Angeles University Foundation

College of Allied Medical Professions

Medical Technology Department

Dengue and Dengue

Hemorrhagic
Fever

Submitted by:
Gamboa, Lois Danielle L.
Paule, Diosshane V.
Cruz, Steffy Mae W.
Banjal, Ryan Ali Y.
Castro, Ronelyn Joy C.

Submitted to:

Mendoza, Regina Carmela S.

Dr. Estelita D. Cayabyab

Contents

Origin and History of Dengue and DHF (Paule)

Causative Organism (Cruz)
Factors Contributing to the Re-emergence of DHF (Banjal)
Transmission (Castro)
Symptoms (Castro)
Laboratory Diagnosis (Gamboa)
Treatment (Mendoza)
Prevention and Control (Gamboa)

Origin and History (Diosshane Paule)

The origins of the word dengue are not clear, but one theory is that it is derived from the
Swahili phrase "Ka-dinga pepo", meaning "cramp-like seizure caused by an evil spirit". The Swahili
word "dinga" may possibly have its origin in the Spanish word "dengue" meaning fastidious or careful,
which would describe the gait of a person suffering the bone pain of dengue fever. Alternatively, the
use of the Spanish word may derive from the similar-sounding Swahili. Slaves in the West Indies who
contracted dengue were said to have the posture and gait of a dandy, and the disease was known as
"Dandy Fever".
The first record of a case of probable dengue fever is in a Chinese medical encyclopedia from the
Jin Dynasty (265420 AD) which referred to a water poison associated with flying insects. The first
recognized Dengue epidemics occurred almost simultaneously in Asia, Africa, and North America in
the 1780s, shortly after the identification and naming of the disease in 1779. The first confirmed case
report dates from 1789 and is by Benjamin Rush, who coined the term "breakbone fever" because of the
symptoms of myalgia and arthralgia.
Dengue fever is a disease caused by a family of viruses that are transmitted by mosquitoes. It is
an acute illness of sudden onset that usually follows a benign course with symptoms such as headache,
fever, exhaustion, severe muscle and joint pain, swollen glands (lymphadenopathy), and rash. The
presence (the "dengue triad") of fever, rash, and headache (and other pains) is particularly characteristic
of dengue. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red
palms and soles.
Dengue can affect anyone but tends to be more severe in people with compromised immune
systems. Because it is caused by one of four serotypes of virus, it is possible to get dengue fever
multiple times. However, an attack of dengue produces immunity for a lifetime to that particular
serotype to which the patient was exposed.
Severe dengue (previously known as Dengue Hemorrhagic Fever) was first recognized in the
1950s during dengue epidemics in the Philippines and Thailand. Today, severe dengue affects most
Asian and Latin American countries and has become a leading cause of hospitalization and death
among children in these regions. Dengue hemorrhagic fever is a more severe form of the viral illness.
Symptoms include headache, fever, rash, and evidence of hemorrhage in the body. Petechiae (small red
or purple splotches or blisters under the skin), 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 and can
progress to the most severe form of the illness, dengue shock syndrome

The viral etiology and the transmission by mosquitoes were only deciphered in the 20th century.
The socioeconomic impact of World War II resulted in increased spread globally. Nowadays, about 2.5
billion people, or 40% of the worlds population, live in areas where there is a risk of dengue
transmission. Dengue spread to more than 100 countries in Asia, the Pacific, the Americas, Africa, and
the Caribbean.
Dengue is a mosquito-borne infection found in tropical and sub-tropical regions around the
world. In recent years, transmission has increased predominantly in urban and semi-urban areas and
has become a major international public health concern. Outbreaks have occurred recently in the
Caribbean, including Puerto Rico, the U.S. Virgin Islands, Cuba, and Central America. Cases have also
been imported via tourists returning from areas with widespread dengue, including Tahiti, Singapore,
the South Pacific, Southeast Asia, the West Indies, India, and the Middle East (similar in distribution to
the areas of the world that harbor malaria and yellow fever). Dengue is now the leading cause of acute
febrile illness in U.S. travelers returning from the Caribbean, South America, and Asia.
In 2011, Bolivia, Brazil, Columbia, Costa Rica, El Salvador, Honduras, Mexico, Peru, Puerto Rico,
and Venezuela reported a large number of dengue cases. Paraguay reported a dengue fever outbreak in
2011, the worst since 2007. Hospitals were overcrowded, and patients had elective surgeries canceled
due to the outbreak.
Dengue fever is common, in at least 100 countries in Asia, the Pacific, the Americas, Africa, and
the Caribbean. Thailand, Vietnam, Singapore, and Malaysia have all reported an increase in cases.
According to the CDC, there are an estimated 100 million cases of dengue fever with several
hundred thousand cases of dengue hemorrhagic fever requiring hospitalization each year. Nearly 40%
of the world's population lives in an area endemic with dengue. The World Health Organization
(WHO) estimates that 22,000 deaths occur yearly, mostly among children.

