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Dengue Fever Information for Interning

Dengue fever, a mosquito-borne viral infection caused by the flavivirus, presents a significant health concern globally. Transmitted mainly by the Aedes aegypti mosquito, it manifests primarily as undifferentiated fever, with potential complications like Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). The disease has four serotypes, each potentially leading to severe illness. Diagnosis relies on clinical evaluation and laboratory tests, while treatment emphasizes supportive care. Personal and community prevention strategies are crucial, as currently, no vaccine exists.

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Dengue Fever Information for Interning

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  1. Dengue FeverInformation for Interning JoDee Summers Walden University

  2. What is Dengue? • Arbovirus • Flavivirus: • Mosquito borne: (Aedes aegypti) • Primarily a daytime feeder that lives around human habitation

  3. Virginia Bioinformatics Institute, 2006

  4. The Virus • 4 serotypes: • DEN-1, DEN-2, DEN-3 and DEN-4 • Each serotype provides specific lifetime immunity and some possible short term cross immunity. • Each serotype carries possibility of serious or life threatening disease, but some appear to be more virulent then others. Centers for Disease Control and Prevention, 2009

  5. Clinical Syndromes • Undifferentiated fever: • Most common manifestation • Majority asymptomatic or mildly symptomatic • Classic dengue fever • Dengue hemorrhagic fever (DHF) • Dengue shock syndrome (DSS)

  6. Dengue Hemorrhagic Fever • 4 Criteria: • Fever, or recent history of acute • Hemorrhagic manifestations • Low platelet count (100,000/mm3 or less) • Objective evidence of “leaky capillaries” Pan American Health Organization, 1994

  7. 4 Grades of DHF • Four Grades of DHF • Grade 1 • Fever and nonspecific constitutional symptoms • Positive tourniquet test is only hemorrhagic manifestation • Grade 2 • Grade 1 manifestations + spontaneous bleeding • Grade 3 • Signs of circulatory failure (rapid/weak pulse, narrow pulse pressure, hypotension, cold/clammy skin) • Grade 4 • Profound shock (undetectable pulse and BP) Centers for Disease Control and Prevention, 2009

  8. Dengue History • 1779-1790: First reported epidemics in Asia, Africa, and North America. • Post WWII: Introduced to Southeast Asia.  • 1950s: : Epidemic Dengue Hemorrhagic Fever in Southeast Asia. • Currently: Most countries in the world.

  9. World Health Organization, 2008

  10. Centers for Disease Control and Prevention, 2009

  11. World Health Organization, 2008

  12. Recent Activity • Puerto Rico outbreak • South Texas = 2005 • Texas 1997 = 3 locally acquired • Texas 1995 = 7 locally acquired • The U.S. has the mosquito, but rarely see cases

  13. Diagnosis • General Recommendations • Epidemiologic considerations • Season of year • Travel history • Important for assessment of symptomatic patients in non-endemic areas • Determine whether the patient traveled to a dengue-endemic area • Determine when the travel occurred • If the patient developed fever more than 2 weeks after travel, eliminate dengue from the differential diagnosis

  14. Differential Diagnosis • Influenza • Measles • Rubella • Malaria • Typhoid fever • Leptospirosis • Meningococcemia • Rickettsial infections • Bacterial sepsis • Other viral hemorrhagic fevers

  15. Laboratory Tests • Clinical laboratory tests • CBC—WBC, platelets, hematocrit • Albumin • Liver function tests • Urine—check for microscopic hematuria • Dengue-specific tests • Virus isolation • Serology (IgM ELISA)

  16. Collection of Samples • The tests for diagnosis are time dependent. • Patient presents within 5 days of onset of symptoms: draw blood immediately. • A convalescent-phase sample should also be drawn. • Patient presents 6 or more days after symptom onset: the blood sample should be drawn as soon as possible. This sample should then be tested for serum IgM antibody.

  17. Treatment • Fluids • Rest • Antipyretics (avoid aspirin and non-steroidal anti-inflammatory drugs) • Monitor blood pressure, hematocrit, platelet count, level of consciousness • Avoid invasive procedures when possible • Unknown • Patients in shock may require treatment in an intensive care unit

  18. Personal Prevention • No vaccine • Prevent mosquito breeding • Eliminate standing water • Fix window screens • DEET or Picaridin

  19. Community Prevention • Lessons for Future Dengue Prevention Programs • Sustainable environmental control vs. eradication • Community-based programs • Promote the priority among health officials and general public

  20. Examples of What YOU Can Do! • Involve the children! • Interactive exhibits • Public service announcements • Television • Radio • Brochures

  21. Further Reading • http://www.cdc.gov/dengue/educationTraining/index.html • http://www.cdc.gov/dengue/about/inPuerto.html • http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

  22. References: • World Health Organization (2008). Global alert and response. Impact of Dengue. Retrieved from http://www.who.int/csr/disease/dengue/impact/en/ • Centers for Disease Control and Prevention (2009). Dengue epidemiology. Retrieved from http://www.cdc.gov/dengue/epidemiology/index.html • Virginia Bioinformatics Institute, (2006). Dengue transmission cycle. Retrieved from ci.vbi.vt.edu/pathinfo/pathogens/Dengue1.html • Pan American Health Organization. (1994) Dengue and dengue hemorrhagic fever: Guidelines for Prevention and Control. PAHO: Washington, D.C., 1994: 12.

  23. Questions??

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