Dengue

in Children 2017
Clinical Practice Guidelines Pediatric Infectious Disease
Society of the Philippines
Philippine Pediatric Society
Dengue classification by severity
•
• Severe Dengue
• Non-severe Dengue With warning
signs without warning signs
 Fluid therapy for dengue

Maintenance intravenous fluids

• Maintaining fluid and electrolyte balance and homeostasis

Hypotonic fluids
• Most commonly for children admitted in a hospital

An ideal physiologic fluid is one that resembles the extracellular and

intracellular fluids
• Isotonic solutions such as 0.9% Saline or Ringer’s Lactate (recommended)
4. Among Dengue patients without shock
how effective are isotonic IVFs compared
to hypotonic IVFs in reducing mortality?
5. Among Dengue patients with shock, how
effective are colloidal IVFs compared to
crystalloid IVFs in reducing mortality?
Role of blood product transfusion in Dengue:

• Bleeding in dengue may be due to vasculopathy , thrombocytopenia,

platelet dysfunction, and deranged coagulation

• Bleeding may result from liver failure

• Blood products are not routinely used in dengue fever unless there
is profuse bleeding or clinical deterioration refractory to vigorous
fluid resuscitation
6. Among patients with thrombocytopenia
because of Dengue, how effective is
prophylactic platelet transfusion in improving
platelet count, preventing hemorrhage, and
reducing mortality?
7. Among Dengue patients with significant
bleeding, how effective is plasma
transfusion in controlling bleeding and
reducing mortality?
 Insect repellents in Dengue

• Repellents play very important role in the prevention of

mosquito-borne infections

• FDA approved repellents

• N, N-diethyl-m-toluamide (DEET)
• Dimethylphthalate (DMP)

• Plant based repellents have been used for generations

8. Among populations at risk of Dengue
transmission, how effective are citronella-based
repellents compared to DEET-based repellents in
reducing the incidence in Dengue?
Recommendations for Fluid Therapy for
Compensated Shock and Hypotensive Shock
Based on the 2012 PPS Revised Guidelines
on Fluid Management of Dengue Fever and
Dengue Hemorrhagic Fever
 PROGNOSIS

• Dengue Fever -The prognosis for dengue fever is good. Care should be taken
to avoid the use of drugs that suppress platelet activity.
• Dengue Hemorrhagic FeverThe prognosis of dengue hemorrhagic fever is
adversely affected by a late diagnosis and delayed or improper treatment.
Death has occurred in 40–50% of patients with shock, but with adequate
intensive care, deaths should occur in < 1% of cases. Infrequently, there is
residual brain damage as a consequence of prolonged shock or occasionally
of intracranial hemorrhage. Many fatalities are caused by overhydration.
 PREVENTION
• Dengvaxia, developed by Sanofi Pasteur, is a mixture of four chimeras, DENV
structural genes coupled with nonstructural genes of yellow fever 17D.
• In 2015, Dengvaxia completed phase III per protocol analyses on 32,568
children, vaccinated and controls, ages 2-16 yr.
• These studies revealed poor protection of seronegative and good protection
of seropositive with a reduction of hospitalization and severe disease in
vaccinated children 9 yr old versus controls.
• Based on these data, this vaccine was endorsed by the WHO for targeted use
in individuals 9 yr of age and older, living in countries that are highly endemic
for dengue; it now is licensed for use in 14 countries.
• Prophylaxis in the absence of vaccine consists of avoiding daytime
household-based mosquito bites through the use of insecticides,
repellents, body covering with clothing, screening of houses, and
destruction of A. aegypti breeding sites.
• If water storage is mandatory, a tight-fitting lid or a thin layer of oil may
prevent egg laying or hatching
• Mosquito repellants and other personal anti mosquito measures are
effective in preventing mosquito bites in the field, forest, or jungle.