Causative Organism (Steffy Cruz)

Dengue Fever (DF) is a viral infectious disease transmitted by mosquito (AEDES) bite. The virus
attack blood cell, liver, and spleen and leads to low white blood cell and decreases platelets (Blood
Clotting component). There are four distinct, but closely related, serotypes of the virus that cause
dengue (DEN-1, DEN-2, DEN-3 and DEN-4). Recovery from infection by one provides lifelong
immunity against that particular serotype. However, cross-immunity to the other serotypes after
recovery is only partial and temporary. Subsequent infections by other serotypes increase the risk of
developing severe dengue.

The Aedes aegypti mosquito is the primary vector of dengue. The virus is transmitted to
humans through the bites of infected female mosquitoes. After virus incubation for 410 days, an
infected mosquito is capable of transmitting the virus for the rest of its life.
Infected humans are the main carriers and multipliers of the virus, serving as a source of the
virus for uninfected mosquitoes. Patients who are already infected with the dengue virus can transmit
the infection (for 45 days; maximum 12) via Aedes mosquitoes after their first symptoms appear.
The Aedes aegypti mosquito lives in urban habitats and breeds mostly in man-made containers.
Unlike other mosquitoes Ae. aegypti is a daytime feeder; its peak biting periods are early in the
morning and in the evening before dusk. FemaleAe. aegypti bites multiple people during each feeding
period.
Aedes albopictus, a secondary dengue vector in Asia, has spread to North America and Europe
largely due to the international trade in used tires (a breeding habitat) and other goods (e.g. lucky
bamboo). Ae. albopictus is highly adaptive and therefore can survive in cooler temperate regions of
Europe. Its spread is due to its tolerance to temperatures below freezing, hibernation, and ability to
shelter in microhabitats.

Factors Contributing to the Re-emergence of DHF (Ryan Banjal)

The disease pattern associated with dengue-like illness from 1780 to 1940 was characterized by
relatively infrequent but often large epidemics. However, it is likely that dengue viruses became
endemic in many tropical urban centers during this time because during inter-epidemic periods, when
there was no apparent disease transmission, non-immune visitors invariably contracted a dengue-like
illness within months of their arrival.
The ecologic disruption in the Southeast Asia and Pacific theaters during and following World
War II created ideal conditions for increased transmission of mosquito-borne diseases, and it was in this
setting that a global pandemic of dengue began. With increased epidemic transmission,
hyperendemicity (the cocirculation of multiple dengue virus serotypes) developed in Southeast Asian
cities and epidemic dengue hemorrhagic fever (DHF), a newly described disease, emerged. The first
known epidemic of DHF occurred in Manila, Philippines, in 1953 to 1954, but within 20 years the
disease in epidemic form had spread throughout Southeast Asia; by the mid-1970s, DHF had become a
leading cause of hospitalization and death among children in the region. In the 1970s, dengue was
reintroduced to the Pacific Islands and epidemic activity increased there and in the Americas. During
the 1980s and 1990s, epidemic dengue transmission intensified, and there is now a global resurgence of
dengue fever, with expanding geographic distribution of both the mosquito vectors and the viruses,

