What is dengue?
temperature, relative humidity, degree of urbanization
Dengue is fast emerging pandemic-prone viral disease in
many parts of the world. Dengue flourishes in urban poor
areas, suburbs and the countryside but also affects more
affluent neighbourhoods in tropical and subtropical
countries.
Dengue is a mosquito-borne viral infection causing a
severe flu-like illness and, sometimes causing a potentially
lethal complication called severe dengue. The incidence
of dengue has increased 30-fold over the last 50 years. Up
to 50-100 million infections are now estimated to occur
annually in over 100 endemic countries, putting almost
half of the world’s population at risk.
Severe dengue (previously known as dengue
haemorrhagic fever) was first recognized in the 1950s
during dengue epidemics in the Philippines and Thailand.
Today it affects Asian and Latin American countries and
has become a leading cause of hospitalization and death
among children and adults in these regions.
The full life cycle of dengue fever virus involves the role of
mosquito as a transmitter (or vector) and humans as the
main victim and source of infection.
The virus
The dengue virus (DEN) comprises four distinct serotypes
(DEN-1, DEN-2, DEN-3 and DEN-4) which belong to the
genus Flavivirus, family Flaviviridae.
Distinct genotypes have been identified within each
serotype, highlighting the extensive genetic variability of
the dengue serotypes. Among them, “Asian” genotypes of
DEN-2 and DEN-3 are frequently associated with severe
disease accompanying secondary dengue infections.
The mosquito
The Aedes aegypti mosquito is the main vector that
transmits the viruses that cause dengue. The viruses are
passed on to humans through the bites of an infective
female Aedes mosquito, which mainly acquires the virus
while feeding on the blood of an infected person.
The human
Once infected, humans become the main carriers and
multipliers of the virus, serving as a source of the virus for
uninfected mosquitoes. The virus circulates in the blood
of an infected person for 2-7 days, at approximately the
same time that the person develops a fever. Patients who
are already infected with the dengue virus can transmit
the infection via Aedes mosquitoes after the first
symptoms appear (during 4-5 days; maximum 12).
In humans recovery from infection by one dengue virus
provides lifelong immunity against that particular virus
serotype. However, this immunity confers only partial and
transient protection against subsequent infection by the
other three serotypes of the virus. Evidence points to the
fact that sequential infection increases the risk of
developing severe dengue. The time interval between
infections and the particular viral sequence of infections
may also be of importance.
Epidemiology
Dengue is widespread throughout the tropics, with risk
factors influenced by local spatial variations of rainfall,
and quality of vector control services in urban areas.
Before 1970, only nine countries had experienced severe
dengue epidemics. Today, the disease is endemic in more
than 100 countries in WHO’s African, Americas, Eastern
Mediterranean, South-East Asia and Western Pacific
regions; the Americas, South-East Asia and Western
Pacific regions are the most seriously affected.
Member States in three WHO regions regularly report the
annual number of cases to the Secretariat. Figure 1 shows
the number of dengue cases (suspected or confirmed)
notified to WHO since 1990.
Dengue Fever
Causative agent
Dengue fever is an acute mosquito-borne infection caused by
the dengue viruses. This is found in tropical and sub-tropical
regions around the world. For instance, dengue fever is an
endemic illness in many countries in South East Asia. The
dengue viruses encompass 4 different serotypes, each of
which can lead to dengue fever and severe dengue (also
known as 'dengue haemorrhagic fever').
Clinical features (signs and symptoms)
Dengue fever is clinically characterised by sudden onset of
high fever, severe headache, pain behind the eyes, muscle
and joint pain, loss of appetite, nausea and rash. Some
infected people may not develop apparent symptoms, and
some may only have mild symptoms like fever, e.g. young
children may exhibit a milder non-specific febrile illness with
rash.
The symptoms of first infection are usually mild. Once
recovered, immunity to that serotype of dengue virus will
develop but subsequent infections with other serotypes of
dengue virus are more likely to result in severe dengue.
Severe dengue is a severe and potentially fatal complication
of dengue fever. Initially, the features include high fever,
which lasts for 2 – 7 days and can be as high as 40 – 41oC,
facial flush and other non-specific constitutional symptoms of
dengue fever. Later, it may be followed by manifestations of
bleeding tendency such as skin bruises, nose or gum bleeding,
and possibly internal bleeding. In severe cases, it may
progress to circulatory failure, shock and death.
Immunity is attained against that serotype after recovery
from its infection. However, no effective protection is
conferred against subsequent infection by the other 3
serotypes.
Mode of transmission
Dengue fever is transmitted to humans through the bites of
infective female Aedes mosquitoes. When a patient suffering
from dengue fever is bitten by a vector mosquito, the
mosquito is infected and it may spread the disease by biting
other people. The disease cannot be spread directly from
human to human. In Hong Kong, the principal vector Aedes
aegypti is not found, but the prevailing species Aedes
albopictus can also spread the disease.
Incubation period
The incubation period ranges from 3 – 14 days, commonly 4 –
7 days.
Management
There is no specific medication for dengue fever and severe
dengue. Dengue fever is mostly self-limiting. Symptomatic
treatment is given to relieve discomfort. Patients with severe
dengue should be treated promptly with supportive
management. The mainstay of treatment is to maintain the
circulating fluid volume. With appropriate and timely
treatment, mortality rate is less than 1%.
Prevention
At present, there is no locally registered dengue vaccine
available in Hong Kong. The best preventive measure in Hong
Kong is to eliminate pockets of stagnant water that serve as
breeding sites for mosquitoes, and to avoid mosquito bites.
 Ensure air-conditioner drip trays are free of stagnant
water
 Put all used cans and bottles into covered dustbins
2. Control vectors and reservoir of the diseases
 Store food and dispose of garbage properly
Pregnant women and children of 6 months or older can use
DEET-containing insect repellent. For details about the use of
insect repellents and the key points to be observed, please
refer to 'Tips for using insect repellents'.
For more information about control and prevention of
mosquito breeding, please visit the website of the Food and
Environmental Hygiene Department (FEHD)
at http://www.fehd.gov.hk/english/safefood/handbook_prev
_mos_breeding.html
Related link: World Health Day 2014
http://www.who.int/denguecontrol/disease/en/
http://www.who.int/immunization/diseases/dengue/en/
http://www.chp.gov.hk/en/content/9/24/19.html

General measures on preventing mosquito-borne diseases

1. Wear loose, light-coloured, long-sleeved tops and

trousers, and use DEET-containing insect repellent on
exposed parts of the body and clothing.
2. Take additional preventive measures when engaging in
outdoor activities:
 Avoid using fragrant cosmetics or skin care products
 Re-apply insect repellents according to instructions
3. Special notes when travelling abroad:
 If going to affected areas or countries, arrange a
consultation with doctor at least 6 weeks before the
trip, and have extra preventive measures to avoid
mosquito bite
 During the trip, if travelling in endemic rural areas,
carry a portable bed net and apply permethrin (an
insecticide) on it. Permethrin should NOT be applied
to skin. Seek medical attention promptly if feeling
unwell
 Travellers who return from affected areas should
apply insect repellent for 14 days after arrival in
Hong Kong. If feeling unwell e.g. run a fever, should
seek medical advice promptly, and provide travel
details to doctor

Help prevent mosquito proliferation

1. Prevent accumulation of stagnant water

 Change the water in vases once a week
 Clear the water in the saucers under potted plants
every week
 Cover water containers tightly