HEALTH TIPS: DENGUE

WHAT IS DENDUE:
Dengue is a viral disease. It is transmitted by the infective bite of female Aedes Aegypti
mosquito. Man develops disease after 5-6 days of being bitten by an infective mosquito.
It occurs in two forms: Dengue Fever and Dengue Haemorrhagic Fever(DHF)
Dengue Fever is a severe, flu-like illness (Influenza).
Dengue Haemorrhagic Fever (DHF) is a more severe form ofdisease, which may cause
death. Person suspected of having dengue fever or DHF must see a doctor at once
RISK FACTORS FOR DENGUE:
Construction activities /Water storage practice /Population movement /Heavy rainfall
/Vector abundance
DENGUE CLINICAL SYNDROME
There are four dengue clinical syndromes:
1. Undifferentiated fever
2. Classic dengue fever
3. Dengue hemorrhagic fever, or DHF &
4. Dengue shock syndrome, or DSS.Dengue shock syndrome is actually a severe form of
DHF.
SIGNS & SYMPTOMS
1. DENGUE FEVER:
1. Abrupt onset of high fever
2. Severe frontal headache
3. Pain behind the eyes which worsens with eye movement
4. Muscle and joint pains
5. Loss of sense of taste and appetite
6. Measles-like rash over chest and upper limbs
7. Nausea, diarrhea and vomiting
8. Respiratory symptoms: cough, sore throat.
2. DENGUE HEMORRHAGIC FEVER:
1. Thrombocytopenia (blood platelet count <100,000)
2. Fever for 2-7 days.
3. Mortality of 10-20% if untreated but decreases to <1% if adequately treated.
4. Hemoconcentration or evidence of plasma leakage
5. Plasma leakage may progress to dengue shock syndrome
3. DENGUEHAEMORRHAGIC FEVER AND SHOCK SYNDROM:
1. Symptoms similar to dengue fever
2. Severe continuous stomach pains
3. Skin becomes pale, cold or clammy

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4.
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Bleeding from nose, mouth & gums and skin rashes

Frequent vomiting with or without blood
Sleepiness and restlessness
Patient feels thirsty and mouth becomes dry
Rapid weak pulse
Difficulty in breathing.

LABORATORY DIAGNOSIS OF DENGUE

Haemagglutination inhibition (HI) test.
Compliment Fixation Test (CFT).
Neutralization test (NT)
IgM-capture Enzyme-Linked Immunosorbent Assay (MAC-ELISA)
IgG-ELISA Rapid Diagnostic tests (NS 1)
MANAGEMENT OF DENGUE FEVER .
I. No specific therapy, management of Dengue fever is symptomatic and supportive.
II. Bed rest is advisable during the acute phase.
III. Use cold sponging to keep temperature below 39o C.
IV. Antipyretics may be used to lower the body temperature.
V. Aspirin/NSAID like Ibuprofen etc., should be avoided since it may cause gastritis,
vomiting, acidosis and platelet dis-function. Paracetamol is preferable.
VI. Oral fluid and electrolyte therapy are recommended for patients with excessive
sweating or vomiting.
Patients should be monitored in DHF endemic area until they become afebrile for one day
without the use of antipyretics and after platelet and haematocrit determinations are stable,
platelet count is >50,000/ cumm
VACCINATION
No current dengue vaccine. Estimated availability is in 5-10 years. Vaccine
development is problematic as the vaccine must provide immunity to all 4 serotype
and lack of dengue animal models.
PREVENTION (PERSONAL):
1. Clothing to reduce exposed skin.
2. Insect repellent especially in early morning, late afternoon.
3. Bed netting is important.
4. Mosquito repellents (pyrethroid based).
5. Coils, sanitation measures.
PREVENTION (ENVIRONMENTAL):
1. Reduced vector breeding sites.
2. Solid waste management.
3. Public education.
4. Empty the open water containers and cut weed/tall grasses.

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PREVENTION (BIOLOGICAL):
1. Target larval stage of Aedes in large water storage containers.
2. Larvivorous fish (Gambusia), endotoxin producing bacteria (Bacillus), copepod
crustaceans (mesocyclops)
CHEMICAL (PREVENTION)
1. Thermal fogging-malathion,pyrethrum
2. Insecticide treatment of water containers
3. Space spraying (thermal fogs
4. Indoor space spraying(2% pyrethrum), organophosphorus compounds.
SOCIAL AWARENESS PROGRAMS
1. Educating the public to encourage and enable them to carry out vector control in their
homes, Offices and neighbourhood.
2. Although the goal of disease control is to prevent epidemic transmission, if an
epidemic does occur, ways to minimize its impact include measures for communitywide vector control activities. Such plans should be prepared with the participation of
all parties and agencies involved, and should be ready for implementation prior to the
emergence of an epidemic.
AGENT FACTORS
The dengue viruses are the members of the genus flavivirus. There are four virus
serotypes, which are designated asDEN-1, DEN-2, DEN-3 and DEN-4.
Although all four serotypes are antigenicaly similar, they are different enough to elicit
cross-protection only for a few months after infection by any one of them. Infection
with any one serotype confers lifelong immunity to the virus.
Man and mosquito are reservoirs of infection.
Trans-ovarian transmission (infection carried over to next progeny of mosquitoes
through eggs) has made the control more complicated.
At present DEN1 and DEN2 serotypes are widespread in India.
VECTORS OF DENGUE (Factors/carriers)
Dengue is transmitted by the bite of female Aedes mosquito.
In India, Ae. aegypti is the main vector in most urban areas, however, Ae albopictus is
also found as vector in few areas of southern India.
Female Aedes mosquito deposits eggs singly on damp surfaces just above the water
line. Under optimal conditions the life cycle of aquatic stage of Ae. Aegypti (the time
taken from hatching to adult emergence) can be as short as seven days. The eggs can
survive one year without water. At low temperature however, it may take several
weeks to emerge.
Ae. aegypti has an average adult survival of fifteen days. During the rainy season, when
survival is longer, the risk of virus transmission is greater.
It is a day time feeder and can fly up to a limited distance of 400 meters.
To get one full blood meal the mosquito has to feed on several persons, infecting all of
them.

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TRANSMISSION CYCLE OF DENGUE:

The virus is inoculated into humans with the mosquito saliva.
The virus localizes and replicates in various target organs, for example, local lymph
nodes and the liver
The virus is then released from these tissues and spreads through the blood to infect
white blood cells and other lymphatic tissues.
The virus is then released from these tissues and circulates in the blood.
The mosquito ingests blood containing the virus.
The virus replicates in the mosquito midgut, the ovaries, nerve tissue and fat body. It
then escapes into the body cavity, and later infects the salivary glands.
The virus replicates in the salivary glands and when the mosquito bites another
human, the cycle continues.
There is evidence that vertical transmission of dengue virus from infected female
mosquitoes to the next generation occurs through eggs, which is known as trans-ovarian
transmission.

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