Clinical Management of Patients with Dengue Infection in Japan: Results from National Database of Health Insurance Claims

Dengue guidelines for diagnosis, treatment, prevention, and control (WHO, 2011) recommend acetaminophen and isotonic fluid for patients with dengue infection but do not recommend nonsteroidal anti-inflammatory drugs (NSAIDs) and hypotonic fluid. Other research showed no evidence of efficacy of platelet infusion in prophylactic. This research aims to clarify to what extent dengue patients were managed in accordance with the guidelines in Japan. We extracted claim data of patients with either dengue fever (DF) or dengue hemorrhagic fever (DHF) from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between 2011 and 2015. The total number of patients was 1,370, which consisted of 1,306 DF patients and 64 DHF patients; 185 patients were younger than (<) 20 years and 1,185 patients were aged 20 years or older (>=) Among them, 24.5% of DF patients and 48.4% of DHF patients received hypotonic intravenous fluid, 12.9% and 18.8% NSAIDs, and 1.3% and 17.2% platelet transfusion, respectively. Comparing patients aged < 20 years with patients aged >= 20 years, 57.8% and 54.5% received acetaminophen, 6.5% and 14.3% received NSAIDs, 40.0% and 38.3% received isotonic fluid, and 37.8% and 23.7% received hypotonic fluid, respectively. Platelet transfusion was used for 1.3% of DH and 17.2% of DHF patients. The study indicated that dengue patients in Japan might have increased risks of developing adverse events because of receiving the treatment that the guidelines do not recommend. More effort is needed to facilitate medical practitioners to follow the guidelines.