| Summary: | 碩士 === 國立臺灣大學 === 公共衛生碩士學位學程 === 102 === Background and Objectives: Dengue fever is an important infectious disease in southern Taiwan. If complicated with dengue hemorrhagic fever, dengue can lead to death. Currently, the pathogenesis of dengue hemorrhagic fever has not yet been fully understood. The goal of this study was to examine the risk factors of progression to dengue hemorrhagic fever after acquiring dengueinfection, and the predictors of mortality after developing dengue hemorrhagic fever, using epidemiologic study methods.
Method: All of the confirmed indigenous dengue fever and dengue hemorrhagic fever cases reported to notificable infectious diseases surveillance system during 2003-2013 were included in this study. The study was divided into two parts. (1) Case-control study that was aimed to examinethe risk factors of progression to dengue hemorrhagic fever after acquiring dengueinfection. Cases included all notified patients with dengue hemorrhagic fever during the study period. Controls were randomly selected from all notified patients with dengue but without hemorrhagic fever during the same period, individually matched by onset month and residential country in 1:4 ratio. (2) Cohort study that retrospectively tracked the outcomes of all notified patients with dengue hemorrhagic fever toanalyze the predictors of mortality.
Result: A total of 142 dengue hemorrhagic fever cases and 568 controls were included in the case-control study. Multivariate conditional logistic regression analysis showed that age over 60 years (OR = 4.53, P <0.0001) and infection by type 2 dengue virus (OR = 5.39, P = 0.0081) were two independent risk factors for progression to dengue hemorrhagic fever after acquiring dengueinfection.The 142 dengue hemorrhagic fever cases were included in the cohort study. There were 42 deaths. Multivariate conditional logistic regression analysis showed that the age over 60 years (OR = 3.21, P <0.027) and diabetes mellitus (OR = 3.08, P <0.005) were the twoindependent predictors of mortality after developing dengue hemorrhagic fever.
Conclusion: These results enhance our understanding on risk factors and prognostic factors of dengue hemorrhagic fever, and will enablepublic health authority to focus the control effort on the most vulnerable groups. Knowledge on risk factors and prognostic factors will also enable communities and health care professionals to better coordinate the effort on environmental cleansing, personal protection, early diagnosis and treatment of dengue hemorrhagic fever to minimize the dengue-associated morbidity and mortality.
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