s it Dengue or is it COVID-19?

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What You Need to Know

 During the COVID-19 pandemic, healthcare providers in areas where
dengue is endemic or who are treating patients with recent travel history
to these areas, need to consider dengue and COVID-19 in the differential
diagnosis of acute febrile illnesses.
 Most people with dengue and COVID-19 have mild illness and can recover
at home; symptoms usually last a few days, and people tend to feel better
after a week.
 However, both dengue and COVID-19 can cause severe illness that can
result in death.
 The clinical management for people who develop severe illness with either
of these two diseases is quite different, often requiring hospital-based
care.
 Anyone of any age can develop severe illness with dengue or COVID-19.
Both infections are more likely to cause complications in adults with
underlying chronic conditions, such as diabetes and heart disease.
o Dengue: Risk factors for severe illness pdf icon[PDF – 1 page]
o COVID-19: People at higher risk for severe illness
 Healthcare providers should perform appropriate tests (for dengue;
for COVID-19) and follow the patient closely for warning signs.
o Dengue warning signs include persistent vomiting, mucosal bleeding,
difficulty breathing, lethargy/restlessness, postural hypotension, liver
enlargement and progressive increase in hematocrit.
o COVID-19 warning signs include difficulty breathing, persistent pain
or pressure in the chest, new confusion, inability to wake or stay
awake, bluish lips or face. This list is not all possible symptoms.
 Complications for both dengue and COVID-19 can develop before test
results come back. Clinical management should be guided by clinical
presentation.
Dengue and COVID-19 symptoms
Dengue COVID-19
Transmission
Dengue, an illness caused by any of 4 dengue COVID-19, a respiratory illness caused by the virus
viruses, is mainly transmitted to people through the SARS-CoV-2, is mainly transmitted from person to
bites of infected Aedes species mosquitoes person through respiratory droplets that are spread
(primarily Ae. aegypti or Ae. albopictus species). when an infected person coughs, sneezes, or talks.
Incubation Period
The incubation period for dengue ranges between The incubation period for COVID-19 is thought to
3-10 days, typically 5-7 days. extend to 14 days, with a median of 4-5 days from
exposure to symptoms onset.
Clinical Course
The clinical manifestations of both dengue and COVID-19 can range from mild to critical.
Signs and Symptoms
Mild to moderate disease Mild to moderate disease
 
 Fever or chills
Febrile phase  Cough
 Shortness of breath or difficulty breathing
 Fever  Fatigue
 Headache with eye pain  Muscle or body aches
 Myalgia  Headache
 Nausea  New loss of taste or smell
 Vomiting  Sore throat
 Rash  Congestion or runny nose
 Leukopenia  Nausea or vomiting
 Warning signs for severe illness: abdominal  Diarrhea
pain or tenderness, persistent vomiting, NOTE: These signs and symptoms of COVID-19
clinical fluid accumulation, mucosal are the ones most persons with the illness have
bleeding, lethargy, restlessness, and liver experienced. However, this list is not inclusive.
enlargement.
Critical Phase

Warning signs may appear, and rapid clinical

deterioration may occur within 48 hours after
defervescence (3–7 days after fever onset).
Severe Illness
Severe dengue is defined by dengue with any of Among patients who developed severe disease, the
the following symptoms and signs: medium time to dyspnea ranged from 5 to 8 days,
the median time to acute respiratory distress
 Plasma leakage leading to shock syndrome (ARDS) ranged from 8 to 12 days, and
 Fluid accumulation with respiratory distress the median time to ICU admission ranged from 10
 Severe bleeding with thrombocytopenia to 12 days.
 Severe organ impairment such as liver Signs and symptoms for severe illness can include:
disease with elevated transaminases, or
Dengue and COVID-19 symptoms
Dengue
meningoencephalitis with impaired
consciousness
 Heart impairment
Risk Factors for Severe Illness
Risk factors for severe dengue include:
 Age (infant)
 Second dengue infection
o In most dengue-endemic countries,
children and young adults are at
highest risk for a second infection
 Patients with chronic medical conditions,
including diabetes, asthma, or heart disease
Dengue
COVID-19
COVID-19
 dyspnea
 hypoxia
 respiratory failure
 shock
 multiorgan system dysfunction
Clinicians should be aware of the potential for
some patients to rapidly deteriorate one week
after illness onset.
See: Interim Guidelines for Management of
Patients with Confirmed Coronavirus Disease
(COVID-19)
Children: CDC and partners are also investigating
reports of multisystem inflammatory syndrome in
children (MIS-C) associated with COVID-19
Risks factors for severe illness with COVID-19
include:
 Age >65
 Underlying conditions like cardiovascular
disease, diabetes, chronic respiratory
disease, hypertension, prior stroke, liver
disease, obesity, chronic lung disease,
chronic kidney disease undergoing dialysis,
or immunocompromise (e.g., poorly
controlled HIV, undergoing cancer
treatment, using corticosteroids, smoking)
 People who live in a nursing home or long-
term care facility
Dengue is caused by one of any of four related viruses: Dengue virus 1, 2, 3,
and 4. For this reason, a person can be infected with a dengue virus multiple
times in his or her lifetime.
Coronavirus disease 2019 or COVID-19 is a respiratory illness caused by a
coronavirus called SARS-CoV-2. It is unclear if antibodies created from a
COVID-19 infection can provide protection against getting infected again.
How does it spread?
How does it spread?
Dengue viruses are spread to people through the bites of infected
mosquitoes, mainly Aedes aegypti mosquitoes.
The virus that causes COVID-19 is thought to spread mainly through
respiratory droplets produced when an infected person coughs, sneezes, or
talks.
Signs and Symptoms
Signs and Symptoms
The most common symptom of dengue is fever with any of the following:

 Aches and pains (eye pain, typically behind the eyes, muscle, joint, or
bone pain)
 Nausea, vomiting
 Rash
Symptoms of dengue typically last 2–7 days.

Contact a healthcare provider if you develop a fever or have symptoms of

dengue.
People with COVID-19 have had a wide range of symptoms reported –
ranging from mild symptoms to severe illness. Symptoms may appear 2-14
days after exposure to the virus. People with these symptoms may have
COVID-19:

 Fever or chills
 Cough
 Shortness of breath or difficulty breathing
 Fatigue
 Muscle or body aches
 Headache
 New loss of taste or smell
  Sore throat
 Congestion or runny nose
 Nausea or vomiting
 Diarrhea
This list does not include all possible symptoms. CDC will continue to update
this list as we learn more about COVID-19.
Warning Signs – Seek Medical Attention
Warning Signs – Seek Medical Attention
Watch for warning signs of severe dengue, which generally begin within 24–
48 hours after the fever has gone away.

If you develop any of the following symptoms, get medical attention

immediately:

 Stomach pain, tenderness

 Vomiting (at least 3 times in 24 hours)
 Bleeding from the nose or gums
 Blood in vomit or stool
 Feeling tired, restless, or irritable
Look for emergency warning signs* for COVID-19. If someone is showing
any of these signs, seek emergency medical care immediately

 Trouble breathing
 Persistent pain or pressure in the chest
 New confusion
 Inability to wake or stay awake
 Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
*This list is not all possible symptoms. Please call your medical provider for
any other symptoms that are severe or concerning to you.

Call 911 or call ahead to your local emergency facility: Notify the operator
that you are seeking care for someone who has or may have COVID-19.