WHO 2009 dengue case classification. Tick the features present and get the category, the management group, and the findings that drove the result.
Tick everything that applies. Nothing is sent anywhere — evaluation happens in your browser.
The WHO 2009 warning signs are: abdominal pain or tenderness; persistent vomiting; clinical fluid accumulation; mucosal bleed; lethargy or restlessness; liver enlargement greater than 2 cm; and the laboratory finding of a rising haematocrit with a concurrent rapid fall in platelet count. Any one of these means the patient needs in-hospital observation.
WHO places three kinds of patient in hospital (Group B): those with any warning sign; those with co-existing conditions such as pregnancy, infancy, old age, obesity, diabetes, renal failure or chronic haemolytic disease; and those whose social circumstances make safe home care unlikely, such as living alone or living far from a facility without reliable transport. Patients with severe dengue (Group C) need emergency treatment and urgent referral.
Group A — patients who can tolerate adequate volumes of oral fluids AND are passing urine at least once every six hours AND have none of the warning signs. Both criteria must be met; failing either one means the patient should not be sent home even if there are no warning signs.
Severe plasma leakage leading to shock (dengue shock syndrome) or fluid accumulation with respiratory distress; severe bleeding as judged by the clinician; or severe organ involvement — liver with AST or ALT of 1000 or above, CNS with impaired consciousness, or involvement of the heart and other organs.
Typically around defervescence — as the fever settles, which is when families often assume the patient is improving. This is the critical phase and the point at which deterioration is most commonly missed.
No. WHO advises paracetamol only, at intervals of not less than six hours, with tepid sponging for persistent fever. Aspirin, ibuprofen and other NSAIDs may aggravate gastritis and bleeding, and aspirin carries a risk of Reye's syndrome. This matters particularly in Pakistan, where self-medication with NSAIDs before presentation is common.
Not on its own in the WHO 2009 scheme. The laboratory warning sign is a rising haematocrit together with a rapidly falling platelet count — the trend and the combination matter, not an isolated number. Provincial protocols during epidemic surges may set their own thresholds; where they differ, follow local guidance.
No, deliberately. It classifies the patient and states the disposition. WHO's fluid regimens for Groups B and C are referenced by section so you can consult the guideline directly, but no rates or volumes are calculated here. Fluid management in dengue should be titrated against serial haematocrit and clinical response at the bedside.
No. This tool implements the WHO 2009 classification. Punjab's Dengue Expert Advisory Group and other provincial bodies publish national-context guidance, and where that differs from WHO — admission thresholds during epidemic surges being the likeliest difference — your provincial guidance takes precedence.
Background reading — the critical phase, the platelet-count trap, and what to tell a patient going home: dengue warning signs and when to admit.