What Is the History of Dengue Fever Outbreaks?

Dengue fever is endemic in tropical and subtropical areas. Dengue fever is estimated by
the World Health Organization (WHO) to cause about 50-100 million infections per year
worldwide. The U.S. Centers for Disease Control and Prevention (CDC) considers
dengue fever to cause the majority of acute febrile illnesses in travelers returning to the
U.S. The first clinical report of dengue fever was in 1789 by B. Rush, although the
Chinese may have described the disease associated with "flying insects" as early as
420 AD. Africans described "ka dinga pepo" as cramp-like seizure caused by an evil
spirit. The Spanish may have changed "dinga" to dengue since it means fastidious or
careful in Spanish, which describes the gait of people trying to reduce the pain of
walking.

Unfortunately, the disease incidence seems to be increasing. Researchers suggest the

surge in dengue fever may be due to several factors:

 Increased urban crowding with more sites for mosquitoes to develop

 International commerce that contains infected mosquitoes, thus introducing the disease to areas
previously free of the disease
 Local and world environmental changes that allow mosquitoes to survive the winter months
 International travelers who carry the disease to areas where mosquitoes have not been previously
infected

Dengue has spread widely throughout the world; the WHO distribution map (available at
http://apps.who.int/ithmap/) shows that dengue fever mainly occurs in tropical and
subtropical areas. In the U.S., dengue fever has been detected in California, Florida,
Texas, and Hawaii. Other areas where it has been detected or there has been an
outbreak of the disease include the Philippines, Taiwan, Samoa, Brazil, Puerto Rico,
Costa Rica, Thailand, and New Delhi. However, as climates warm, experts suggest
dengue will become more prevalent.

In 2015, an outbreak of dengue fever occurred in New Delhi, the worst in five years.
Over 10,000 people tested positive for dengue fever; there have been at least 32 deaths
attributed to this outbreak. State-run hospitals were so overcrowded that patients were
sharing beds. An independent group (Brandeis University) suggests the actual numbers
of people in India with dengue are "vastly underreported." Continue Reading
 What Causes Dengue Fever, and How Is Dengue Fever Transmitted?

Four closely related viruses cause dengue fever. The viruses are transmitted
fromAedes aegypti and Aedes albopictusmosquitoes to humans in a viral life cycle that
requires both humans and these mosquitoes. There is no human-to-human dengue
fever transmission. Once a mosquito is infected, it remains infected for its life span. A
human can infect mosquitoes when the human has a high number of viruses in the
blood (right before symptoms develop). The viruses belong to the Flaviviridae family
and have an RNA strand as its genetic makeup. Virologists term them dengue virus
types 1-4 (DENV 1-4). All four serotypes are closely related. However, there are enough
antigenic differences between them that if a person becomes immune to one serotype,
the person can still be infected by the other three serotypes

. Mosquitoes carry the virus that causes dengue fever. But mosquitoes first become infected when they
bite an infected person. In this way, humans and mosquitoes are both responsible for the spread of
dengue. The virus can enter a person’s body when an infected mosquito feeds on his or her
blood. Dengue fever can be caused by any one of 4 types of dengue virus:

 DEN-1.
 DEN-2.
 DEN-3.
 DEN-4.
You can be infected by more than one type at different times during your life. You can only be infected
once by the same type. This is known as immunity. People who have been infected with classic dengue
fever have a higher risk of developing severe dengue fever, also known as dengue hemorrhagic fever.
Their risk goes up each time they are reinfected with a dengue virus.

What Are Symptoms and Signs of Dengue Fever?