increased incidence of disease caused by an increased frequency of epidemic transmission, and the
emergence of DHF in many new countries.
In Asia, epidemic DHF has expanded geographically from Southeast Asian countries west to
India, Sri Lanka, the Maldives, and Pakistan and east to China. Several island countries of the South
and Central Pacific (Niue, Palau, Yap, Cook Islands, Tahiti, New Caledonia, and Vanuatu) have
experienced major or minor DHF epidemics. Epidemiologic changes in the Americas, however, have
been the most dramatic. In the 1950s, 1960s, and most of the 1970s, epidemic dengue was rare in the
American region because the principal mosquito vector, Aedes aegypti, had been eradicated from most
of Central and South America. The eradication program was discontinued in the early 1970s, and this
species then began to reinvade the countries from which it had been eradicated. By the 1990s, A.
aegyptihad nearly regained the geographic distribution it held before eradication was initiated.
Epidemic dengue invariably followed reinfestation of a country byA. aegypti. By the 1980s, the
American region was experiencing major epidemics of dengue in countries that had been free of the
disease for 35 to 130 years. New dengue virus strains and serotypes were introduced (DEN-1 in 1977, a
new strain of DEN-2 in 1981, DEN-4 in 1981, and a new strain of DEN-3 in 1994). Moreover, many
countries of the region evolved from nonendemicity (no endemic disease) or hypoendemicity (one
serotype present) to hyperendemicity (multiple serotypes present), and epidemic DHF emerged, much
as it had in Southeast Asia 25 years earlier. From 1981 to 1997, 24 American countries reported
laboratory-confirmed DHF.
The factors responsible for the dramatic resurgence and emergence of epidemic dengue and
DHF, respectively, as a global public health problem in the past 17 years are complex and not fully
understood. However, the resurgence appears to be closely associated with demographic and societal
changes over the past 50 years. Two major factors have been the unprecedented global population
growth and the associated unplanned and uncontrolled urbanization, especially in tropical developing
countries. The substandard housing, crowding, and deterioration in water, sewer, and waste
management systems associated with unplanned urbanization have created ideal conditions for
increased transmission of mosquito-borne diseases in tropical urban centers.
A third major factor has been the lack of effective mosquito control in areas where dengue is
endemic. The emphasis during the past 25 years has been on space spraying with insecticides to kill
adult mosquitoes; this has not been effective and, in fact, has been detrimental to prevention and
control efforts by giving citizens of the community and government officials a false sense of security
(38). Additionally, the geographic distribution and population densities of A. aegypti have increased,
especially in urban areas of the tropics, because of increased numbers of mosquito larval habitats in the
domestic environment. The latter include nonbiodegradable plastics and used automobile tires, both of
which have increased dramatically in prevalence during this period.

A fourth factor responsible for the global emergence of dengue and DHF is increased air travel,
which provides the ideal mechanism for the transport of dengue and other urban pathogens between
population centers of the world. For instance, in 1994, an estimated 40 million persons departed the
United States by air, over 50% of who traveled for business or holiday to tropical countries where
dengue is endemic. Many travelers become infected while visiting tropical areas but become ill only
after returning home, resulting in a constant movement of dengue viruses in infected humans to all
areas of the world and ensuring repeated introductions of new dengue virus strains and serotypes into
areas where the mosquito vectors occur.
A fifth factor that has contributed to the resurgence of epidemic dengue has been the decay in
public health infrastructures in most countries in the past 30 years. Lack of resources has led to a critical
shortage of trained specialists who understand and can develop effective prevention and control
programs for vector-borne diseases. Coincident with this has been a change in public health policy that
placed emphasis on emergency response to epidemics by using high-technology mosquito control
methods rather than on preventing those epidemics by using larval source reduction through
environmental hygiene, the only method that has been shown to be effective.
In summary, demographic and societal changes, decreasing resources for vector-borne
infectious disease prevention and control, and changes in public health policy have all contributed to
increased epidemic dengue activity, the development of hyperendemicity, and the emergence of
epidemic DHF.

Tropical country
o Mosquitos are mostly in tropic countries.
No effective mosquito control efforts are underway in most countries with
dengue.
o Precautionary measures should always be followed.
- Application of mosquito repellant.
- Removal of stagnant water
- Tires should be disposed properly
Public health systems to detect and control epidemics are deteriorating around
the world.
- It is for reason that the community would be aware on how to prevent
dengue and to know whats happening.
Rapid growth of cities in tropical countries has led to overcrowding urban decay,
and substandard sanitation, allowing more mosquitoes to live closer to more
people.
The increase in non-biodegradable plastic packaging and discarded tires is
creating new breeding sites for mosquitoes

Increased jet air travel is helping people infected with dengue viruses to move
easily from city to city.

