Management of dengue in Australian travellers: a retrospective multicentre analysis

Alex YC Tai, Sarah L McGuinness, Roselle Robosa, David Turner, G Khai Lin Huang, Karin Leder, Tony M Korman, Irani Thevarajan, Andrew J Stewardson, Alexander A Padiglione and Douglas F Johnson
Med J Aust 2017; 206 (7): 295-300. || doi: 10.5694/mja16.01056


Objectives: To describe the epidemiology, clinical and laboratory features and outcomes of dengue in returned Australian travellers, applying the revised WHO dengue classification (2009) to this population.

Design, setting and participants: Retrospective case series analysis of confirmed dengue cases hospitalised at one of four Australian tertiary hospitals, January 2012 – May 2015.

Main outcome measures: Clinical features, laboratory findings and outcomes of patients with dengue; dengue classification according to 2009 WHO guidelines.

Results: 208 hospitalised patients (median age, 32 years; range, 4–76 years) were included in the study. Dengue was most frequently acquired in Indonesia (94 patients, 45%) and Thailand (40, 19%). The most common clinical features were fever (98% of patients) and headache (76%). 84 patients (40%) met the WHO criteria for dengue with warning signs, and one the criteria for severe dengue; the most common warning signs were mucosal bleeding (44 patients, 21%) and abdominal pain (43, 21%). Leukopenia (176 patients, 85%), thrombocytopenia (133, 64%), and elevated liver enzyme levels (154, 76%) were the most common laboratory findings. 46 patients (22%) had serological evidence of previous exposure to dengue virus. WHO guidelines were documented as a management benchmark in ten cases (5%); 46 patients (22%) received non-steroidal anti-inflammatory drugs (NSAIDs).

Conclusions: A significant proportion of returning Australian travellers hospitalised for dengue have unrecognised warning signs of severe disease. Many received NSAIDs, which can increase the risk of haemorrhage in dengue. As travel to Asia from Australia continues to increase, it is vital for averting serious outcomes that clinicians can recognise and manage dengue.

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  • Alex YC Tai1
  • Sarah L McGuinness2
  • Roselle Robosa3
  • David Turner4
  • G Khai Lin Huang2
  • Karin Leder4,5
  • Tony M Korman3
  • Irani Thevarajan4
  • Andrew J Stewardson1
  • Alexander A Padiglione3
  • Douglas F Johnson1,6

  • 1 Austin Health, Melbourne, VIC
  • 2 Royal Darwin Hospital, Darwin, NT
  • 3 Monash Infectious Diseases, Monash Health and Monash University, Melbourne, VIC
  • 4 Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, VIC
  • 5 Monash University, Melbourne, VIC
  • 6 University of Melbourne, Melbourne, VIC



We thank Mike Catton, Director of the Victorian Infectious Diseases Reference Laboratory (VIDRL), for helping provide us with data for dengue cases at the three Victorian study sites (Austin Health, Monash Health and Melbourne Health).

Competing interests:

No relevant disclosures.