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The symptoms and signs for dengue begin about three to 15 days (incubation period)
after a mosquito bite transfers a virus (dengue virus serotypes 1-4) to a person
previously unexposed to the viruses. Fever and painful muscle, bone, and joint aches
can occur during the first few hours of symptoms whenheadache, chills (shivering
and/orsweating), rash (may be itchy) and/or red spots or flushing, and swollen lymph
nodes first appear. Pain behind or in back of the eyes is also a common symptom.
Some individuals may develop a sore throat, vomiting, nausea, abdominal and/orback
pain, and loss of appetite. These symptoms usually last about two to four days and then
diminish, only to reappear again with a rash that covers the body and spares the face.
The rash also may occur on the palms of the hands and the bottom of the feet, areas
 frequently spared in many viral and bacterial infections. The symptoms may last about
one to two weeks with complete recovery, in most cases, in a few weeks. However,
some people can develop more severe symptoms and complications, such
ashemorrhagic areas in the skin (easy bruising), gums, and the gastrointestinaltract.
This condition is termed dengue hemorrhagic fever (DHF). The majority of DHF is seen
in children under 15 years of age, but it can occur in adults. Another clinical variation of
dengue fever is termed dengue shock syndrome (DSS); DHF usually precedes DSS.
The patients eventually develop severe abdominal pain, heavy bleeding, and blood
pressure drops; this syndrome, if not treated quickly, may cause death. Continue
Reading

Symptoms of classic dengue fever usually start within 4 to 7 days after you have been bitten by an
infected mosquito. Fever is often the first symptom. The fever may cause atemperature of up to 105°F.
Other symptoms of dengue fever include:

 Nausea and vomiting.

 Pain behind the eye.
 Severe headache.
 Severe joint and muscle pain.
A rash may also appear over most of your body. This often happens 3 to 4 days after the fever begins. The
rash usually goes away after 1 to 2 days. You may get a second rash a few days later. Most people
completely recover from dengue fever within 2 weeks. Some people, especially adults, may be tired or
depressed for several weeks to months after being infected with the virus. Symptoms of dengue
hemorrhagic fever include all of the symptoms of classic dengue plus:
 Bleeding from the nose, gums or under the skin, causing purplish bruises.
 Damage to blood and lymph vessels.
This type of dengue disease can cause death. Dengue shock syndrome is the most severe form of dengue
disease. Symptoms include all of the symptoms of classic dengue and dengue hemorrhagic fever, plus:
 Fluids leaking outside of blood vessels.
 Massive bleeding.
 Shock, which is very low blood pressure.
Dengue shock syndrome usually affects children, and sometimes adults, experiencing their second
dengue infection. In some cases, it can cause death, especially in children and young adults.
How Do Health-Care Professionals Diagnose Dengue Fever?

Patient CommentsShare Your Story

Dengue fever is presumptively diagnosed by a medical caregiver by the relatively
characteristic sequence of high fever, rash appearance, and other symptoms in a
person who has a history of recent travel to dengue endemic areas and recalls
mosquito bites while in the endemic area. However, if not all of the symptoms are
present or the history is not complete, the caregiver is likely to run a number of tests to
obtain a definitive diagnosis. Other diseases may yield similar symptoms (for
example, leptospirosis, typhoid fever,yellow fever, scarlet fever, Rocky Mountain
spotted fever, meningococcemia,malaria, chikungunya, food poisoning, and several
others). If the patient has severe symptoms; or if the medical caregiver does not have
enough information to make a presumptive diagnosis, the patient is likely to undergo a
number of other tests to definitively distinguish dengue fever from other diseases. In
general, the more serious the symptoms such as easy bruising, fevers at or above 104
F, hemorrhages or shock syndrome, the more tests are likely to be done.

In general, most physicians will order a complete blood test (CBC), with a metabolic
panel, along with coagulation studies in most patients with high fever and any bleeding
problems. Low platelet and low white cell counts may occur with the disease. In
addition, depending on the symptoms (especially headache), blood and urine cultures
plus a spinal tap may be done to help differentiate between dengue fever and other
diseases. A MAC-ELISA assay (an immunoglobulin M-based test) is the most widely
used test for dengue fever virus. However, other tests are available; they also are based
on the person's immunological response to the dengue viruses (for example, IgG-
ELISA, dengue viral plaque reduction tests, and PCR tests). These tests are considered
definitive for exposure to dengue virus; definitive diagnosis of dengue fever is isolation
and identification (usually by immunological tests) of the dengue virus serovar from the
patient. Continue Reading
 How Is Dengue Fever Treated?