Transmission (Ronelyn Castro)

Dengue viruses are transmitted to humans (host) through the bites of the female striped Aedes
aegypti mosquito (vector). This variety of mosquito breeds easily during the rainy seasons. The dengue
virus is transmitted to its host during probing and blood feeding. The mosquito may carry the virus
from one host to another host and the mosquito is most active in the early morning and later afternoon.
Incubation period occurs when the viruses has been transmitted to the human host. The period ranges
from 3 to 15 days before the characteristics of dengue appear. During incubation time, the dengue
viruses multiply.
The dengue virus is spread through a human-to-mosquito-to-human cycle of transmission.
Typically, four days after being bit by an infected Aedes aegypti mosquito, a person will develop
viremia, a condition in which there is a high level of the dengue virus in the blood. Viremia lasts for
approximately five days, but can last as long as twelve days. On the first day of viremia, the person
generally shows no symptoms of dengue. Five days after being bit by the infected mosquito, the person
develops symptoms of dengue fever, which can last for a week or longer.

How does an Aedes aegypti mosquito become a dengue vector? After a mosquito feeds on the
blood of someone infected with the dengue virus, that mosquito becomes a dengue vector. The
mosquito must take its blood meal during the period of viremia, when the infected person has high
levels of the dengue virus in the blood. Once the virus enters the mosquito's system in the blood meal,
the virus spreads through the mosquito's body over a period of eight to twelve days. After this period,

the infected mosquito can transmit the dengue virus to another person while feeding. Does a mosquito
infected with the dengue virus only transmit the virus to the next person it feeds on? No, once infected
with dengue, the mosquito will remain infected with the virus for its entire life. Infected mosquitoes
can continue transmitting the dengue virus to healthy people for the rest of their life spans, generally a
three- to four-week period.
Both male and female mosquitoes feed on plant nectars, fruit juices, and other plants sugars as
their main energy source. Why, then, do mosquitoes bite humans? Female mosquitoes require blood to
produce eggs, so they bite humans. Each female mosquito can lay multiple batches of eggs during its
lifetime, and often Aedes aegypti take several blood meals before laying a batch of eggs. When a female
mosquito is infected with the dengue virus, the virus is present in its salivary glands. How does the
virus travel from the mosquito's salivary glands into a human? When taking a blood meal, an infected
female mosquito injects its saliva into the human host to prevent the host's blood from clotting and to
ease feeding. This injection of saliva infects the host with the dengue virus.
Are mosquito bites the only way the dengue virus can be transmitted to humans? In rare events,
dengue can be transmitted during organ transplantations or blood transfusions from infected donors.
There is also evidence that an infected pregnant mother can transmit the dengue virus to her fetus.
Despite these rare events, the majority of dengue infections are transmitted by mosquito bites.
Because of the approximately 7-day viremia in humans, bloodborne transmission is possible
through exposure to infected blood, organs, or other tissues (such as bone marrow). In addition,
perinatal DENV transmission occurs, and the highest risk appears to be among infants whose mothers
are acutely ill around the time of delivery. It is not known if DENV is transmitted through breast milk.

Symptoms (Ronelyn Castro)

The signs and symptoms of Dengue fever are as follows:
- High fever (104 F, 40C)
- Chills
- Headache
- Red eyes, pain in the eyes
- Enlarged lymph nodes
- Deep muscle and joint pains (during first hours of illness)
- Loss of appetite

- Nausea and vomiting

- Low blood pressure and heart rate
- Extreme fatigue
Basically, dengue commences with high fever and other signs as listed above for 2 to 4 days.
Then, the temperature drops rapidly and intense sweating takes place. After about a day with normal
temperature and a feeling of well-being, the temperature rises abruptly again. Rashes (small red
bumps) show up on the arms, legs and the entire body simultaneously along with fever. However,
rashes rarely occur on the face. The palms of the hands and soles of the feet may be swollen and bright
red. Although the patient may feel exhausted for several weeks, most cases of dengue take
approximately one week to recover. Once a person recovers from dengue, he or she will have antibodies
in their bloodstream which will prevent them from having a relapse for about a year.
Characteristics of the stages of Dengue Fever:

Stage I: Acute fever stage. (~Day 1-5). At this phase the patients have high fever (39-40
degree Celsius) with aching, abdominal pain, nausea, vomiting. Anti-pyritic such as
paracetamol is important to lower body temperature in order to provide the body
minimizes fluid loss. REHYDRATION by food and electrolyte fluid, will replace the
fluid in the circulation for the patients. If the patient, especially children do not
eat/drink enough and look weak, seek medical attention urgently.

