Dengue Hemorrhagic Fever

It used to be known as Philippine hemorrhagic fever in 1953 and was later reclassified as Dengue
Hemorrhagic Fever. DHF is an acute infectious disease manifested initially with fever and clinical
manifestations in three stages:

1. Febrile or invasive stage

- occurs in first 4 days, starts abruptly as high fever, abdominal pain and headache; later flushing
which may be accompanied by vomiting, conjunctival infection and epistaxis

2. Toxic or hemorrhagic stage

- begins on 4.7 days; there is lowering of temperature, severe abdominal pain, vomiting and
frequent bleeding from gastrointestinal tract in the form of hematemesis or melena,
unstable BP, narrow pulse pressure and shock which may be followed by death. Tourniquet
test which may have been positive during the third day can become negative due to low or
vasomotor collapse.

3. Convalescent or recovery stage

- occurs on the 7-10 day: shows generalized flushing with intervening areas of blanching:
appetite regained and stabilized blood pressure.

Classification of Dengue Fever

1. Severe, frank type - with flushing, sudden high fever, severe hemorrhage, followed by sudden
drop of temperature and shock which may terminate in recovery or death.

2. Moderate -characterized by high fever but with less hemorrhage, no shock

3. Mild - slight fever, with or without petechial hemorrhage but epidemiologically related to
typical cases usually discovered in the course of investigation of typical cases.

Transmission

Aedes aegypti, the transmitter of the disease, is a day-biting mosquito which lays eggs in clear and
stagnant water found in flower vases, cans, rain barrels, old rubber tires, etc. The adult mosquitoes rest
in dark places of the house
Signs and Symptoms

There is sudden onset of high fever which may last 2 to 7 days. Joint and muscle pain and pain
behind the eyes may also be present. Other manifestations include weakness, skin rashes
(maculopapular rash or red tiny spots on the skin called petechiae), nose bleeding when fever starts to
subside, abdominal pain, vomiting of coffee-colored matter, and dark colored stools.

Dengue Cases in the Philippines

The DOH (2010) revealed that most of the dengue cases came from Western Visayas (16.1%),
CaLaBarzon (10.9%), Central Mindanao (10.5%), Eastern Visayas (9.2%), National Capital Region (8.9%),
Southern Mindanao (8.1%) and Northern Mindanao (7.4%).

The ages of cases ranged from 1 month to 95 years old. Majority (52%) of the cases were male.
The most affected age group was the 1-10 years while there were more deaths recorded in the less than
one-year age group and the 1-10 years’ age group).

The DOH identified hotspots for dengue. A hotspot is defined as clustering of cases with
increasing number in the past four weeks. Hotspots were observed in the several barangays in the
following areas: Lipa City and San Jose in Batangas (Region 4A); Puerto Princesa City in Palawan (Region
4B); Kalibo, Aklan (Region VI); Tagbilaran City, Bohol (Region VII); Pudtol, Apayao (CAR); and Kalookan
and Valenzuela in NCR.

Prevention and Control

Prevention and control include the following activities:

1. Covering water drums and water pails at all times to prevent mosquitoes from breeding.
2. Replacing water in flower vases once a week.
3. Cleaning all water containers once a week.
4. Scrubbing the sides well to remove eggs of mosquitoes sticking to the sides.
5. Cleaning gutters of leaves and debris so that rain water will not collect as breeding places of
mosquitoes.
6. Old tires used as roof support should be punctured or cut to avoid accumulation of water.
7. Collecting and disposing all unusable tin cans, jars, bottles and other items that can collect and
hold water.

DENGUE Strategy

In 2010, the Department of Health (DOH) assured that many dengue cases, if mild, can be
managed at home and not all cases require hospitalization. Instead of confining patients in a hospital
facility, parents and caregivers can practice the D.E.N.G.U.E. strategy, which stands for:
D - Daily monitoring of patient's status,

E - Encourage intake of oral fluids like oresol, water, juices

N - Note any dengue warning signs like persistent vomiting and bleeding

G - Give paracetamol for fever and NOT aspirin, because aspirin induces bleeding

U - Use mosquito nets

E - Early consultation is advised for any warning signs

The new D.E.N.G.U.E. strategy has been devised by the DOH to educate the public on home
treatment of mild dengue cases. This is to also help decongest hospitals by giving an assurance that not
all dengue cases require hospital confinement. The DOH also reiterated that the most effective way to
prevent and fight dengue is still by practicing the DOH's 4-S strategy which consists of:

1. Search and destroy

2. Self-protective measures
3. Seek early treatment and
4. Say no to indiscriminate fogging