The incidence of dengue has grown dramatically around the world in recent decades. The peak of the dengue epidemic period is the rainy season. It is believed that climate is an important factor for dengue transmission. The simulations suggest that the greatest potential for the dengue transmission occurs when the temperature is 28.9 °C.
Dengue:
Dengue is a mosquito-borne viral infection. Dengue virus is transmitted by female mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Ae. albopictus. This mosquito also transmits chikungunya, yellow fever and Zika infection.
Unlike other mosquitoes Ae. aegypti is a day-time feeder; its peak biting periods are early in the morning and in the evening before dusk.
Symptoms of Dengue:
Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death. Dengue should be suspected when a high fever (40°C/104°F) is accompanied by 2 of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands or rash. Symptoms usually last for 2–7 days, after an incubation period of 4–10 days after the bite from an infected mosquito.
Symptoms of Severe dengue:
Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. About 1 in 20 people who get sick with dengue will develop severe dengue. Infants and pregnant women are at increased risk for developing severe dengue. Warning signs occur 3–7 days after the first symptoms in conjunction with a decrease in temperature (below 38°C/100°F) and include: severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness and blood in vomit. The next 24–48 hours of the critical stage can be lethal; proper medical care is needed to avoid complications and risk of death.
Treatment:
There is no specific treatment for dengue fever and home care for dengue patients is essential as dengue can lead to severe dengue.
For severe dengue, medical care by physicians and nurses experienced with the effects and progression of the disease can save lives – decreasing mortality rates from more than 20% to less than 1%. Maintenance of the patient’s body fluid volume is critical to severe dengue care.
Homecare for Dengue Patients:
Your child or family member might have dengue. It is important for you to carefully watch them because dengue can rapidly become severe between the third and seventh day of illness when the fever is going away.
With Fever:
Bed rest: Let your sick child or family member rest as much as possible.
Control high fever
• Do not give ibuprofen (Motrin, Advil), aspirin, or aspirin- containing drugs.
• Sponge the patient’s skin with cool water if fever remains high.
• Give acetaminophen or paracetamol (Tylenol) every 6 hours if needed for high fever (maximum 4 doses per day).
Prevent dehydration:
Give plenty of fluids, and watch for signs of dehydration, which occurs when a person loses too much body fluid from fever, vomiting, or if he or she does not drink enough fluids.
Bring your child or sick family member to a clinic or emergency room if any of the following signs appear:
• Decrease in urination (check the number of wet diapers or trips to the bathroom)
• Few or no tears when a child cries
• Dry mouth, tongue, or lips
• Sunken eyes
• Listlessness, overly agitated, or confused
• Rapid heartbeat (more than 100 beats per minute)
• Cold or clammy fingers and toes
• Sunken soft spot (fontanel) in an infant’s head
As Fever Goes Away:
Watch for warning signs. Although the fever is going away, this phase of dengue can be dangerous for some patients.
- Watch for warning signs as temperature declines, 3-7 days after symptoms began.
Return IMMEDIATELY to the clinic or emergency department if any of the following warning signs appear:
- Severe abdominal pain or persistent vomiting
- Red spots or patches on the skin
- Bleeding from nose or gums
- Vomiting blood or blood in stools
- Drowsiness or irritability
- Pale, cold, or clammy skin
- Difficulty breathing
Prevent spread of dengue inside your house:
Mosquitoes that bite the affected family member can go on to bite and infect others.
• Allow the sick child or family member to rest and sleep under a bed net or use insect repellant while feverish. Kill all mosquitoes in the house and empty containers that carry water on patios.
• Place screens on windows and doors to prevent mosquitoes from entering the house
Immunization:
The first dengue vaccine, Dengvaxia® (CYD-TDV) developed by Sanofi Pasteur was licensed in December 2015.
Dengvaxia Overview:
Dengvaxia is only for use in people from 9 to 45 years of age who have been infected with dengue virus before and who live in areas where this infection is endemic. Endemic areas are areas where the disease occurs regularly throughout the year.
Dengvaxia contains attenuated (weakened) yellow fever viruses that have been manipulated so that they contain proteins from dengue virus.
Dengvaxia Use: Dengvaxia must only be given to people who have had a positive test result showing a previous infection with dengue virus. The vaccine is given as 3 doses, 6 months apart. The injection is given under the skin, preferably in the upper arm.
How does it work?
Vaccines work by ‘teaching’ the immune system (the body’s natural defences) how to defend the body against a disease. Dengvaxia contains weakened viruses that do not cause disease. When a person is given the vaccine, the immune system recognises the dengue proteins in the weakened viruses as ‘foreign’ and makes antibodies against them. In the future, when the person comes into contact with dengue virus, these antibodies together with other components of the immune system will be able to kill the virus and help protect against the disease.
Side effects with Dengvaxia:
The most common side effects with Dengvaxia (which may affect more than 1 in 10 people) are headache, injection site pain, malaise (feeling unwell), muscle pain, weakness and fever. Allergic reactions, which may be severe, are a very rare side effect of Dengvaxia.
Dengvaxia must not be given to people with weakened immune systems, including people whose immune system has been weakened by HIV infection or medicines such as cancer medicines or high doses of corticosteroids. Dengvaxia must also not be given to women who are pregnant or breastfeeding.
Which countries Dengvaxia is approved?
Mexico is the first country to approve the use of the dengue vaccine. Later it was approved in US, European countries, the Philippines, Indonesia, Brazil, El Salvador, Costa Rica, Paraguay, Guatemala, Peru, Thailand, and Singapore.
WHO guidance to receive Dengvaxia:
The dengue vaccine has been shown in clinical trials to be efficacious and safe in persons who have had a previous dengue virus infection (seropositive individuals), but carries an increased risk of severe dengue in those who experience their first natural dengue infection after vaccination (seronegative individuals).
Only persons with evidence of a past dengue infection would be vaccinated (based on an antibody test, or on a documented laboratory confirmed dengue infection in the past).
Prevention and control of Dengue:
At present, the main method to control or prevent the transmission of dengue virus is to combat vector mosquitoes through:
- preventing mosquitoes from accessing egg-laying habitats by environmental management and modification;
- disposing of solid waste properly and removing artificial man-made habitats;
- covering, emptying and cleaning of domestic water storage containers on a weekly basis;
- applying appropriate insecticides to water storage outdoor containers;
- using of personal household protection measures, such as window screens, long-sleeved clothes, repellents, insecticide treated materials, coils and vaporizers (These measures have to be observed during the day both at home and place of work since the mosquito bites during the day);
- improving community participation and mobilization for sustained vector control;
- applying insecticides as space spraying during outbreaks as one of the emergency vector-control measures;
- active monitoring and surveillance of vectors should be carried out to determine effectiveness of control interventions.
Careful clinical detection and management of dengue patients can significantly reduce mortality rates from severe dengue.
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