Dengue With more than one-third of the world s population living in areas at risk for transmission, dengue infection

is a leading cause of illness and death in the tropics and subtropics. As many as 100 million people are infected yearly. Dengue is caused by any one of four related viruses transmitted by mosquitoes. There are not yet any vaccines to prevent infection with dengue virus (DENV) and the most effective protective measures are those that avoid mosquito bites. When infected, early recognition and prompt supportive treatment can substantially lower the risk of developing severe disease. Dengue has emerged as a worldwide problem only since the 1950s. Although dengue rarely occurs in the continental United States, it is endemic in Puerto Rico, and in many popular tourist destinations in Latin America and Southeast Asia; periodic outbreaks occur in Samoa and Guam. How to reduce your risk while visiting areas with dengue International travelers risk of dengue infection can vary dependant on transmission in the area as well as exposure to mosquitoes. You are at greater risk when an outbreak or epidemic is occurring. If your hotel or resort does not have air conditioning or windows and doors with secure, intact screens you may be at higher risk. You should take precautions like using repellent and killing any visible mosquitoes. CDC recommends repellents containing DEET, picaridin, oil of lemon eucalyptus or IR3535 as the active ingredient. Repellent can be applied to exposed skin and/or clothing. Clothing impregnated with permethrin is another option (pre-treated or you can treat yourself). Some spatial repellent/insecticide products (mosquito coils, plug-in or butane powered devices), may assist in reducing the risk of mosquito around you. How to reduce your risk of dengue infection: There is no vaccine available against dengue, and there are no specific medications to treat a dengue infection. This makes prevention the most important step, and prevention means avoiding mosquito bites if you live in or travel to an endemic area. The best way to reduce mosquitoes is to eliminate the places where the mosquito lays her eggs, like artificial containers that hold water in and around the home. Outdoors, clean water containers like pet and animal watering containers, flower planter dishes or cover water storage barrels. Look for standing water indoors such as in vases with fresh flowers and clean at least once a week. The adult mosquitoes like to bite inside as well as around homes, during the day and at night when the lights are on. To protect yourself, use repellent on your skin while indoors or out. When possible, wear long sleeves and pants for additional protection. Also, make sure window and door screens are secure and without holes. If available, use air-conditioning. If someone in your house is ill with dengue, take extra precautions to prevent mosquitoes from biting the patient and going on to bite others in the household. Sleep under a mosquito bed net, eliminate mosquitoes you find indoors and wear repellent! List of repellant products approved by the EPA :

Symptoms and What To Do If You Think You Have Dengue The principal symptoms of dengue are:
y

High fever and at least two of the following:

o o o o o o o

Severe headache Severe eye pain (behind eyes) Joint pain Muscle and/or bone pain Rash Mild bleeding manifestation (e.g., nose or gum bleed, petechiae, or easy bruising) Low white cell count

Generally, younger children and those with their first dengue infection have a milder illness than older children and adults. Watch for warning signs as temperature declines 3 to 7 days after symptoms began. Go IMMEDIATELY to an emergency room or the closest health care provider if any of the followingwarning signs appear:
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Severe abdominal pain or persistent vomiting Red spots or patches on the skin Bleeding from nose or gums Vomiting blood Black, tarry stools (feces, excrement) Drowsiness or irritability Pale, cold, or clammy skin Difficulty breathing

For a list of Hospitals, laboratories and health care centers in Puerto Rico that will draw serum samples. (Spanish) DOC (105 KB/1 page) Dengue hemorrhagic fever (DHF) is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms consistent with dengue fever. When the fever declines, warning signs may develop. This marks the beginning of a 24 to 48 hour period when the smallest blood vessels (capillaries) become

