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were found in only two of our patients (6%). There were no mechanical failures. IV; Retrospective cohort study. IV; Retrospective cohort study. In early 2019, an outbreak of severe dengue was reported in Manado, North Sulawesi Province, Indonesia. This epidemic raised public concern and recorded the highest number of cases in the last 10 years. This study aimed to determine the clinical spectrum, disease aetiology and virological characteristics associated with this outbreak of severe dengue. Dengue was diagnosed using non-structural