Professional Documents
Culture Documents
January 2009
LECTURE # 4
Dengue Fever
WHO Data
Dengue Infections
• Incubation 4-7 days (3-14)
• Infection
– Asymptomatic or mild
– Acute febrile illness (dengue fever)
– Dengue hemorrhagic fever (DHF)
– Dengue shock syndrome (DSS)
– No chronic carrier state
Clinical Findings
• Headache, fever, myalgia
• Nausea, vomiting
• Rash (50%)
• Laboratory
– Low WBC
– Low platelets
– Abnormal liver function
Dengue Hemorrhagic Fever
• Mortality > 20% (<1% with good care)
• Risk for DHF increased ~100x with
2nd infection (different serotype)
• Thailand, 2 cohort studies
– DHF rate 0 in primary infection
– 1.8% and 12.5% with 2nd
• Virulence may also vary by genotype
Am J Epidemiol 1984;120:653
AJTMH 1988;38:172
Dengue: 2007, CDC
Dengue Fever, 2002
Aedes aegypti
Aedes Aegypti
• Wide distribution in urban areas
– Well adapted to contemporary urban
life
• Breeding sites
– Discarded plastic containers, cans
– Used tires, flowerpots, tree holes
• Enters homes; prefers human blood
• Nervous feeder; multiple hosts
Aedes Aegypti
Hospitalizations
Reported Cases
50000
600000
500000 DEN3 DEN2 40000
400000 30000
DENV3
300000
20000
200000 DENV1 DENV2
100000 10000
0 0
86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08
16000
250,000
14000
Reported Cases
Hospitalizations
200,000 12000
10000
150,000
8000
100,000 6000
4000
50,000
2000
0 0
98 99 00 01 02 03 04 05 06 07 08
PNAS 2004;101:15125.
Receptivity to Introductions
• Physicochemical environment
• Intermediate and reservoir hosts; vectors
• Housing, sanitation, living conditions
• Nutrition, immunity, genetics
• Human behavior and activities
• Surveillance, access to care
Increase in Dengue Fever
• Urbanization, especially in tropics
• Growing population
– More urban areas large enough to sustain
ongoing viral circulation
• Poor housing, inadequate water supply
• Poor vector control and resistance
• Travel and migration
Chikungunya Virus
Chikungunya Virus
• Alphavirus, family Togaviridae (first
identified in Tanzania, 1953)
• Emerged in Indian Ocean islands 2005
• Has moved to India, other countries in
region; explosive outbreaks; high attack
rates
• Spread by Aedes aegypti and Ae
albopictus
• Will it spread to the Americas?
Clinical Manifestations: Chikungunya
• Rash 39-50%
• Myalgia 50-60%
• Headache 50-70%
• Arthralgia 78-100%
– Severe, incapacitating,
persistent
• Fever 100%
Lancet ID 2008;8:5.
Aedes Albopictus Female
Distribution of Dengue, Yellow Fever, & Ae. aegypti