DENGUE FEVER

Dr Abu Zar Taizai

DENGUE A MAJOR GLOBAL HEALTH PROBLEM

Dengue in recent years has become a major

international public health concern. Dengue is
found in tropical and sub-tropical regions around
the world, predominantly in urban and semiurban areas.

Dengue Haemorrhagic fever (DHF) a potentially

lethal complication was first recognized in the
1950s during the dengue epidemics in the
Philippines and Thailand, but today DHF affects
most Asian countries and has become a leading
cause of hospitalization and death among
children.

The global prevalence of dengue has grown

dramatically in recent decades. The disease is now
endemic in more than 100 countries in Africa, the
Americas, the Eastern Mediterranean, Southeast Asia and the Western Pacific.

South-east Asia and the Western Pacific are most

seriously affected.

Before 1970 only nine countries had experienced

DHF epidemics, a number that had increased
more than four-fold by 1995.

Some 2500 million people - two fifths of the world's

population - are now at risk from dengue. WHO
currently estimates there may be 50 million
cases of dengue infection worldwide every
year.

In 2001 alone, there were more than

609000 reported cases of dengue in the
Americas, of which 15000 cases were
Dengue Haemorrhagic Fever. This is greater
than double the number of dengue cases
which were recorded in the same region in
1995.

Not only is the number of cases increasing

as the disease is spreading to new areas,
but explosive outbreaks are occurring.

In 2001, Brazil reported over 390000 cases

including more than 670 cases of DHF.

Distribution Western Hemisphere

Distribution of dengue, Eastern Hemisphere

An estimated 500,000 cases of DHF require

hospitalization each year, of whom a very large
proportion are children. At least 2.5% of cases die,
although case fatality could be twice as high.

Without proper treatment, DHF case fatality rates

can exceed 20%. With modern intensive supportive
therapy, such rates can be reduced to less than 1%.

The spread of dengue is attributed to expanding

geographic distribution of the four dengue viruses
and of their mosquito vectors, the most important
of which is the predominantly urban species Aedes
aegypti.

A rapid rise in urban populations is bringing greater

numbers of people into contact with this vector,
especially in areas that are favourable for mosquito
breeding, e.g. where household water storage is
common and where solid waste disposal services
are inadequate

In Asia and Amrecas the Aedes aegypti

breeds primarily in man-made containers
like:

Earthenware jars,
Metal drums and
Concrete cisterns used for domestic water
storage.
Discarded plastic food containers
Used automobile tires and other items that
collect rainwater.

In Africa it also breeds extensively in

natural habitats such as tree holes and leaf

 In

recent years, Aedes albopictus, a

secondary dengue vector in Asia, has
become established in the United States,
several Latin American and Caribbean
countries, in parts of Europe.

The

rapid geographic spread of this

species has been largely attributed to the
international trade in used tyres.

Dengue Syndrome

Dengue fever and dengue hemorrhagic

fever (DHF) are viral diseases transmitted
by Aedes mosquitoes, usually Aedes
aegypti.

There are four types of this virus

(serotypes 1 to 4) and are closely related
to one another.

Recovery from infection by one provides

lifelong immunity against that serotype but
confers
only
partial
and
transient
protection against subsequent infection by
the other three.

There is good evidence that sequential

infection increases the risk of more serious
disease resulting in DHF.

Dengue viruses are capable of infecting

humans and causing disease. These infections
may be symptomatic, or may lead to:

1.

Classical dengue fever

2.

Dengue Haemorrhagic fever without shock

3.

Dengue Haemorrhagic fever with shock

DENGUE VIRUS INFECTION

Asymptomatic

Symptomatic
Dengue
Haemorrhagic fever

Undiffrentiated fever
(viral syndrome)

Dengue fever
(syndrome)

(Plasma
leakage)

Dengue Fever

Dengue Shock
Syndrome (DSS)
No Shock
Dengue
Haemorrhagic fever

CLASSICAL DENGUE FEVER

Reservoir both man and mosquito

The mosquito becomes infective by feeding on
the patient from the day before onset to the 5 th
day of illness.
After an extrinsic incubation period of 8-10
days the mosquito becomes infective and is
able to transmit infection.
The illness is characterized by an incubation
period of 3-10 days.

1.

Onset is sudden with chills and high fever.

Temperature rises quickly as high as 104 F
(40 C), with relative bradycardia and
hypotension.

2.

Reddened eyes

3.

Intense muscles and joint pains

4.

A flushing or pale pink rash comes over the face and

then disappears. The glands (lymph nodes) in the
neck and groin are often swollen

5.

