Clinical diagnostic delays and epidemiology of dengue fever during the 2002 outbreak in Colima, Mexico

Dengue fever is a re-emergent and challenging public health problem in the world. Here, we assess retrospectively the epidemiological and clinical characteristics of the 2002 dengue epidemic in the state of Colima, Mexico. This study is carried out by analysing a database containing demographic, epidemiological and clinical information. Of the 4040 clinical dengue cases diagnosed in the hospitals of the Mexican Institute of Public Health in the state of Colima, 548 cases were confirmed by laboratory tests, and 495 cases presented at least one haemorrhagic manifestation. Of the total clinically diagnosed, cases, the most common symptoms observed were: fever (99.6%), headache (92.4%), myalgia (89.4%) and arthralgia (88.6%). The most common haemorrhagic manifestations were: petechiae (7.1%), gingivitis (3.4%) and epistaxis (3.6%). The median time between the onset of illness and visit to the health care clinic (diagnostic delay) was 1 day (interquartile range [IQR]: 0-3). For cases presenting haemorrhagic manifestations, the diagnostic delay was higher (median: 2 days, IQR: 0-4) than for non-haemorrhagic cases (median: 1 day, IQR: 0-3). The proportion of males presenting haemorrhagic manifestations was higher than females (Fisher Exact test; p<0.01). Moreover, the age group 0-5 years presented a lower proportion of cases with haemorrhagic manifestations compared with the age group of 6 years and older (p=0.0281). No significant differences were found between the diagnostic delays in the case of males and females.