Table 1 Summary of diagnosis criteria and classification for dengue [11]

Issued by

Chinese Ministry of Health

Chinese Ministry of Health

Date issued

23 November 2001

28 February 2008

Date enforced

1 May 2002

1 September 2008

Epidemiologic Linkage

1.1 Living in or travel to a dengue endemic country/region or presence at location with ongoing outbreak within previous 15 days of dengue-like illness, and reported being bitten by mosquito within 5–9 days of illness onset.

1.1 Travel to a dengue endemic country/region within previous 14 days of dengue-like illness.

1.2 Around the place of residence or place of work (e.g. 100 m radius), there have been dengue case(s) within one month.

Clinical description

2.1 Sudden onset, chills and fever (39–40 °C within 24-36 h, a small number of patients showed a biphasic fever), with symptoms such as fatigue, nausea and/or vomiting.

2.2 Aches and pains (e.g., headache, retro-orbital pain, joint pain, myalgia, arthralgia).

2.3 Flushed skin on face, neck and chest, and conjunctival congestion.

2.4 Superficial lymphadenopathy.

2.5 Measles-like rash, scarlatiniform rash, and/or petechiae in the limbs, trunk, head and face in the course of illness (days 5–7); itching; no scaling; continued 3-5d.

2.6 Encephalitis, encephalopathy, or meningitis-like neurological disorders.

2.7 Bleeding tendency (tourniquet test positive): occurs in the course of illness (days 5–8) with gingival bleeding, nose bleeding, gastrointestinal bleeding, subcutaneous hemorrhage, hematuria, hemoptysis, and vaginal bleeding, and/or chest and abdominal cavity bleeding, etc.

2.8 Multiple organ bleeding.

2.9 Liver enlargement.

2.10 Shock.

2.1 Sudden onset, fever (39–40 °C within 24-36 h, someone shows biphasic fever); severe headache, retro-orbital pain, myalgia, arthralgia and fatigue; flushed skin on face, neck and chest, and conjunctival congestion, etc.

2.2 Rash: measles-like rash, scarlatiniform rash, and/or needle-like hemorrhagic rash in the limbs, trunk, head and face in the course of illness (days 5–7); itching; no scaling; continued 3-5d.

2.3 Bleeding tendency (tourniquet test positive): petechia, ecchymoses, purpura and injection site bleeding, or bleeding from the mucous membranes of mouth and nose, gastrointestinal bleeding, hemoptysis, hematuria and vaginal bleeding in the course of illness (days 5–8).

2.4 Massive hemorrhage of gastrointestinal tract, or chest and abdominal cavity bleeding, or intracranial hemorrhage.

2.5 Liver enlargement, pleural or pericardial effusion.

2.6 Shock syndrome: clammy skin, restlessness, rapid and weak pulse and narrow pulse pressure < 20 mmHg (2.7 kPa) and undetectable in blood pressure, oliguria etc.

Diagnosis and Classification

3.1 Thrombocytopenia (<  100 × 109/L). White blood cell count decrease, lymphocytes and mononuclear cell count increase.

3.2 Hematocrit increased more than 20%.

3.3 IgG anti-DENV positive in a serum specimen.

3.4 IgM anti-DENV positive in a serum specimen.

3.5 IgG anti-DENV ≥4-fold rise in titer in paired acute and convalescent serum specimens. The serologic tests included enzyme-linked immunosorbent assay (ELISA), HI, CF, immunofluorescence method (FA/IFA), Dengue blot (DB), and NT.

3.6 Cell culture isolation of DENV by Aedes albopictus C6/36 cell or 1–3 day-old newborn mice; or detection of DENV nucleic acid by RT-PCR; or detection of antigens by monoclonal antibodies immunofluorescence (mbAb-FIA) in serum, cerebrospinal fluid (within 5 days of illness course), other body fluid or tissue.

3.1 A total white blood cell count decrease.

3.2 Thrombocytopenia (<  100 × 109/L).

3.3 Hemoconcentration (an increase in hematocrit ≥20% above average for age or a decrease in hematocrit ≥20% of baseline following fluid replacement therapy); hypoproteinemia.

3.4 IgG or IgM anti-DENV positive in a serum specimen.

3.5 Cell culture isolation of DENV by Aedes

albopictus C6/36 cell or 1–3 day-old newborn mice in acute serum, cerebrospinal fluid, blood, or other tissue specimens.

3.6 IgG anti-DENV ≥4-fold rise in titer in paired acute and convalescent serum samples. The serologic tests included ELISA, mac-ELISA, HI, FA/IFA, NT.

3.7 Detection of DENV nucleic acid by RT-PCR or real-time fluorescence quantitative PCR.

Diagnosis and Classification

4.1 Suspected case: a patient with item 1.1, 2.1 and 2.2, and one of item 2.3 to 2.7, as defined above.

4.2 Probable case: a suspected case with item 3.1 in a confirmed outbreak, or a suspected case with item 3.1 and 3.3 in an unconfirmed outbreak or presented as a sporadic case.

4.3 Confirmed case:

DF: a probable case with one of item 3.4, 3.5 and 3.6.

DHF: a confirmed DF case with item 2.8, 2.9 and 3.2.

DSS: a confirmed DHF case with item 2.10.

4.1 Suspected case: a patient with item 1.1 and 2.1, or a patient with item 2.1, 3.1 and 3.2, as defined above.

4.2 Probable case:

DF: a suspected case with 1.2, 3.1 and 3.2; or a suspect case with item 2.1, 3.1, 3.2 and 3.4.

DHF: a probable case of DF with item 3.2, 3.3 and one of item 2.3 to 2.5.

DSS: a probable case of DHF with item 2.6.

4.3 Confirmed case: a probable case with one of item 3.5 to 3.7.