The intensity and risk factors were also determined from all four provinces of Pakistan. A total of 391 cases of CCHF have been reported from all over Pakistan during period of 2013-2018. Majority of them were recorded at the time of Eid-ul-Adha. CCHF cases were identified predominantly in Baluchistan (n=12), Karachi (n=5), Bahawalpur (n=2), and Khyber Pakhtunkhwa (n=1). The prevalence of disease were different in different areas of Pakistan (Fata 1%, Islamabad 5%, Punjab 21%, Sindh 8%, KPK 14% and Baluchistan 39%). The political disturbances faced by the Pakistan have increased Pakistan's susceptibility because large number of refugees have migrated to Pakistan from Afghanistan which is an endemic country. Most of the immigrants and their cattles from Afghanistan settled in Khyber, Pakhtunkhwa and Baluchistan provinces which ultimately cause higher prevalence of CCHF in these arears. Currently there is no complete cure or commercially available vaccine of CCHF available in Pakistan. Mostly Ribavirin antiviral drug is used to treat CCHF. The disease can be controlled by implementing preventive measures like avoiding contact with blood of the suspected animal and tick bites.
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Kyasanur forest disease (KFD) is a known viral haemorrhagic fever in India, for the last 60 years. However, in recent years, the change in epidemiological profile of the disease has suggested that it is now time to consider KFD as an emerging tropical disease in India. The preference should be to educate not only the villagers where it is being reported or detected but also to public health experts, veterinarians, forest officials and medical professionals to pay attention while seeing a patient overlapping with endemic diseases such as Japanese encephalitis, West Nile, dengue, chikungunya, malaria and tuberculosis. Although the existence of KFD is known for a long time, updated understanding of its clinical profile in humans is still limited. This article describes in detail the clinical presentation of KFD reported till date. It also highlights geographical distribution of the disease, risk factors for virus transmission, biochemical/haematological findings and control measures. There is an urgent need for research on KFD, particularly for understanding biphasic nature of illness, development of cost-effective diagnostic tools, utility of non-invasive samples for diagnosis and development of new vaccines.
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Dengue remains an unmet public health burden. We determined risk factors for dengue in-hospital mortality in Brazil. Of 326,380 hospitalised dengue cases in 9-45-year-old individuals, there were 971 deaths. Risk of dying was 11-times higher in the presence of underlying common comorbidities (renal, infectious, pulmonary disease and diabetes), similar to the risk of dying from severe dengue and much higher with the combination. Ensuring access to integrated dengue preventative measures in individuals aged ≥ 9 years including those with comorbidities may help achieve the WHO objective of 50% reduction in mortality and 25% reduction in morbidity due to dengue by 2020.