geographic spread in Bangladesh, India,
Maldives ,Pakistan and Sri Lanka and lower
Name of disease Dengue Fever
Identification of  An acute febrile viral disease characterized
the disease by sudden onset, fever for 2-7days
(sometimes biphasic), intense
headache,myalgia,arthralgia,retro-orbital
pain,anorexia,nausea,vomiting,erythema and
rash.A generalized maculopapular rash may
appear about the time of
defervescense.Rash is frequently not visible
in dark-skinned patients
 Minor bleeding such as petechiae,epitaxis or
gum bleeding may occur during febrile
phase.Adult may have major bleeding such
as GI hemorrhage in peptic ulser cases or
menorrhagia.Recovery may be associated
with prolonged fatigue and depression.
 Laboratory confirmation of dengue infection
is through detection in acute phase
blood/serum within 5 days of onset of illness
or specific antibodies in convalescent phase
serum obtained 6 days or more after onset
of illness.
 Virus identification in blood is reverse
transcriptase polymerase chain reaction(RT-
PCR),culture in mosquitoes cell lines,or
inoculation to mosquitoes then identified
through immunofluorescence with serotype-
specific monoclonal antibodies.
Infectious Agent Flaviviruses and include serotypes 1,2,3 and 4
(dengue-1,-2,-3,-4).The same viruses are responsible
for dengue hemorrhagic fever.
Occurrence  Endemic in most countries in the tropics
especially in Asia that established in
Combodia, China, Indonesia, Malaysia ,
Myanmar ,Philippines, Thailand and Vietnam
with increasing epidemic activity and
endemicity in New Guinea,Singapore and
Taiwan.
 Dengue -1,-2,-3,-4 are endemic in Africa.In
large areas of western Africa,dengue viruses
are probably transmitted epizootically in
monkeys,urban dengue involving humans is
also common in this area.
 Epidemics occurs wherever vectors are
present and virus is introduced,whether in
urban or rural area.
Reservoir The viruses are maintained in humans/Aedes aegypti
mosquito cycle in tropical urban centers;a
monkey/mosquito cycle may serve as a reservoir in
the forests of southeastern Asia and western Africa.
Mode of  Bite of infective mosquitoes,principally
transmission Aedes agypti.This is a day-biting species,with
increased biting activity for 2 hours after
sunrise and several hours before sunset.
 Ae.albopictus is less anthrophilic than
Ae.aegypti and hence a less efficient
epidemic vector.
 Mosquitoes of Ae. nivaeus complex in
Malaysia and Ae.furcifer-taylori complex in
western Africa are involved in enzootic
monkey/mosquito transmission.
Incubation period From 3 to 14 days,commonly 4-7 days
Period No direct person to person transmission.Patients are
communicability infective for mosquitoes during the period of high
viremia,from shortly before the febrile period to the
end thereof,usually 3-5 days.
Susceptibility and Children have a milder disease than
resistance adults.Asymptomatic can occur.Recovery from
infection with one serotype provides lifelong
homologous immunity ,but only short term
protection against other serotypes and may
 exacerbate disease upon subsequent infections.Given
a particular patient who presents with dengue,it may
be difficult,especially at early stage,to predict its
eventual severity.
Control Methods  Preventive Measures:
 Educate the public to remove mosquito
vector larval habitats which Ae.aegypti
artificial water holding containers close to
human habitations such as old tires,flower-
pots,discarded containers food)
 Personal protection against day-biting
through repellents,screening and protective
clothing
appropriate intravenous fluid resuscitation.
 Epidemic measures:
 Search for and destroy Aedes mosquitoes in
sites of human habitation and eliminate
larvicide to all potential Ae.Agypti larval
habitats.Adulticide should target indoor
mosquitoes where most transmission takes
place.
 Use mosquitoes repellents for people
exposed to vector mosquitoes.

 Control of patient,contacts,and the

immediate environment:
 Report to local authority:Obligatory report of
epidemics;Class 4
 Isolation:Blood precautions:Screening the
sickroom or using mosquito bed
net,preferably insecticide-impregnated,for
febrile patients or spraying quarters with a
knockdown adulticide or residual insecticide.
 Concurrent disinfection:Not applicable
 Quarantine: Not applicable
 Immunization of contacts: Not applicable.If
dengue occurs near possible jungle foci of
yellow fever, immuniza them against yellow
fever,because the urban vector for the two
disease is the same.
 Investigation of contacts and source of
infection:Determine patient place of
residence during the 2 weeks before onset of
illness.
 Specific Treatment: Acetylsalicylic
acid(aspirin) is contraindicated because of
hemorrhagic potential and requires