Association of ABO Blood Groups with Dengue Fever and its Severity: A Study in Surabaya, Indonesia

Authors

Sulistiawati Sulistiawati, Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, IndonesiaFollow
Linda Dewanti, Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
Ronald Pratama Adiwinoto, Faculty of Medicine Hang Tuah University, Surabaya, Indonesia
Raissa Manika Purwaningtias, Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
Bilqis Inayatillah, Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
Jan Nouwen, Internal Medicine - Infectious Diseases section, Erasmus MC - University Medical Center Rotterdam

Abstract

Background: Indonesia, a dengue-endemic country, has high morbidity and mortality rates. Dengue infection manifestations vary from asymptomatic to mild to severe. One of the risk factors for infection that plays a role in this severity is blood type. A better understanding of the risk factors for dengue infection is required to prevent and control it.

Methods: This analytical observational cross-sectional study was conducted at three hospitals in Surabaya from March to May 2013. Consecutive sampling included 95 patients aged >12 years with confirmed dengue infection (IgM/IgG positive) and without comorbid severe illness. Data were collected using questionnaires, interviews, and checklists, with informed consent obtained. Laboratory examinations included ABO blood grouping and dengue serology (IgM/IgG) using standardized procedures. Dengue severity was classified according to WHO criteria. Data were analyzed using SPSS 19.0 with chi-square tests, considering p < 0.05 statistically significant.

Results: The risk factors for dengue hemorrhagic fever (DHF) associated with ABO blood type were investigated. The most common blood groups in patients with dengue hemorrhagic fever were O (47.3%) and AB (8.4%). According to this study, there were significant differences in the severity of dengue infection based on the blood type (p = 0.019). Moreover, we observed that patients with blood type B tended to develop more severe dengue infections.

Conclusions: This study indicates that blood type B is more susceptible to dengue severity; however, other factors can also affect severity in addition to blood type.

Keywords: Dengue, Dengue Hemorrhage Fever, Human and health, Infectious disease, Indonesia.

Recommended Citation

Sulistiawati S, Dewanti L, Adiwinoto R, Purwaningtias R, Inayatillah B, Nouwen J. Association of ABO Blood Groups with Dengue Fever and its Severity: A Study in Surabaya, Indonesia. J Health Res. 2025; 39(6):Title Page-References. DOI: https://doi.org/10.56808/2586-940X.1165

References

[1] Harapan H, Michie A, Yohan B, Shu PY, Mudatsir M, Sasmono RT, et al. Dengue viruses circulating in Indonesia: a systematic review and phylogenetic analysis of data from five decades. Rev Med Virol 2019 Jul 1;29(4):e2037. https://doi.org/10.1002/rmv.2037.

[2] Swatan JP, Alkaff FF, Sukmajaya WP, Sulistiawati S, Karimah A. Are Indonesian new pictorial health warnings more effective than the old ones? Int J Publ Health Sci  (IJPHS) 2022 Sep 1;11(3):975—81. https://doi.org/10.11591/ijphs.v11i3.21543.

[3] World Health Oraganization [WHO]. Dengue and severe dengue. [cited 2022 Aug 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/dengue-and-severedengue.

[4] Karyanti MR, Uiterwaal CSPM, Kusriastuti R, Hadinegoro SR, Rovers MM, Heesterbeek H, et al. The changing incidence of Dengue Haemorrhagic Fever in Indonesia: a 45-year registry based analysis. BMC Infect Dis 2014 Jun 24;14(1):1—7. https://doi.org/10.1186/1471-2334-14-412.

[5] Maula AW, Fuad A, Utarini A. Ten-years trend of dengue research in Indonesia and South-East Asian  countries: a bibliometric analysis. Glob Health Action 2018;11(1):1504398.  https://doi.org/10.1080/16549716.2018.1504398.

[6] World Health Oraganization [WHO]. Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever. Geneva: WHO; 2011.

[7] Whitehorn J, Simmons CP. The pathogenesis of dengue. Vaccine 2011 Sep 23;29(42):7221—8. https://doi.org/10.1016/j.vaccine.2011.07.022.

[8] Hashan MR, Ghozy S, El-Qushayri AE, Pial RH, Hossain MA, Al Kibria GM. Association of dengue disease severity and blood group: a systematic review and meta-analysis. Rev Med Virol 2021 Jan 1;31(1):1—9. https://doi.org/10.1002/rmv.2147.

[9] Bidayah HF, Triyono T, Fichou Y, Pratiwi R, Nurpratami D, Sofro AS. Distribution of ABO and D antigen expression in Yogyakarta, Java Island: a pioneer large-scale study in Indonesia. BMC Res Notes 2024 Dec 1;17(1). https://doi.org/10.1186/s13104-024-06914-5.

[10] Sudarsanareddy L, Sarojamma V, Ramakrishna V. Genetic predisposition to chikungunya a blood group study in chikungunya affected families. Virol J 2009 Jun 16;6(1):1—3.

[11] Ewald DR, Sumner SC. Blood type biochemistry and human disease. Wiley Interdiscip Rev Syst Biol Med 2016 Nov;8(6):517—35.