excessively permeable ( leaky ), allowing the fluid component to escape from the blood vessels into the peritoneum (causing ascites) and pleural cavity (leading to pleural effusions). This may lead to failure of the circulatory system and shock, and possibly death without prompt, appropriate treatment. In addition, the patient with DHF has a low platelet count and hemorrhagic manifestations, tendency to bruise easily or have other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding. Treatment There is no specific medication for treatment of a dengue infection. Persons who think they have dengue should use analgesics (pain relievers) with acetaminophen and avoid those containing ibuprofen, Naproxen, aspirin or aspirin containing drugs. They should also rest, drink plenty of fluids to prevent dehydration, avoid mosquito bites while febrile and consult a physician. As with dengue, there is no specific medication for DHF. If a clinical diagnosis is made early, a health care provider can effectively treat DHF using fluid replacement therapy. Adequately management of DHF generally requires hospitalization. Epidemiology Dengue fever (DF) is caused by any of four closely related viruses, or serotypes: dengue 1-4. Infection with one serotype does not protect against the others, and sequential infections put people at greater risk for dengue hemorraghic fever (DHF) and dengue shock syndrome (DSS). Transmission of the Dengue Virus Dengue is transmitted between people by the mosquitoes Aedesaegypti and Aedes albopictus, which are found throughout the world. Insects that transmit disease are vectors. Symptoms of infection usually begin 4 - 7 days after the mosquito bite and typically last 3 - 10 days. In order for transmission to occur the mosquito must feed on a person during a 5- day period when large amounts of virus are in the blood; this period usually begins a little before the person become symptomatic. Some people never have significant symptoms but can still infect mosquitoes. After entering the mosquito in the blood meal, the virus will require an additional 8-12 days incubation before it can then be transmitted to another human. The mosquito remains infected for the remainder of its life, which might be days or a few weeks. In rare cases dengue can be transmitted in organ transplants or blood transfusions from infected donors, and there is evidence of transmission from an infected pregnant mother to her fetus. But in the vast majority of infections, a mosquito bite is responsible. In many parts of the tropics and subtropics, dengue is endemic, that is, it occurs every year, usually during a season when Aedes mosquito populations are high, often when rainfall is optimal for breeding. These areas are, however, additionally at periodic risk for epidemic dengue, when large numbers of people become infected during a short period. Dengue epidemics require a coincidence of large numbers of vector mosquitoes, large numbers of people with no immunity to one of the four virus types

(DENV 1, DENV 2, DENV 3, DENV 4), and the opportunity for contact between the two. Although Aedes are common in the southern U. S., dengue is endemic in northern Mexico, and the U.S. population has no immunity, the lack of dengue transmission in the continental U.S. is primarily because contact between people and the vectors is too infrequent to sustain transmission. Top of Page Dengue is an Emerging Disease

The four dengue viruses originated in monkeys and independently jumped to humans in Africa or Southeast Asia between 100 and 800 years ago. Dengue remained a relatively minor, geographically restricted disease until the middle of the 20th century. The disruption of the second world war in particular the coincidental transport of Aedesmosquitoes around the world in cargo - are thought to have played a crucial role in the dissemination of the viruses. DHF was first documented only in the 1950s during epidemics in the Philippines and Thailand. It was not until 1981 that large numbers of DHF cases began to appear in the Carribean and Latin America, where highly effective Aedes control programs had been in place until the early 1970s. Top of Page Global Dengue Today about 2.5 billion people, or 40% of the world s population, live in areas where there is a risk of dengue transmission see WHO/Impact of Dengue . Dengue is endemic in at least 100 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean. The World Health Organization (WHO) estimates that 50 to 100 million infections occur yearly, including 500,000 DHF cases and 22,000 deaths, mostly among children. Frequently Asked Questions Q. What is dengue? A. Dengue (pronounced den' gee) is a disease caused by any one of four closely related dengue viruses (DENV 1, DENV 2, DENV 3, or DENV 4). The viruses are transmitted to humans by the bite of an infected mosquito. In the Western Hemisphere, the Aedes aegypti mosquito is the most important transmitter or

