研究背景：登革熱為全球重要的蚊媒傳染病，對多個國家造成嚴峻疫情。我國監測系統顯示近10年的登革熱病例數及流行疫情規模有擴增趨勢，而近年來嚴重特殊傳染性肺炎(COVID-19)大流行更增加了公共衛生挑戰。先前的研究指出，新型冠狀病毒(SARS-CoV-2)和登革病毒(DENV)之間的相互作用，可能降低COVID-19感染風險或影響COVID-19嚴重程度。然而，登革病毒感染是否是影響COVID-19患者病程的風險因素，目前仍無一致結論。
研究目的：鑒於南臺灣具備登革熱流行背景且曾經歷COVID-19的雙重流行，本研究旨在透過大規模實證數據，探討 COVID-19 確診前登革熱確定病例紀錄與 COVID-19 患者後續發展為重症及死亡風險之關聯。
研究方法：本研究使用衛生福利部疾病管制署傳染病通報系統資料庫，進行回溯性配對世代研究。研究對象為 2020 年 1 月 20 日至 2023 年 3 月 19 日期間，法定居住地為高雄市、屏東縣及澎湖縣之首次 COVID-19 確定病例。本研究以 COVID-19 確診前是否具有登革熱確定病例紀錄為主要暴露變項，並依性別、年齡組、居住縣市及 COVID-19 確診時間區間進行最多 1：4 精確配對，選取無登革熱確定病例紀錄者作為對照組。主要研究結局為 COVID-19 重症，次要研究結局為以 COVID-19 確診日期為起點之 30 天內全因死亡。統計分析採用條件式邏輯斯迴歸模型，評估登革熱確定病例紀錄與 COVID-19 重症及 30 天內全因死亡風險之關聯，並進一步校正慢性病或 COVID-19 重症高風險因子及疫苗接種劑次。此外，本研究亦透過慢性病資訊處理方式、排除登革熱高流行區及延長死亡追蹤期間等敏感度分析，評估研究結果之穩健性。
研究結果：配對後共納入 81,803 名 COVID-19 確定病例，其中 16,361 名具有 COVID-19 確診前登革熱確定病例紀錄，65,442 名無登革熱確定病例紀錄。配對後，有登革熱確定病例紀錄組與無登革熱確定病例紀錄組之 COVID-19 重症比例分別為 0.54% 與 0.65%；30 天內全因死亡比例分別為 0.28% 與 0.38%。條件式邏輯斯迴歸分析顯示，在校正慢性病或 COVID-19 重症高風險因子及疫苗接種劑次後，COVID-19 確診前登革熱確定病例紀錄與 COVID-19 重症風險未達統計顯著關聯（aOR = 0.82，95% CI = 0.62–1.08，p = 0.155）。次要結局分析亦顯示，COVID-19 確診前登革熱確定病例紀錄與 COVID-19 確診後 30 天內全因死亡未達統計顯著關聯（aOR = 0.75，95% CI = 0.53–1.07，p = 0.113）。敏感度分析結果與主分析方向一致，均未觀察到統計顯著關聯。
結論：整體而言，本研究未觀察到 COVID-19 確診前登革熱確定病例紀錄與 COVID-19 重症或 30 天內全因死亡之間具有統計顯著關聯，亦未支持其會增加 COVID-19 嚴重結果風險。此結果顯示，在本研究南臺灣 COVID-19 確定病例中，通報系統可辨識之登革熱確定病例紀錄，不宜作為單獨判定 COVID-19 重症風險之依據。臨床與公共衛生風險評估仍應優先考量年齡、慢性病或重症高風險狀態、COVID-19 疫苗接種狀態及其他已知重要風險因子。

Dengue fever and coronavirus disease 2019 (COVID-19) have both posed substantial public health challenges. Previous studies have suggested possible immunological interactions between dengue virus and severe acute respiratory syndrome coronavirus 2, but whether prior dengue infection affects COVID-19 severity remains inconclusive. This retrospective matched cohort study used data from Taiwan’s infectious disease surveillance systems to examine the association between prior confirmed dengue case records and severe COVID-19 among individuals first diagnosed with COVID-19 between January 20, 2020, and March 19, 2023, in Kaohsiung City, Pingtung County, and Penghu County. Individuals with prior dengue records were exactly matched with those without such records at a maximum ratio of 1:4 by sex, age group, residence city or county, and COVID-19 diagnosis time interval. Conditional logistic regression was used to estimate adjusted odds ratios. After matching, 81,803 COVID-19 cases were included. Prior confirmed dengue case records were not statistically significantly associated with severe COVID-19 or 30-day all-cause mortality after adjustment for chronic disease/high-risk conditions and vaccination doses. These findings suggest that prior confirmed dengue case records alone may not serve as an independent indicator for severe COVID-19 risk in southern Taiwan.

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