Stage II: Critical stage. (~Day 5-7), at this stage when the body temperature drops,
normally within 24 hours, the plasma (Fluid part of blood component) leaks and the
blood pressure will drop. Patients will be restless, weak, have cold clammy skin, fast
pulse, in severe case with very low platelets they could vomit up blood, have internal
hemorrhage and die with circulatory failure or respiratory failure due to internal
bleeding/ fluid retention. It is very important to provide appropriate intravenous fluid
to the patients in this stage to prevent poor blood perfusion to the vital organ and not to
overload the fluid in term of third space leakage prevention.

Stage III: Recovery phase. It takes a couple days for the patients to get back to normal.
At this phase the patients will gain back appetite (A), have slower pulse rate
(Bradycardia=B), have convalescent rash at legs and arms (C) and pass more water
(Diuresis=D). You may recognize these steps by A-B-C-D.

Stage 4: Shock and death (10% of all cases reach this stage)

Typical dengue is fatal in less than 1% of cases. The acute phase of the illness with fever and
myalgias lasts about one to two weeks. Convalescence is accompanied by a feeling of weakness
(asthenia), and full recovery often takes several weeks.

Laboratory Diagnosis (Lois Gamboa)

Clinicians should consider dengue in a patient who was in an endemic area within 2 weeks
before symptom onset. All suspected cases should be reported to the local health department, because
dengue is a nationally reportable disease. Laboratory confirmation can be made from a single acutephase serum specimen obtained early (5 days after fever onset) in the illness by detecting DENV
genomic sequences with RT-PCR or DENV nonstructural protein 1 (NS1) antigen by immunoassay.
Later in the illness (4 days after fever onset), IgM anti-DENV can be detected with ELISA. For patients
presenting during the first week after fever onset, diagnostic testing should include a test for DENV
(PCR or NS1) and IgM anti-DENV. For patients presenting >1 week after fever onset, IgM anti-DENV is
most useful, although NS1 has been reported positive up to 12 days after fever onset.
Presence of DENV by PCR or NS1 antigen in a single diagnostic specimen is considered
laboratory confirmation in patients with a compatible clinical and travel history. IgM anti-DENV in a
single serum sample suggests a probable, recent DENV infection. IgM anti-DENV seroconversion in
acute- and convalescent-phase serum specimens is considered laboratory confirmation of dengue.
IgG anti-DENV by ELISA in a single serum sample is not useful for diagnostic testing, because it
remains elevated for life after any DENV infection and can be falsely positive in people with antibodies
to other flaviviruses (such as West Nile, yellow fever, Japanese encephalitis).
Diagnosis of dengue involves isolation of the virus through serological tests, or by molecular
methods. Diagnosis of acute or recent dengue infection can be established by testing serum samples
during the first 5 days of symptoms and/or early convalescent phase.
Tests may include:

o
o
o
o
o
o
o
o
o

Arterial blood gases

Antibody titer for dengue virus types
Complete blood count (CBC)
Polymerase chain reaction (PCR) test for dengue virus types
Coagulation studies
Electrolytes
Hematocrit
Liver enzymes
Platelet count

o Serum studies from samples taken during acute illness and convalescence (increase
in titer to Dengueantigen)
o Tourniquet test (causes petechiae to form below the tourniquet)
o X-ray of the chest (may demonstrate pleural effusion)
Laboratory diagnosis of dengue virus infection can be made by the detection of specific virus,
viral antigen, genomic sequence, and/or antibodies. At present, the three basic methods used by most
laboratories for the diagnosis of dengue virus infection are viral isolation and characterization,
detection of the genomic sequence by a nucleic acid amplification technology assay, and detection of
dengue virus-specific antibodies. After the onset of illness, the virus is found in serum or plasma,
circulating blood cells, and selected tissues, especially those of the immune system, for approximately 2
to 7 days, roughly corresponding to the period of fever. Molecular diagnosis based on reverse
transcription (RT)-PCR, such as one-step or nested RT-PCR, nucleic acid sequence-based amplification
(NASBA), or real-time RT-PCR, has gradually replaced the virus isolation method as the new standard
for the detection of dengue virus in acute-phase serum samples.
Laboratory findings commonly include leucopenia, thrombocytopenia, hyponatremia, elevated
aspartate aminotransferase and alanine aminotransferase, and a normal erythrocyte sedimentation rate.
Data are limited on health outcomes of dengue in pregnancy and effects of maternal DENV
infection on the developing fetus. Perinatal DENV transmission can occur, and peripartum maternal
infection may increase the likelihood of symptomatic disease in the newborn. Of the 34 perinatal
transmission cases described in the literature, all developed thrombocytopenia and all but 1 had fever
in the first 2 weeks after birth. Nearly 40% had a hemorrhagic manifestation, and one-fourth had
hypotension. Transplacental transfer of maternal IgG anti-DENV (from a previous maternal infection)
may increase risk for severe dengue among infants infected at 612 months of age.