vector of dengue viruses, although a 2001 outbreak in Hawaii was transmitted by Aedes albopictus. It is estimated that there are over 100 million cases of dengue worldwide each year. Q.What is dengue hemorrhagic fever (DHF)? A.DHF is a more severe form of dengue infection. It can be fatal if unrecognized and not properly treated in a timely manner. DHF is caused by infection with the same viruses that cause dengue fever. With good medical management, mortality due to DHF can be less than 1%. Q.How are dengue and dengue hemorrhagic fever (DHF) spread? A. Dengue is transmitted to people by the bite of an Aedes mosquito that is infected with a dengue virus. The mosquito becomes infected with dengue virus when it bites a person who has dengue virus in their blood. The person can either have symptoms of dengue fever or DHF, or they may have no symptoms. After about one week, the mosquito can then transmit the virus while biting a healthy person. Dengue cannot be spread directly from person to person. Q.What are the symptoms of the disease? A. The principal symptoms of dengue fever are high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash, and mild bleeding (e.g., nose or gums bleed, easy bruising). Generally, younger children and those with their first dengue infection have a milder illness than older children and adults. Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms consistent with dengue fever. When the fever declines, symptoms including persistent vomiting, severe abdominal pain, and difficulty breathing, may develop. This marks the beginning of a 24- to 48-hour period when the smallest blood vessels (capillaries) become excessively permeable ( leaky ), allowing the fluid component to escape from the blood vessels into the peritoneum (causing ascites) and pleural cavity (leading to pleural effusions). This may lead to failure of the circulatory system and shock, followed by death, if circulatory failure is not corrected. In addition, the patient with DHF has a low platelet count and hemorrhagic manifestations, tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding. Q.What is the treatment for dengue? A. There is no specific medication for treatment of a dengue infection. Persons who think they have dengue should use analgesics (pain relievers) with acetaminophen and avoid those containing aspirin. They should also rest, drink plenty of fluids, and consult a physician. If they feel worse (e.g., develop vomiting and severe abdominal pain) in the first 24 hours after the fever declines, they should go immediately to the hospital for evaluation. Q.Is there an effective treatment for dengue hemorrhagic fever (DHF)? A. As with dengue fever, there is no specific medication for DHF. It can however be effectively treated by fluid replacement therapy if an early clinical diagnosis is made. DHF management frequently requires hospitalization. Physicians who suspect that a patient has DHF may want to consult the Dengue Branch at CDC, for more information.

Q. Where can outbreaks of dengue occur? A.Outbreaks of dengue occur primarily in areas where Ae. aegypti (sometimes also Ae. albopictus) mosquitoes live. This includes most tropical urban areas of the world. Dengue viruses may be introduced into areas by travelers who become infected while visiting other areas of the tropics where dengue commonly exists. Q.What can be done to reduce the risk of acquiring dengue? A.There is no vaccine for preventing dengue. The best preventive measure for residents living in areas infested with Ae. aegypti is to eliminate the places where the mosquito lays her eggs, primarily artificial containers that hold water. Items that collect rainwater or to store water (for example, plastic containers, 55-gallon drums, buckets, or used automobile tires) should be covered or properly discarded. Pet and animal watering containers and vases with fresh flowers should be emptied and cleaned (to remove eggs) at least once a week. This will eliminate the mosquito eggs and larvae and reduce the number of mosquitoes present in these areas. Using air conditioning or window and door screens reduces the risk of mosquitoes coming indoors. Proper application of mosquito repellents containing 20% to 30% DEET as the active ingredient on exposed skin and clothing decreases the risk of being bitten by mosquitoes. The risk of dengue infection for international travelers appears to be small. There is increased risk if an epidemic is in progress or visitors are in housing without air conditioning or screened windows and doors. Q.How can we prevent epidemics of dengue hemorrhagic fever (DHF)? A.The emphasis for dengue prevention is on sustainable, community-based, integrated mosquito control, with limited reliance on insecticides (chemical larvicides, and adulticides). Preventing epidemic disease requires a coordinated community effort to increase awareness about dengue fever/DHF, how to recognize it, and how to control the mosquito that transmits it. Residents are responsible for keeping their yards and patios free of standing water where mosquitoes can be produced.