Fever lasts 2-4 days rarely more than 7 days.

6.

Recovery is complete

7.

Case fatality is very low

Dengue Haemorrhagic Fever

Dengue hemorrhagic fever is a more severe form of the
viral illness. Caused by more than one dengue viruses.
It is due to double infection with dengue virus. The first
infection sensitizes the patient and the second appears
to produce immunological catastrophe.
Manifestations include:

Headache, high fever (continuous and lasting 2-7 days)

Rash, and
evidence of hemorrhage in the body
(Petechiae)
Bleeding in the nose or gums,
Black stools, or easy bruising are all possible signs of
hemorrhage.
This form of dengue fever can be life-threatening or
even fatal.

Symptoms

Skin rash

THERE IS NO DRUG FOR DENGUE.

To prevent dengue fever, you must prevent the

breeding of its carrier, the Aedes mosquitoes.

Treatment
Because dengue is caused by a virus, there is no
specific medicine or antibiotic to treat it.
For typical dengue, the
concerned with relief
(symptomatic).

treatment
of the

is purely
symptoms

Rest and fluid intake for adequate hydration is

Immunization

Vaccine development for dengue and DHF is

difficult because any of four different viruses
may cause disease.

Nonetheless, progress is being made in the

development of vaccines that may protect
against all four dengue viruses. Such products
may become available for public health use
within several years.

The mosquito flourishes during rainy seasons

but can breed in water-filled flower pots,
plastic bags, and cans year-round.

One mosquito bite can inflict the disease.

Under optimal conditions, the egg of an

Aedes mosquito can hatch into a larva in less
than a day.

The larva then takes about four days to

develop in a pupa, from which an adult
mosquito will emerge after two days.

Three days after the mosquito has bitten a

person and taken in blood, it will lay eggs,
and the cycle begins again.

Facts about the mosquito

Only the female aedes mosquito bites as it

needs the protein in blood to develop its
eggs.

The
mosquito
becomes
infective
approximately 7 days after it has bitten a
person carrying the virus.

This is the extrinsic incubation period,

during which time the virus replicates in
the mosquito and reaches the salivary
glands.

 Peak
The

biting is at dawn and dusk.

average lifespan of an
mosquito in Nature is 2 weeks.

Aedes

The

mosquito can lay eggs about 3 times

in its lifetime, and about 100 eggs are
produced each time.

The

eggs can lie dormant in dry conditions

for up to about 9 months, after which they
can hatch if exposed to favourable
conditions, i.e. water and food.

Potential Breeding Sites

Prevention

The application of appropriate insecticides to

larval habitats.

During outbreaks, emergency control measures

may also include the application of insecticides
as:

space sprays to kill adult mosquitoes using

portable or truck-mounted machines or even
aircraft.

However, the killing effect is only transient,

variable in its effectiveness because the aerosol
droplets may not penetrate indoors to
microhabitats where adult mosquitoes are
hiding.

Dengue Prevention Checklist

To

prevent the spread of dengue fever, we

must first prevent the breeding of its
vector, the Aedes mosquitoes.

The

Aedes mosquito is easily identifiable

by its distinctive black and white stripes
on their body. It prefers to breed in clean,
stagnant water easily found in our homes.

We

can get rid of the Aedes mosquito by

frequently
checking
and
removing
stagnant water in our premises.

CHECKLIST
At all times
Turn

pails and watering cans over and

store them under shelter.

 Remove

water in plant pot plates.

Clean and scrub the plate thoroughly
to remove mosquito eggs. Avoid the
use of plant pot plates, if possible.

 Loosen

soil from potted plants to prevent

the accumulation of stagnant water on the
surface of the hardened soil.

Do

not block the flow of water in scupper

drains.

Cover rarely used gully traps. Replace the

gully trap with non-perforated ones and
install anti-mosquito valves.

No tray or receptacles should be placed beneath and

or/ on top of any air-conditioning unit so as not to
create a condition favourable for mosquito breeding.

Every other day

Change water in flower vases. Clean and scrub the
inner sides of vases. Wash roots of flowers and plants
thoroughly as mosquito eggs can stick to them easily.

Once a week

Clear fallen leaves and stagnant water in your

scupper drains and garden.
These leaves could collect water or cause
blockages to the drains, thus resulting in the
build-up
of
stagnant
water.

Clear any stagnant water in your air cooler unit.

Once a month
Add prescribed amounts of sand granular
insecticide into vases, gully traps and roof
gutters, even if they are dry.

Thanks

DENGUE

FEVER

Dr Abu Zar Taizai