DENGUE FEVER

By: Dr. Atif Ahmad Jan

Dengue Fever

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It is a disease caused by any one of four closely related dengue viruses (DENV 1, DENV 2, DENV 3 & DENV 4). The viruses are transmitted to humans by the bite of an infected Female Mosquito (Aedes Aegypti) It is estimated that there are over 100million cases of dengue worldwide each year.

Aedes Aegypti

Aedes Albopictus

Dengue Fever

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Symptoms and What to do if you think you have dengue The principal symptoms of dengue are: 1.High fever and at least two of the following; 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 brusing) Low White Cell Count

Dengue Fever

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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.

Dengue Fever

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Go IMMEDIATELY to an Emergency Room or the closest health care provider if any of the following Warning Signs appear: Severe abdominal pain or persistent vomiting Red spots or patches on skin Bleeding from nose or gums Vomiting blood Black, tarry stool (feces, excrement) Drowsiness or irritability Pale, cold or clammy skin Difficulty breathing

Dengue Fever
How it is Diagnosed

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It is diagnosed by a Blood Test. ELISA 1gm antibody Immunochromatographic technique ICT Immunoblot PCR virus location

Dengue Fever
Dengue Hemorrhagic Fever (DHF)

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DHF is a more serious form of dengue infection. It can be fatal if unrecognized and not properly treated in a timely manner. It is caused by the same virus that causes dengue 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, 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.

Dengue Fever
Treatment

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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.

Dengue Fever
Treatment for DHF

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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.

Dengue Fever
Outbreaks of Dengue

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Outbreaks of dengue occur primarily in areas where Aedes Aegypti (sometimes also Aedes 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.

Dengue Fever
Prevention

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There is no vaccine for preventing dengue. The best preventive measure for residents living in areas infested with Aedes 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. 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.

Dengue Fever
Prevent Epidemics

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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
Travel and Dengue Outbreaks

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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. Use 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.

Dengue Fever
Pregnancy

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Dengue is transmitted by the bite of infected Aedes Aegypti mosquitoes. A pregnant woman infected with dengue virus may infect her unborn baby or her newborn baby at birth Harmful effects of dengue virus infection include death of the unborn baby, low birth weight and premature birth If a pregnant woman has dengue at the time of delivery, her newborn baby may develop dengue during the first two weeks of life To prevent dengue virus infection during pregnancy Use mosquito repellents with up to 50% DEET, picaridin, IR3535 or Oil of Lemon Eucalyptus during pregnancy. Always read and follow the directions on the product Dress in loose cotton clothing that covers your arms and legs

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Protect your Baby from getting Dengue Cover cribs, strollers and baby carriers with mosquito netting at all times day and night both inside and outside of your home For babies over 2 months of age, use repellents with up to 30% DEET, picaridin or IR3535. Always read and follow the directions on the product Do not use repellents on babies less than 2 months of age Dress your baby in loose cotton clothing that covers arms and legs

Dengue Fever
Historical Background

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In Pakistan first outbreak was in 1994 probably came from Thailand or Malaysia

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Dengue Fever Hits Punjab Province Pakistan Punjab is in the grip of a dengue epidemic with dozens of cases being reported daily at various hospitals across the province. The total dengue fever cases in Punjab are 1,419 since the beginning of this year, out of which 1,358 Dengue patients had recovered and been discharged from hospitals. People have been advised not to allow water to stand in containers, to use mosquito repellents, spray homes and be particularly vigilant at dawn and twilight when the dengue- carrying mosquitoes bite.