Dengue Fever in the Philippines Dengue Fever in the Philippines According to a Promed article, Dengue fever is moving fast and on the rise. I chose to report on the Philippines because that is where my family is from. As of September 2007, there has been 4000 new cases of Dengue fever. Since January 2007, 283 cases out of 24, 689 have been fatal. The wet weather (it's rainy season from June to November) provides a breeding ground for Aedes aegypti, a day-biting mosquito that prefers to feed on humans.

www.worldtravels.com recommends those traveling to the Philippines that the best protection against Dengue fever is to "avoid mosquito bites". Now that doesn't sound hard! The Philippine Health department has initiated a 4-S Campaign against Dengue: S - Search and destroy mosquito breeding grounds S - Seek immediate consultation S - Self-protection (i.e. avoiding mosquito bites) S - Say "no" to indiscriminate fogging *indiscriminate fogging makes use of insectides to target mosquitoes. In some cases, fogging has led to an increase in Dengue fever. Aimed to minimize infections from dengue strain Cebu City (18 February) A vaccine being developed to protect against the dengue virus is currently being tested to children aged six to 14 years old in Cebu City where the incidence of dengue cases is increasing. Dr. Jocelyn Abellana, the regional dengue coordinator of the Dept. of Health (DOH-7) bared the news during a recent PIA Kapihan that tackled the perennial health threat of dengue disease in the city. "The Armed Forces Research Institute of Medical Sciences is establishing a satellite unit at the Vicente Sotto Memorial Medical Center and they are trying a new vaccine against dengue," Abellana said. The Armed Forces Research Institute of Medical Sciences (AFRIMS) is a collaborating center of the World Health Organization for diagnostic reference, training and investigation of emerging infectious diseases. It has programs in enteric diseases, malaria vaccine and drug research, viral diseases especially dengue fever and hepatitis among others. Abellana said the AFRIMS central office in Asia is in Bangkok, Thailand while the Vicente Sotto Memorial Medical Center (VSMMC) is a government-manned tertiary hospital under the DOH. The dengue vaccine that has been tested to specific age-group children is aimed at minimizing the infections caused by the virus providing temporary immunity and not meant to achieve permanent immunity against the dengue virus, Abellana declared. Abellana stressed there can be no immunity against the dengue virus as there are four types of dengue strains and there is no cross immunity drug.

"In case the vaccine is effective, it can only provide temporary immunity of over a year against the active infectious strain while a person only has four infections in a lifetime," Abellana pointed out. The DOH-7 regional dengue program coordinator said the findings on the effectivity of the vaccine can be ascertained in six months time. Abellana on the other hand, revealed a clinical study initiated by the VSMMC and the Cebu CityMedical Center that undernourished children are more likely to survive the dengue fever compared to healthy babies. Although the DOH-7 official said they could not medically explain nor elaborate of the finding but that this is a subject that requires more research. The DOH-7 meanwhile, has provided 500 insecticide-treated mosquito nets to Calamba, one of the 80 barangays in Cebu City where they conducted a pulong-pulong with the residents on dengue prevention measures. The nets are treated to ward off mosquitoes including the Aedes Egypti, the dengue-virus carrying mosquito, this is said. "We are encouraging the barangay captains of the city to also adopt this as part of the dengue prevention measure," according to Abellana. Abellana said they are encouraging residents in dengue-prone areas to put up the nets permanently in the windows and doors as the Aedes mosquito is a daytime mosquito. Abellana said they do not recommend fogging but in extreme cases like during outbreaks, fogging may be necessary. Cebu City has 217 cases of dengue and six deaths recorded from January to February 13 of this year alone sharing the biggest bulk out of the 724 dengue cases in the region of the same period, based on the dengue registry record. (PIA-Cebu/FCR) Dengue fever and a local cure in the Philippines (tawa tawa, Gatas gatas or as i know it milk milk plant!) how to make a herbal tea. June 16th, 2010 | Author: Matt

Seems that dengue is back as reports from different areas seem to be coming in must be to do with the

recent rainfall giving some breeding grounds. But anyway just wanted to share with you about the milk milk plant which cured me when i had dengue previously. It generally seems to grow like a weed and i have borrowed a photo from another blog as i don t have any recent pictures (should have taken some). Take 5 to 6 full whole Milk Milk plants. Cut off the roots, throw it away, it is not included in the tea. Wash and clean Fill your boiling pot with clean water. Boil the Milk Milk for 1 (one) minute in a slow boil. Pour the Milk Milk water and let cool. Let the dengue fever victim drink only the Milk Milk water for 24 hours. Sip 1 to 1.5 glasses of Milk Milk water every 1 hour