Dengue

I. Introduction
Dengue is a mosquito-borne viral infection, found in tropical and sub-tropical climates
worldwide, mostly in urban and semi-urban areas. Dengue virus is transmitted by female
mosquitoes mainly of the species Aedes aegypti. These mosquitoes are also vectors of
chikungunya, yellow fever and Zika viruses. Each year, up to 400 million people get infected
with dengue. Approximately 100 million people get sick from infection, and 40,000 die from
severe dengue. Given the number of dengue cases each year, it is best for us nurses to be well-
versed in the various dengue preventions, disease processes in order to provide appropriate
nursing interventions. It is also critical to gather relevant disease information in order to
provide comprehensive health education to those at risk and those affected by the disease.
II. Mode of Transmission
Mosquito-to-human transmission
The virus is transmitted to humans through the bites of infected female mosquitoes,
primarily the Aedes aegypti mosquito. Other species within the Aedes genus can also act as
vectors, but their contribution is secondary to Aedes aegypti.
Human-to-mosquito transmission
Mosquitoes can become infected from people who are viremic with DENV. This can be
someone who has a symptomatic dengue infection, someone who is yet to have a
symptomatic infection (they are pre-symptomatic), but also people who show no signs of
illness as well (they are asymptomatic)
maternal transmission (from a pregnant mother to her baby). A pregnant woman already
infected with dengue can pass the virus to her fetus during pregnancy or around the time of
birth.) breastmilk.
Infected blood, laboratory, or healthcare setting exposures
Rarely, dengue can be spread through blood transfusion, organ transplant, or through a
needle stick injury.
III. Signs and Symptoms
Dengue
Dengue should be suspected when a high fever (40°C/104°F) is accompanied by 2 of
the following symptoms during the febrile phase:
- severe headache
- pain behind the eyes
- muscle and joint pains
- nausea
 - vomiting
- swollen glands
- rash.
Severe dengue
A patient enters what is called the critical phase normally about 3-7 days after illness
onset. fever is dropping (below 38°C/100°F). Severe dengue is a potentially fatal
complication, due to plasma leaking, fluid accumulation, respiratory distress, severe
bleeding, or organ impairment.
- severe abdominal pain
- persistent vomiting
- rapid breathing
- bleeding gums
- fatigue
- restlessness
- blood in vomit.
If patients manifest these symptoms during the critical phase, close observation
for the next 24–48 hours is essential so that proper medical care can be provided,
to avoid complications and risk of death
IV. Prevention
o Prevention of mosquito breeding:
- Prevent mosquitoes from accessing egg-laying habitats by environmental
management and modification;
- Disposing of solid waste properly and removing artificial man-made habitats that
can hold water; (fish ponds..)
- Covering, emptying and cleaning of domestic water storage containers on a
weekly basis;
- Applying appropriate insecticides to water storage outdoor containers;
o Personal protection from mosquito bites:
- Using of personal household protection measures, such as window screens,
repellents, insecticide treated materials, coils and vaporizers.
- Wearing clothing that minimizes skin exposure to mosquitoes (pajamas, pants, long
sleeves..)
o Community engagement: (community education).
- Educating the community on the risks of mosquito-borne diseases;
- Engaging with the community to improve participation and mobilization for
sustained vector control; which I have mentioned earlier such as protection from
mosquito bites, destroying and preventing breeding grounds of mosquitos
o Reactive vector control:
 - Emergency vector control measures such as applying insecticides as space spraying
during outbreaks which may be used by health authorities; (fogging)

Hand, Foot, and Mouth Disease

I. Introduction
Hand, foot, and mouth disease (HFMD) is a common infection in children that causes sores
called ulcers inside or around their mouth and a rash or blisters on their hands, feet, legs, or
buttocks. It can be painful and is very contagious, but it isn't a serious disease (since
complications of this disease are rare and it only required minimum medical treatment)
The viruses that usually cause hand, foot, and mouth are named coxsackievirus a16 and
enterovirus 71.
Anyone can have the disease, but children under age 5 are most likely to get it. It tends to
spread easily in the summer and fall. (due to temperate climates)

II. Mode of Transmission

The virus can spread to others through an infected person’s:
- Nose and throat secretions, such as saliva, drool, or nasal mucus
- Fluid from blisters or scabs
- Feces (poop)
- Person-to-person contact
o -Touching an infected person or making other close contact, like kissing,
hugging, or sharing cups or eating utensils
- Respiratory droplets containing virus particles when an infected person coughs or
sneezes
o - Contact with respiratory droplets containing virus particles after a sick person
coughs or sneezes
- Contact with contaminated surfaces and objects
o -Touching an infected person’s feces, such as changing diapers, then touching
your eyes, nose, or mouth
o - Touching objects and surfaces that have the virus on them, like doorknobs or
toys, then touching your eyes, nose, or mouth

III. Signs and Symptoms

- Fever
- Sore throat
 - Feeling unwell
- Painful, red, blister-like lesions on the tongue, gums and inside of the cheeks
- A red rash, without itching but sometimes with blistering, on the palms, soles and
sometimes the buttocks
- Irritability in infants and toddlers
- Loss of appetite

IV. Prevention
- Wash hands carefully.
- Wash hands frequently and thoroughly, especially after using the toilet or changing a
diaper and before preparing food and eating.
- When soap and water aren't available, use hand wipes or gels treated with germ-killing
alcohol.
- Disinfect common areas.
- Get in the habit of cleaning high-traffic areas and surfaces first with soap and water,
then with a diluted solution of chlorine bleach and water.
- In Child care centers (since children under 5 yrs old are most likely to have this disease),
they should follow a strict schedule of cleaning and disinfecting all common areas,
including shared items such as toys, as the virus can live on these objects for days.
- Clean your baby's pacifiers often.
- Teach good hygiene to the children
- Show the children how to practice good hygiene and how to keep themselves clean.
(washing of hands before and after using toilet, eating and etc.)
- Explain to them why it's best not to put their fingers, hands or any other objects in their
mouths. (because it can be a possible access for the virus to infect the host)
- Isolate contagious people.
- hand-foot-and-mouth disease is highly contagious, people with the illness should limit
their exposure to others while they have active signs and symptoms.
- Keep children with hand-foot-and-mouth disease out of child care or school until fever is
gone and mouth sores have healed. If you have the illness, it is better to stay at home.