  • 1. World Health Organization. Neglected tropical diseases [website]. 2016. (accessed Feb 2017).
  • 2. World Health Organization. Global strategy for dengue prevention and control 2012–2020. Geneva: WHO, 2012. (accessed Feb 2017).
  • 3. Knope K, National Arbovirus and Malaria Advisory Committee, Giele C. Increasing notifications of dengue in Australia related to overseas travel, 1991 to 2012. Commun Dis Intell Q Rep 2013; 37: E55-E59.
  • 4. Australian Government, Department of Health. National notifiable diseases: Australia’s notifiable diseases status: annual report of the National Notifiable Diseases Surveillance System [website]. Updated Apr 2016. (accessed Feb 2017).
  • 5. Russell RC, Currie BJ, Lindsay MD, et al. Dengue and climate change in Australia: predictions for the future should incorporate knowledge from the past. Med J Aust 2009; 190: 265-268. <MJA full text>
  • 6. Australian Bureau of Statistics. 3401.0. Overseas arrivals and departures, Australia, Jun 2015 [website]. Aug 2015. (accessed Feb 2017).
  • 7. Cobelens FG, Groen J, Osterhaus AD, et al. Incidence and risk factors of probable dengue virus infection among Dutch travellers to Asia. Trop Med Int Health 2002; 7: 331-338.
  • 8. Potasman I, Srugo I, Schwartz E. Dengue seroconversion among Israeli travelers to tropical countries. Emerg Infect Dis 1999; 5: 824-827.
  • 9. Baaten GG, Sonder GJ, Zaaijer HL, et al. Travel-related dengue virus infection, the Netherlands, 2006–2007. Emerg Infect Dis 2011; 17: 821-828.
  • 10. Ratnam I, Black J, Leder K, et al. Incidence and seroprevalence of dengue virus infections in Australian travellers to Asia. Eur J Clin Microbiol Infect Dis 2012; 31: 1203-1210.
  • 11. Cohen S, Halstead S. Shock associated with dengue infection. I. Clinical and physiologic manifestations of dengue hemorrhagic fever in Thailand, 1964. J Pediatr 1966; 68: 448-456.
  • 12. World Health Organization. Dengue haemorrhagic fever. Diagnosis, treatment, prevention and control. 2nd edition. Geneva: WHO, 1997. (accessed Feb 2017).
  • 13. Phuong C, Nhan N, Kneen R, et al. Clinical diagnosis and assessment of severity of confirmed dengue infections in Vietnamese children: is the World Health Organization classification system helpful? Am J Trop Med Hyg 2004; 70: 172-179.
  • 14. Balmaseda A, Hammond S, Perez M, et al. Assessment of the World Health Organization scheme for classification of dengue severity in Nicaragua. Am J Trop Med Hyg 2005; 73: 1059-1062.
  • 15. Alexander N, Balmaseda A, Coelho IC, et al. Multicentre prospective study on dengue classification in four South-east Asian and three Latin American countries. Trop Med Int Health 2011; 16: 936-948.
  • 16. World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention and control. New edition. Geneva: WHO, 2009. (accessed Feb 2017).
  • 17. Basuki PS, Budiyanto, Puspitasari D, et al. Application of revised dengue classification criteria as a severity marker of dengue viral infection in Indonesia. Southeast Asian J Trop Med Public Health 2010; 41: 1088-1094.
  • 18. Barniol J, Gaczkowski R, Barbato E, et al. Usefulness and applicability of the revised dengue case classification by disease: multi-centre study in 18 countries. BMC Infect Dis 2011; 11: 106.
  • 19. Hoffmeister B, Suttorp N, Zoller T. The revised dengue fever classification in German travelers: clinical manifestations and indicators for severe disease. Infection 2015; 43: 21-28.
  • 20. Wieten RW, Vlietstra W, Goorhuis A, et al. Dengue in travellers: applicability of the 1975–1997 and the 2009 WHO classification system of dengue fever. Trop Med Int Health 2012; 17: 1023-1030.
  • 21. Tai A, Robosa R, Padiglione AA, et al. Dengue fever in travellers: are we missing warning signs of severe dengue in a non-endemic setting? Med J Aust 2016; 204: 267. <MJA full text>
  • 22. Warrilow D, Northill JA, Pyke AT. Sources of dengue viruses imported into Queensland, Australia, 2002–2010. Emerg Infect Dis 2012; 18: 1850-1857.
  • 23. Anantapreecha S, Chanama S, A-nuegoonpipat A, et al. Serological and virological features of dengue fever and dengue haemorrhagic fever in Thailand from 1999 to 2002. Epidemiol Infect 2005; 133: 503-507.
  • 24. Sangkawibha N, Rojanasuphot S, Ahandrik S, et al. Risk factors in dengue shock syndrome: a prospective epidemiologic study in Rayong, Thailand. I. The 1980 outbreak. Am J Epidemiol 1984; 120: 653-669.
  • 25. Ratnam I, Leder K, Black J, Torresi J. Dengue fever and international travel. J Travel Med 2013; 20: 384-393.
  • 26. Halstead SB. Dengue in the Americas and Southeast Asia: do they differ? Rev Panam Salud Publica 2006; 20: 407-415.
  • 27. Trojanek M, Maixner J, Sojkova N, et al. Dengue fever in Czech travellers: a 10-year retrospective study in a tertiary care centre. Travel Med Infect Dis 2016; 14: 32-38.
  • 28. Tavakolipoor P, Schmidt-Chanasit J, Burchard GD, Jordan S. Clinical features and laboratory findings of dengue fever in German travellers: a single-centre, retrospective analysis. Travel Med Infect Dis 2016; 14: 39-44.
  • 29. Webb CE. Are we doing enough to promote the effective use of mosquito repellents? Med J Aust 2015; 202: 128-129. <MJA full text>


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