Treatment (Regina Mendoza)

There is no specific treatment for dengue fever. No specific antiviral agents exist for dengue.
Patients should be advised to stay well hydrated and to avoid aspirin (acetylsalicylic acid), aspirincontaining drugs, and other non-steroidal anti-inflammatory drugs (such as ibuprofen) because of their
anticoagulant properties. Fever should be controlled with acetaminophen and tepid sponge baths.
Febrile patients should avoid mosquito bites to reduce risk of further transmission. For those who
develop severe dengue, close observation and frequent monitoring in an intensive care unit setting may
be required. Prophylactic platelet transfusions in dengue patients are not beneficial and may contribute
to fluid overload.

For severe dengue, medical care by physicians and nurses experienced with the effects and
progression of the disease can save lives decreasing mortality rates from more than 20% to less than
1%. Maintenance of the patient's body fluid volume is critical to severe dengue care.

o A transfusion of fresh blood or platelets can correct bleeding problems

o Intravenous (IV) fluids and electrolytes are also used to correct electrolyte
imbalances
o Aspirin and non-steroidal anti-inflammatory drugs should only be taken under a
doctor's supervision because of the possibility of worsening bleeding
complications.
o Acetaminophen (Tylenol) and codeine may be given for severe headache and for
joint and muscle pain (myalgia).
o Oxygen therapy may be needed to treat abnormally low blood oxygen
o Rehydration with intravenous (IV) fluids is often necessary to treat dehydration
o Supportive care in an intensive care unit/environment
There is no vaccine to protect against dengue. Developing a vaccine against dengue/severe
dengue has been challenging although there has been recent progress in vaccine development. The
WHO provides technical advice and guidance to countries and private partners to support vaccine
research and evaluation. Several candidate vaccines are in various phases of trials.
Note: Researchers have found that the juice obtained from the papaya leaves helps in the dengue fever
treatment. The extract obtained from the papaya leaf increases the platelet count also known as
thrombocytes in patients with dengue fever.

Prevention and Control (Lois Gamboa)

At present, the only method to control or prevent the transmission of dengue virus is to combat
vector mosquitoes through:

o Preventing mosquitoes from accessing egg-laying habitats by environmental

management and modification;
o Disposing of solid waste properly and removing artificial man-made habitats;
o Covering, emptying and cleaning of domestic water storage containers on a weekly
basis;
o Applying appropriate insecticides to water storage outdoor containers;
o Using of personal household protection such as window screens, long-sleeved clothes,
insecticide treated materials, coils and vaporizers;
o Improving community participation and mobilization for sustained vector control;

o Applying insecticides as space spraying during outbreaks as one of the emergency

vector control measures;
o Active monitoring and surveillance of vectors should be carried out to determine
effectiveness of control interventions.
Since no vaccine is currently available, although several are in clinical trials; no chemoprophylaxis is
available to prevent dengue. Travelers to dengue-endemic areas are at risk of getting dengue; risk
increases with longer duration of travel and disease incidence in the travel destination (such as during
dengue season and during epidemics). Travelers should be advised to avoid mosquito bites by taking
the following preventive measures:

o Select accommodations with well-screened windows and doors or air conditioning

when possible. Aedes mosquitoes typically live indoors and are often found in dark,
cool places, such as in closets, under beds, behind curtains, and in bathrooms. Travelers
should be advised to use insecticides to get rid of mosquitoes in these areas.
o Wear clothing that adequately covers the arms and legs, especially during the early
morning and late afternoon, when risk of being bitten is the highest.
o Use insect repellants.
o For long-term travelers, empty and clean or cover any standing water that can be
mosquito-breeding sites in the local residence (such as water storage tanks or flowerpot
trays).

