Community Medicine- Dengue. 20 May 2020.

Dengue
● It is an arboviral disease- arthropod borne disease
● Ades aegypti and Ades albopictus mosquito are the responsible vector
● Dengue is found in tropical and sub-tropical climates worldwide, mostly in
urban and semi-urban areas

Problem Statement: Global

● The actual Numbers of dengue cases are underreported and misclassified
● Estimates indicates 390 million dengue infections per year
● Reported cases- 3.2 million in 2015
● Cases were seen in 9 countries before 1970, now more than 100 countries
● Severe dengue is a leading cause of serious illness and death among
children in some Asian and Latin American Countries

Problem Statement: Nepal

● Causes have been reported from 2005, sporadic outbreak in 2006 and
2010
● Initially imported cases, later indigenous
● 19 districts reported cases in 2070/71 and 12 in 2071/72, highest in Chitwan
and Parsa
● 34 cases were reported from 26 districts in 2072/73, Chitwan (70) followed
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by Nawalparasi and Parsa (12 each)
● 1527 dengue cases were reported from 42 districts in 2073/74

Epidemiology- Agent
● Dengue virus member of genus flavivirus, belonging to flaviviridae
● 4 serotypes are present- DEN1, DEN2, DEN3, DEN4

Epidemiology- Environment
● Vector
● The Aedes aegypti mosquito is the primary vector of dengue
– lives in urban habitats and breeds mostly in man-made containers
– day-time feeder; peak biting periods- early morning and evening before
dusk
– bites multiple people during each feeding period
● Aedes albopictuss is also another vector (secondary in Asia)
● Aedes population fluctuates
– Rainfall
– water storage
● Survives best in 16C-30C
Transmission
● The virus is transmitted to humans through the bites of infected female
mosquitoes
● After virus incubation for 4-10 days, an infected mosquito is capable of
transmitting the virus for the rest of its life
● infected symptomatic or asymptotic humans are the main carriers and
multipliers of the virus, serving as a source of the virus for uninfected
mosquitoes
● Patients who are already infected with the dengue virus can transmit the
infection (4-5 days; max 12) via Aedes mosquitoes after their first
symptoms appear

Undifferentiated fever
● May have just a simple fever
● May or may not have maculopapular rashes
● usually occurs in the ones who are infected for the first time-Primary
dengue