DENGUE

Prepared by: Sherry May Broy

 Overview
Dengue is a mosquito-borne viral disease
transmitted by infected female mosquitoes mainly
of the species Aedes and these mosquitoes are
vectors.
Dengue is caused by a virus of the Flaviviridae
family and there are four distinct, but closely
related, serotypes of the virus that cause dengue
(DENV-1, DENV-2, DENV-3 and DENV-4).
 The most common human arbovirus infections in the
world
Dengue causes a wide spectrum of diseases. This can
range from subclinical disease to severe flu-like
symptoms in those infected.
dengue hemorrhagic fever (DHF) or dengue shock
syndrome
DENV is frequently transported from one place to
another by infected travellers;
Transmission
 Transmission
through mosquito
bite
to humans
The virus is transmitted
through the bites of infected female
mosquitoes
After feeding on an DENV-infected
person, the virus replicates in the
mosquito midgut, before it
disseminates to secondary tissues,
including the salivary glands.
The EIP takes about 8-12 days when
the ambient temperature is between
25-28°C
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)
transmission can occur up to 2 days
before someone shows symptoms of
the illness, up to 2 days after the fever
has resolved
 Maternal Other
transmission transmission

There is evidence however, of the

modes
Rare cases
of transmission
possibility of maternal transmission
via blood products, organ
(from a pregnant mother to her
donation and transfusions
baby). While vertical transmission
have been recorded.
rates appear low, with the risk of
Similarly, transovarial
vertical transmission seemingly linked
transmission of the virus
to the timing of the dengue infection
within mosquitoes have also
during the pregnancy
been recorded.
Vector
Ecology
Aedes aegypti Aedes
albopictus

A mosquito is considered a secondary dengue

the primary vector of vector
DENV
Disease characteristics

majority of dengue cases are

asymptomatic or show mild symptoms
Symptoms usually last for 2–7 days, after
an incubation period of 4–10 days after
the bite from an infected mosquito
The World Health Organization classifies
dengue into 2 major categories: dengue
(with / without warning signs) and severe
dengue.
 Dengue Severe dengue

a high fever (40°C/104°F) is

critical phase normally

accompanied by 2 of the
following symptoms during
the febrile phase (2-7 days)
severe headache
pain behind the eyes
muscle and joint pains
nausea
vomiting
swollen glands
rash.
about 3-7 days after
illness onset
It is at this time, when the
fever is dropping (below
38°C/100°F) in the
patient, that warning
signs associated with
severe dengue can
manifest.
Warning signs that doctors should look for
include:
severe abdominal pain
persistent vomiting
rapid breathing
bleeding gums or nose
fatigue
restlessness
liver enlargement
blood in vomit or stool.
 Diagnostics

Virus isolation methods Serological methods

Treatment
The best options to treat
these symptoms are
acetaminophen or
paracetamol.
NSAIDs (non-steroidal
anti-inflammatory drugs),
such as ibuprofen and
aspirin should be avoided.
 Vaccination against
dengue

The first dengue vaccine, Dengvaxia® (CYD-TDV)

developed by Sanofi Pasteur was licensed in December
2015 and has now been approved by regulatory
authorities in ~20 countries.
 Risk factors

Previous infection with DENV

Urbanization (especially unplanned)

population’s knowledge, attitude and
practice

climate change
Prevention
and
control

 Personal protection from

Prevention of mosquito breeding:
mosquito bites:
Preventing mosquitoes from
Using of personal household
accessing egg-laying habitats by
protection measures, such as
environmental management and
window screens, repellents, coils
modification;
and vaporizers. These measures
Disposing of solid waste properly
must be observed during the day
and removing artificial man-made
both inside and outside of the
habitats that can hold water;
home (e.g.: at work/school)
Covering, emptying and cleaning of
because the primary mosquito
domestic water storage containers
vectors bites throughout the day;
on a weekly basis;
Wearing clothing that minimises
Applying appropriate insecticides to
skin exposure to mosquitoes is
water storage outdoor containers;
advised;
 Active mosquito and virus
Community engagement: surveillance:
Educating the community Active monitoring and surveillance
on the risks of mosquito- of vector abundance and species
borne diseases; composition should be carried out
Engaging with the to determine effectiveness of
community to improve control interventions;
participation and Prospectively monitor prevalence
mobilization for sustained of virus in the mosquito population,
vector control; with active screening of sentinel
mosquito collections;
Vector surveillance can be
combined with clinical and
environment surveillance.