[12] Ravichandran S, Ramya SR, Kanungo R. Association of ABO blood groups with dengue fever and its complications in a tertiary care hospital. J Lab Physicians 2019 Jul;11(3):265—9. https://doi.org/10.4103/JLP.JLP_95_19.

[13] Kalayanarooj S, Gibbons RV, Vaughn D, Green S, Nisalak A, Jarman RG, et al. Blood group AB is associated with increased risk for severe dengue disease in secondary infections. J Infect Dis 2007 Apr 1;195(7):1014—7. https://doi.org/10.1086/512244.

[14] Liu J, Zhang S, Liu M, Wang Q, Shen H, Zhang Y. Distribution of ABO/Rh blood groups and their association with hepatitis B virus infection in 3.8 million Chinese adults: A population-based cross-sectional study. J Viral Hepat 2018 Apr 1;25(4):401—11. https://doi.org/10.1111/jvh.12829.

[15] Wu Y, Feng Z, Li P, Yu Q. Relationship between ABO blood group distribution and clinical characteristics in patients with COVID-19. Clin Chim Acta 2020 Oct 1;509:220—3. https://doi.org/10.1016/j.cca.2020.06.026.

[16] Vasan SK, Rostgaard K, Majeed A, Ullum H, Titlestad KE, Pedersen OBV, et al. ABO blood group and risk of thromboembolic and arterial disease: a study of 1.5 million blood donors. Circulation 2016 Apr 12;133(15):1449—57.

[17] Rosyada A, Sulistiawati Husada D, Nugraha J. Comparison of blood group based on bleeding manifestation in pediatric-dengue cases. In: Jajah F, Susilowati H, editors. UGM digital press health sciences: vol. 1. Proceeding of the 2nd international conference on health sciences; 2018. p. 1—5 [Jakarta]. UGM Digital Press, Yogyakarta, Indonesia.

[18] Khode V, Kabbin G, Ruikar K. Association of ABO Rh blood group with dengue fever and dengue hemorrhagic fever: a case-control study. J Appl Hematol 2013;4(4):145. https://doi.org/10.4103/1658-5127.127899.

[19] Kabrah SM, Abuzerr SS, Baghdadi MA, Kabrah AM, Flemban AF, Bahwerth FS, et al. Susceptibility of ABO blood group to COVID-19 infections: clinico-hematological, radiological, and complications analysis. Medicine 2021 Dec 12;100(52). https://doi.org/10.1097/MD.0000000000028334.

[20] Komal A, Noreen M, Akhtar J, Imran M, Jamal M, Atif M, et al. Analyses of ABO blood groups with susceptibility and symptomatic variations of COVID-19 infection, a questionnaire-based survey. APMIS 2021 Oct 1;129(10):579—86. https://doi.org/10.1111/apm.13169.

[21] Sapanont K, Sunsaneevithayakul P, Boriboonhirunsarn D. Relationship between ABO blood group and gestational diabetes mellitus. J Matern Fetal Neonatal Med 2021 Apr;34(8):1255—9. https://doi.org/10.1080/14767058.2019.1633299.

[22] Sjafaraenan, Alvionita DN, Agus R, Sabran A. Gene distribution of ABO blood type system on the Dengue Hemorrhagic Fever (DHF) patients in the working area of Puskesmas Bonto Bangun, District of Rilau Ale, Bulukumba. J Phys Conf 2018;979:012008. https://doi.org/10.1088/1742-6596/979/1/012008.

[23] Rahayu H, Setyabudi. AB blood type as a risk factor for dengue shock syndrome in children anak. Majalah Kedokt Indones 2008;58:1—10 [in Bahasa].

[24] Fan Q, Zhang W, Li B, Li DJ, Zhang J, Zhao F. Association between ABO blood group system and COVID-19 susceptibility in Wuhan. Front Cell Infect Microbiol 2020;10(July):1—7. https://doi.org/10.3389/fcimb.2020.00404.

[25] Cabezas-Cruz A, Mateos-Hernandez L, Alberdi P, Villar M, Riveau G, Hermann E, et al. Effect of blood type on anti-α-Gal immunity and the incidence of infectious diseases. Exp Mol Med 2017 Mar 10;49(3):e301. https://doi.org/10.1038/emm.2016.164.

[26] Macher BA, Galili U. The Galα1,3Galβ1,4GlcNAc-R (α-Gal) epitope: a carbohydrate of unique evolution and clinical relevance. Biochim Biophys Acta 2008 Feb;1780(2):75—88. https://doi.org/10.1016/j.bbagen.2007.11.003.

[27] Muthana SM, Gildersleeve JC. Factors affecting anti-glycan IgG and IgM repertoires in human serum. Sci Rep 2016 6:1. 2016 Jan 19;6(1):1—11. https://doi.org/10.1038/srep19509.

[28] Abegaz SB. Human ABO blood groups and their associations with different diseases. BioMed Res Int 2021 Jan 23;2021:6629060. https://doi.org/10.1155/2021/6629060.

[29] Kremers RMW, Mohamed ABO, Pelkmans L, Hindawi S, Hemker HC, De Laat HB, et al. Thrombin generating capacity and phenotypic association in ABO blood groups. PLoS One 2015 Oct 28;10(10):e0141491. https://doi.org/10.1371/journal.pone.0141491.