{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:12:23Z","timestamp":1792131143159,"version":"4.4.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T00:00:00Z","timestamp":1718150400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>While persistence of chronic symptoms following dengue infection has been documented in small prospective cohorts, population-based studies are limited. The post-acute risk of new-incident multi-systemic complications following dengue infection was contrasted against that following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a multi-ethnic adult Asian population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>National testing and healthcare claims that databases in Singapore were utilized to build a retrospective population-based adult cohort with laboratory-confirmed infection during overlapping waves of SARS-CoV-2 and dengue transmission (1 July 2021 to 31 October 2022). Risks of new-incident cardiovascular\/neuropsychiatric\/autoimmune complications 31\u2013300\u00a0days of post-dengue infection, contrasted with SARS-CoV-2 infection, were estimated using Cox regression with overlap weights. Risks were reported in terms of adjusted hazard ratio (aHR) and excess burden per 1000 persons.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>11\u2009707 dengue-infected individuals and 1\u2009248\u2009326 contemporaneous coronavirus disease 2019 (COVID-19) cases were included; the majority had mild initial infection not requiring hospitalization. Amongst dengue-infected individuals, there was 21% [aHR\u2009=\u20091.21 (1.06\u20131.38)] increased risk of any sequelae, with 55% [aHR\u2009=\u20091.55 (1.27\u20131.89)] increased risk of cardiovascular sequelae. Specifically, increased risk of dysrhythmias [aHR\u2009=\u20091.79(1.35\u20132.37)], ischemic heart disease [aHR\u2009=\u20091.45(1.12\u20131.89)], other cardiac disorders [aHR\u2009=\u20092.21(1.54\u20133.16)] and thrombotic disorders [aHR\u2009=\u20092.55(1.50\u20134.35)] was noted. Elevated risk of individual neuropsychiatric sequelae, including cerebrovascular disorders [aHR\u2009=\u20091.49(1.09\u20132.13)], cognition\/memory disorders [aHR\u2009=\u20092.13(1.55\u20132.93)], extrapyramidal\/movement disorders [aHR\u2009=\u20091.98(1.33\u20132.94)] and anxiety disorders [aHR\u2009=\u20091.61(1.01\u20132.56)], was observed in dengue-infected individuals compared to COVID-19 cases. Elevated risks of post-acute sequelae in dengue survivors were observed when contrasted against COVID-19 survivors infected during Delta\/Omicron predominance, as well as across vaccination strata.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Increased risk of post-acute cardiovascular\/neuropsychiatric complications was observed in dengue survivors, when contrasted against COVID-19 survivors infected during Delta\/Omicron predominance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research in context<\/jats:title>\n                  <jats:sec>\n                     <jats:title>Evidence before this study<\/jats:title>\n                     <jats:p>Post-acute sequelae following SARS-CoV-2 infection has been extensively reported; however, long-term sequelae may also occur after other acute infections, such as dengue. While chronic symptom persistence has been reported in small cohorts of dengue survivors, population-based cohort studies are lacking, given dengue\u2019s disproportionate burden in tropical low-and-middle-income countries (LMICs) where access to diagnostic testing and follow-up is limited. We searched PubMed for studies published until 1 March 2024, using search terms \u2018dengue\u2019, \u2018chronic\u2019, \u2018long term\u2019, \u201cwith search terms found in abstract, title or MESH headings. Current research on post-acute sequelae following dengue is limited to small prospectively recruited cohorts, impairing generalizability to the population at-large. We only found four population-based retrospective cohort studies from a single country, Taiwan, which examined long-term risk of a limited set of autoimmune and cognitive sequelae following dengue infection. Evidence for post-acute sequelae was mixed, particularly when milder non-hospitalized cases were included. There are no reports on the risk of post-acute sequelae across multiple organ systems following dengue infection, and no reports contrasting the risk of post-acute sequelae in dengue versus SARS-CoV-2 infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                     <jats:title>Added value of this study<\/jats:title>\n                     <jats:p>National testing and healthcare claims that databases in Singapore were utilized to build a retrospective population-based adult cohort of laboratory-confirmed dengue and SARS-CoV-2 infections during overlapping waves of COVID-19\/dengue transmission. Increased overall risk of any post-acute sequelae and individual cardiovascular\/neurological sequelae in dengue-infected adults was observed up to 300\u00a0days postinfection, compared against COVID-19 cases infected during Delta\/Omicron predominance. While other studies have compared the risk of post-acute sequelae across different respiratory viral infections, such as influenza and SARS-CoV-2, to the best of our knowledge no prior studies have contrasted the potential risks of post-acute sequelae following dengue with that arising after SARS-CoV-2 infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                     <jats:title>Implication of all the available evidence<\/jats:title>\n                     <jats:p>Risk of chronic multi-systemic sequelae arising post-dengue infection was significantly elevated when contrasted against post-acute sequelae following COVID-19. Post-acute sequelae may increase the burden of disease attributable to dengue in tropical countries where seasonal outbreaks occur; this is increasingly relevant, given that climate change has broadened the list of countries at risk of dengue endemicity.<\/jats:p>\n                  <\/jats:sec>\n               <\/jats:sec>","DOI":"10.1093\/jtm\/taae081","type":"journal-article","created":{"date-parts":[[2024,6,11]],"date-time":"2024-06-11T22:33:39Z","timestamp":1718145219000},"source":"Crossref","is-referenced-by-count":18,"title":["Dengue versus COVID-19: comparing the incidence of cardiovascular, neuropsychiatric and autoimmune complications"],"prefix":"10.1093","volume":"31","author":[{"given":"Liang En","family":"Wee","sequence":"first","affiliation":[{"name":"National Centre for Infectious Diseases , Singapore"},{"name":"Duke-NUS Graduate Medical School, National University of Singapore , Singapore"},{"name":"Department of Infectious Diseases, Singapore General Hospital , 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