Dengue Hemmorhagic Fever (H-Fever)

Introduction:
Philippine hemorrhagic fever was first reported in 1953. in 1958, hemorrhagic fever became a
notifiable disease in the country and was later reclassified as Dengue Hemorrhagic Fever.

the morbidity rate of dengue fever in 2003 is much lower at 13 cases per 100,000 population
compared to the highest ever recorded rate of 60.9 per 100,000 in 1998. the case fatality ratio for
dengue fever and dengue hemorrhagic fever in 2003 is alos lower at 0.8% compared to the
highest recorded ratio of 2.6 percent in 1998. while there were 12 outbreaks a year during the
period of 1999-2004. the sudden increases in the incidence of dengue in 1993,1998 and 2001
were expected because of the cylindrical nature of the disease. The reason dengue remains a
threat to public health despite low incidences reported in recent years. Dengue cases usually
peaks in the months of july to November and lowest during the month of February to april.

Signs and symptoms

-3 stages
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-7th day- toxic or hemorrhagic stage- lowering of temperature, severe abdominal pain,
vomiting and frequent bleeding from gastrointestinal tract in the form of hematemesis or melena.
Unstable BP, narrow pulse pressure and shock. Death may occur. Torniquet test which may be
positive on 3rd day may become negative due to low or vasomotor collapse.
7th-10th day- convalescent or recovery stage- generalized flushing with interventing areas of
blanching appetite regained and blood pressure already stable.

Classification:
Severe, frank type- with flushing, sudden high fever, severe hemorrhage, followed by sudden
drop of temp, shock and terminating in recovery or death.
Moderate- with high fever, but less hemorrhage, no shock
Mild- with slight fever, with or without petechial hemorrhage but epidemiologically related to
typical cases usually discovered in the course of investigation of typical cases.

Etiologic agent:
dengue virus types 1,2,3,4 and chikunguya virus

Source of infection
- immediate source is a vector mosquito, the Aedes Aegypti or the common household
mosquito.
the infected person.

Mode of transmission:
Mosquito Bite (Aedes Aegypti)
Incubation period: uncertain. Probably 6 days to one week.
Period of communicability: Unknown. Presumed to be on the 1st week of illness when virus is still present in the
blood.
Diagnostic test:
Torniquet Test (Rumpel Lead 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.
- A test is (+) when 20 or more petechiae per 2.5 cm square or 1 inch square are observed.

Management:
-Supportive and symptomatic treatment should be provided
- For fever, give paracetamol for muscle pains. For Headache, give analgesic. DON’T give ASPIRIN.
- Rapid replacement of body fluids is the most important treatment.
- Includes intensive monitoring and follow-up.
- Give ORESOL to replace fluid as in moderate dehydration at 75 ml/kg in 4-6 hours or up to 2-3L in adults.
Continue ORS intake until patient’s condition improves.

Methods of Prevention and Control

The infected individual, contacts and environment:
- recognition of the disease
- Isolation of pt.( screening or sleeping under the mosquito net)
- Epidemiological investigation
- Case finding and reporting
- Health Education

Mhal,cnxa na po ah.mejo mgulo pagka2type ko.sna mkatulong 2 sa reporting mo.kaya mo yan.

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