Dengue Fever Epidemic

While research is underway on developing a vaccine to protect against dengue, this presents a
challenge because any effective vaccine would have to offer immunization against all four types to be
effective - and there is still a limited understanding of how the disease typically behaves and how the
virus interacts with the immune system.
There are also few laboratory animal models available to test immune responses to potential
vaccines - but nevertheless two vaccine candidates have already advanced to evaluation in human
subjects in countries with endemic disease, and several potential vaccines are in the earlier stages of
development - however an effective dengue vaccine for public use will not be available for 5 to 10 years.
There are several reasons for the dramatic global emergence of Dengue fever and Dengue
hemorrhagic fever as a major public health problem but they are complex and not well understood.
Several important factors have been identified - major global demographic changes have
occurred resulting in uncontrolled urbanization and concurrent population growth, often accompanied

by substandard housing and inadequate water, sewer, and waste management systems, all of which
increase mosquito populations and facilitates the transmission of mosquito-borne diseases.
Also in most countries public health infrastructures have deteriorated and limited financial and
human resources and competing priorities have resulted in a "crisis mentality" with an emphasis on
implementing so-called emergency control methods in response to epidemics, rather than developing
programs to prevent epidemic transmission.
This approach has been particularly detrimental to dengue control because, in most countries,
surveillance is, as in the U.S., is passive and the systems used to detect increased transmission normally
relies on reports by local doctors who often do not consider Dengue in their differential diagnoses and
as a result, an epidemic has often reached or passed its peak before it is recognized.
Increased travel by airplane also provides the ideal mechanism for infected human transport of
Dengue viruses between population centers of the tropics, resulting in a frequent exchange of Dengue
viruses and other pathogens.
In addition effective mosquito control is virtually nonexistent in most Dengue-endemic
countries and the outlook for reversing the recent trend of increased epidemic activity and geographic
expansion of dengue, is not promising.
Experts say new Dengue virus strains and serotypes are likely to continue to be introduced into
many areas where the mosquito population is high and no new mosquito control technology available.

Despite public health authorities in many countries emphasizing disease prevention and mosquito
control through community efforts to reduce larval breeding sources, this approach will probably only
be effective in the long term and is unlikely to impact disease transmission in the near future.
Disease experts believe improved, proactive, laboratory-based surveillance systems must be developed
to provide early warning of an impending Dengue epidemic to allow the public to take action and
doctors to diagnose and properly treat Dengue and Dengue haemorrhagic fever cases.
The threat to public health posed by Dengue, has been recognized by the National Institute of Allergy
and Infectious diseases (NIAID) which is funding nearly 60 Dengue research projects, including studies
on Dengue haemorrhagic fever and Dengue shock syndrome, the most severe forms of the disease.
According to the WHO the Aedes albopictus mosquito, a secondary Dengue vector in Asia, has now
become established in the United States, several Latin American and Caribbean countries, parts of
Europe and Africa, largely attributed to the international trade in used tires, a known breeding habitat.

References
o Harrisons Principles of Internal Medicine, 18th Edition Volume 1: McGraw Hill, 2012
o Mandell, Douglas, and Burrets Principles and Practices of Infectious Diseases,
6th Edition Volume 1: 2005
o Ellen M. Slaven, Susan C. Stone, Fred A. Lopez, Infectious Diseases: Emergency
Department Diagnosis and Management, 2007
o Deanna E. Grimes, RN, DrPh, Infectious Diseases, 1991
o Shirley Ooi, Guide to the Essentials in Emergency Medicine, 2004
o Management of the Child with a Serious Infection or Severe Malnutrition, 2000
o The Merck Manual: General Medicine, 15th Edition, 1987
Web References:

o http://www.nlm.nih.gov/medlineplus/ency/article/001373.htm
o http://www.healthcaremedicalclinic.com/news-view.php?view=66

o http://www.ncbi.nlm.nih.gov/pmc/articles/PMC440621/
o http://www.wtsp.com/news/science/article/324070/67/5-reasons-why-mosquitoeslove-you
o http://www.denguevirusnet.com/history-of-dengue.html
o http://www.medindia.net/patients/patientinfo/dengue-treatment.html
o http://www.who.int/csr/disease/dengue/en/
o http://www.who.int/mediacentre/factsheets/fs117/en/
o http://www.medicinenet.com/dengue_fever/page3.htm