We thank Nguyen Tien Huy and colleagues for their comments.1 To clarify, our study population was drawn from 2000 to 2012 health records, not 2015.2 The Taiwan National Health Insurance Research Database released data only before 2013; therefore, we cannot identify stroke outcomes in the 2014–2015 outbreaks.
The evidence derived from a cohort study is generally of lower methodological quality than that from a randomized controlled trial, because a cohort study is subject to many biases and unmeasured confounders. Despite our efforts to control biases and adjust for confounding factors, this observational cohort study could find only the association rather than causality between dengue and strokes.
We agree that further studies are needed to explore the cerebrovascular sequelae in patients with dengue and investigate the possible pathogenesis of dengue-related stroke.
Footnotes
Competing interests: None declared.