{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:12:34Z","timestamp":1792131154383,"version":"4.4.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"8","funder":[{"DOI":"10.13039\/100012737","name":"Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012737","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007197","name":"Public Health Service","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007197","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We evaluated dengue presentation by age, the performance of the 2015 Pan American Health Organization (PAHO) case criteria in identifying dengue cases, and variables to improve specificity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with fever \u22647 days (N = 10 408) were recruited from 2 emergency departments from May 2012 through December 2015. Serum samples were tested for dengue, chikungunya, and nasopharyngeal swabs for respiratory viruses. Smoothing splines assessed differences in the frequencies of signs\/symptoms by age. Least absolute shrinkage and selection operator regressions identified the variables that best predicted dengue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 985 dengue cases, children aged &amp;lt;5 years were least likely to have leukopenia, but most likely to have rash and petechiae. Adults had the highest odds of aches\/pains and headaches\/retro-orbital pain. The 2015 PAHO criteria had sensitivity of 93% and specificity of 25%. Specificity could be improved by requiring at least 2 of the following criteria: vomiting\/nausea, petechiae, rash, or leukopenia (specificity 68%, sensitivity 71%) or by using 2015 PAHO criteria plus either (1) aspartate aminotransferase &amp;gt;50\u2005IU\/L or platelet count &amp;lt;100 000 platelets\/\u03bcL (specificity 81%, sensitivity 56%) or (2) itchy skin or absence of rhinorrhea or cough (specificity 51%, sensitivity 82%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The 2015 PAHO dengue case criteria had excellent sensitivity but poor specificity. This can be improved by adding signs\/symptoms associated with dengue diagnosis.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ofid\/ofad373","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T01:06:20Z","timestamp":1689815180000},"source":"Crossref","is-referenced-by-count":5,"title":["The Effect of Age on Dengue Presentation and the Diagnostic Accuracy of the 2015 Pan American Health Organization Case Criteria in a Puerto Rican Cohort"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1730-4380","authenticated-orcid":false,"given":"Camila D","family":"Odio","sequence":"first","affiliation":[{"name":"Division of Vector-Borne Diseases, Centers for Disease Control and Prevention , Bethesda, Maryland 20814 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"S\u00e1nchez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Division of Vector-Borne Diseases, Centers for Disease 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