Patient CommentsRead 2 CommentsShare Your Story

Fortunately, this viral disease is usually self-limited and usually adequate hydration and
pain control will help the person through the infection. However, for dengue fever, a
caution is given by most doctors regarding home treatment. Nonsteroidal anti-
inflammatory agents (for example, aspirin (Bayer, Ecotrin), ibuprofen(Motrin), and other
NSAIDs) should be avoided because of the tendency of the dengue viruses to cause
hemorrhages. The NSAIDs may add to the hemorrhage symptoms. Other medications
such asacetaminophen (Tylenol), codeine, or other agents that are not NSAIDs may be
used.

More severe variations of dengue fever (hemorrhagic and shock syndrome) usually
require additional supportive treatments; these patients often require hospitalization. IV
fluid hydration, blood transfusions, platelet transfusions, blood pressure support, and
other intensive-care measures may need to be utilized in these patients. Consultation
with infectious-disease and critical-care specialists is often advised to optimize patient
care. Continue Reading

There is no specific treatment for classic dengue fever. Most people recover within 2 weeks. To help with
recovery, health care experts recommend:
 Drinking lots of fluids.
 Getting plenty of bed rest.
 Taking medicine to reduce fever.
People with dengue fever should not take aspirin. Aspirin may thin the blood and increase your risk for
bleeding. Talk with your healthcare provider about what fever reducing medicine is safe for you to take.
For severe dengue symptoms, including shock and coma, early and aggressive emergency treatment can
be life saving. Treatment often includes fluid and electrolyte replacement.
 Introduction

Medically Reviewed by a Doctor on 1/7/2016

Dengue is an infectious disease caused by a virus. You can get it if an infected mosquito bites you. It is
common in warm, wet areas of the world. Outbreaks happen during the rainy season. Most people
with denguerecover within 2 weeks. However, some dengue infections are severe and causebleeding from
your nose, gums or under your skin. Severe dengue can also cause massive bleeding and shock, which
is lifethreatening. This program discusses the symptoms, causes, diagnosis and treatment of dengue fever.
Information about ways to prevent dengue fever is also included.

Dengue fever is an infectious disease carried by mosquitoes. It is caused by any of the four
related dengue viruses. Dengue fever used to be called "break-bone" fever. This namerefers to the severe
joint and muscle pain that dengue fever can cause, which feels likebones are breaking. There are three
main types of dengue fever:
 Classic dengue fever, which typically is not complicated by other illnesses.
 Dengue hemorrhagic fever, or DHF, which causes bleeding and internal damage to the body.
 Dengue shock syndrome, which is similar to DHF but also includes the risk of shock.
Dengue hemorrhagic fever and dengue shock syndrome can result in damage to theblood vessels and
liver. Health experts have known about dengue fever for more than 200 years. It is found mostly during,
and shortly after, the rainy season in tropical and subtropical areas of:
 Africa.
 Australia and the South and the Central Pacific.
 The Caribbean and Central and South America.
 India.
 The Middle East.
 Southeast Asia and China.
Although it is mostly found in tropical and subtropical areas of the world, dengue fever is not limited to a
specific location. Any area infested with the types of mosquitoes that transmit dengue virus is at risk.
Worldwide, about 50 million cases of dengue infectionhappen each year. The illness causes 22,000 deaths
per year, mostly in children. In addition to typical dengue, dengue hemorrhagic fever and dengue shock
syndrome also have increased in many parts of the world. Globally, there are several hundred thousand
cases of dengue hemorrhagic fever per year.

Prevention

The best way to prevent dengue fever is to take special precautions to avoid being bitten by mosquitoes.
Although several dengue vaccines are being developed, none are currently available. When outdoors in
an area where dengue fever has been found:

 Use a mosquito repellent containing DEET, picaridin or oil of lemon eucalyptus.

 Dress in protective clothing, including long-sleeved shirts, long pants, socks and shoes.
The type of mosquitoes that cause dengue usually feed during the day. This means it is especially
important to take precautions against mosquito bites during early morning hours after sunrise and in the
late afternoon before dark. Other precautions include:
 Keeping unscreened windows and doors closed.
 Keeping window and door screens repaired.
 Getting rid of areas where mosquitoes breed, such as standing water in flower pots, containers, birdbaths
and other areas where water collects.