Dengue Fever

Dengue Fever is caused by one of the four closely related, but anti genically distinct, virus serotypes Dengue type 1, Dengue type 2, Dengue type 3, and Dengue type 4 of the genus Flavivirus and Chikungunya virus. Infection with one of these serotype provides immunity to only that serotype of life, to a person living in a Dengueendemic area can have more than one Dengue infection during their lifetime. Dengue fever through the four different Dengue serotypes are maintained in the cycle which involves humans and Aedes aegypti or Aedes albopictus mosquito through the transmission of the viruses to humans by the bite of an infected mosquito. The mosquito becomes infected with the Dengue virus when it bites a person who has Dengue and after a week it can transmit the virus while biting a healthy person. Dengue cannot be transmitted or directly spread from person to person. Aedes aegypti is the most common aedes specie which is a domestic, day-biting mosquito that prefers to feed on humans. INTUBATION PERIOD: Uncertain. Probably 6 days to 10 days PERIOD OF COMMUNICABILITY: Unknown. Presumed to be on the 1st week of illness when virus is still present in the blood CLINICAL MANIFESTATIONS: First 4 days: >febrile or invasive stage --- starts abruptly as high fever, abdominal pain and headache; later flushing which may be accompanied by vomiting, conjunctival infection and epistaxis 4th to 7th day: >toxic or hemorrhagic stage --- lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from GIT in the form of melena; unstable BP, narrow pulse pressure and shock; death may occur; vasomotor collapse 7th to 10th day: >convalescent or recovery stage --- generalized flushing with intervening areas of blanching appetite regained and blood pressure already stable MODE OF TRANSMISSION: Dengue viruses are transmitted to humans through the infective bites of female Aedes mosquito. Mosquitoes generally acquire virus while feeding on the blood of an infected person. After virus incubation of 8-10 days, an infected mosquito is capable, during probing and bloodeeding of transmitting the virus to susceptible individuals for the rest of its life. Infected female mosquitoes may also transmit the virus to their offspring by transovarial (via the eggs) transmission. Humans are the main amplifying host of the virus. The virus circulates in the blood of infected humans for two to seven days, at approximately the same time as they have fever. Aedes mosquito may have acquired the virus when they fed on an individual during this period. Dengue cannot be transmitted through person to person mode. CLASSIFICATION: 1.Severe, frank type >flushing, sudden high fever, severe hemorrhage, followed by sudden drop of temperature, shock and terminating in recovery or death

2. Moderate >with high fever but less hemorrhage, no shock present 3. Mild >with slight fever, with or without petichial hemorrhage but epidemiologically related to typical cases usually discovered in the course of invest or typical cases GRADING THE SEVERITY OF DENGUE FEVER: Grade 1: >fever >non-specific constitutional symptoms such as anorexia, vomiting and abdominal pain >absence of spontaneous bleeding >positive tourniquet test Grade 2: >signs and symptoms of Grade 1: plus >presence of spontaneous bleeding: mucocutaneous, gastrointestinal Grade 3: >signs and symptoms of Grade 2 with more severe bleeding: plus >evidence of circulatory failure: cold, clammy skin, irritability, weak to compressible pulses, narrowing of pulse pressure to 20 mmhg or less, cold extremities, mental confusion Grade 4: >signs and symptoms of Grade 3, declared shock, massive bleeding, pulse less and arterial blood Pressure = 1 mmhg (Dengue Syndrome/DS) SUSCEPTABILITY, RESISTANCE, AND OCCURRENCE: >all persons are susceptible >both sexes are equally affected >age groups predominantly affected are the pre-school age and school age >adults and infants are not exempted >peak age affected: 5-9 years old DF is sporadic throughout the year. Epidemic usually occurs during rainy seasons (June November). Peak months are September October. It occurs wherever vector mosquito exists. DIAGNOSTIC TEST: Tourniquet test >Inflate the blood pressure cuff on the upper arm to a point midway between the systolic and diastolic pressure for 5 minutes. >Release cuff and make an imaginary 2.5 cm square or 1 inch square just below the cuff, at the antecubital fossa. >Count the number of petechiae inside the box. A test is positive when 20 or more petechiae per suare are observed.

DENGUE PREVENTION: There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites when traveling to areas where dengue occurs and when in U.S. areas, especially along the TexasMexico border, where dengue might occur. Eliminating mosquito breeding sites in these areas is another key prevention measure. Avoid mosquito bites when traveling in tropical areas: 1 2 Use mosquito repellents on skin and clothing. When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and

long pants tucked into socks. 3 4 Avoid heavily populated residential areas. When indoors, stay in air-conditioned or screened areas. Use bed nets if sleeping areas

are not screened or air-conditioned. 5 If you have symptoms of dengue, report your travel history to your doctor.

Eliminate mosquito breeding sites in areas where dengue might occur: 6 Eliminate mosquito breeding sites around homes. Discard items that can collect rain

or run-off water, especially old tires. 7 Regularly change the water in outdoor bird baths and pet and animal water containers