DENGUE HEMORRHAGIC

FEVER (H-FEVER)
1953- First report of hemorrhagic
fever in the Philippines

1998-There was a highest recorded

rate of 60.9 cases per 100,000
population
- 12 outbreaks of dengue fever

Dengue cases usually peaks in the

months of July to November and lowest
during the month of February and April.
Dengue is the fastest spreading vector-
borne disease in the world endemic in
100 countries·

Dengue virus has four serotypes

(DENV1, DENV2, DENV3 and DENV4)

First infection with one of the four serotypes

usually is non-severe or asymptomatic, while
second infection with one of other serotypes
may cause severe dengue.
MODE OF TRANSMISSION INCUBATON PERIOD

Dengue virus is transmitted by day Uncertain. Probably 6 days to 1

biting Aedes aegypti and Aedes week
albopictus mosquitoes.
 • Usually last 2-7 days
A. FEBRILE • Mild haemorrhagic manifestations like petechiae and mucosal
PHASE membrane bleeding (e.g nose and gums) may be seen.
• Monitoring of warning signs is crucial to recognize its progression to
critical phase.

• Defervescence occurs between 3 to 7 days of illness. Defervescence is

known as the period in which the body temperature (fever) drops to almost
B. CRITICAL normal (between 37.5 to 38°C).
PHASE • Those who will improve after defervescence will be categorized as Dengue
without Warning Signs, while those who will deteriorate will manifest warning
signs and will be categorized as Dengue with Warning Signs or some may
progress to Severe Dengue.
• When warning signs occurs, severe dengue may follow near the time of
defervescence which usually happens between 24 to 48 hours.
 • Happens in the next 48 to 72 hours in which the body fluids go back
to normal.

RECOVERY • Patients’ general well-being improves.

• Some patients may have classical rash of “isles of white in the sea of
PHASE red”.
• The White Blood Cell (WBC) usually starts to rise soon after
defervescence but the normalization of platelet counts typically
happens later than that of WBC.
 SEVERE, FRANK TYPE
With flushing, sudden high fever,
severe hemorrhage, followed by
sudden drop of temperature, shock and
terminating in recovery or death.

MODERATE
With high fever, less hemorrhage, no
shock

MILD
With slightly fever, with or without petechial
hemorrahage but epidemiologically related to
typical cases usually discoveredin the course
of investigation of typical cases.
All persons are susceptible. Both sexes re equally affected. Age
groups predominantly affected are the preschool age and school age.
Adults and infants are not exempted. Peak age affected 5-9 years

Occurance is sporadic throughout the year

 For fever, give Rapid replacement Includes intensive Give ORESOL to
paracetamol for of body fluids is the monitoring and replace fluid in
muscle pains, for most important follow-up. moderate
headache, give treatment dehydration at 75
analgesics, DO NOT
give ASPIRIN. ml/kg in 4-6 hours
up to 2-3L in adults.
 Recognition of the disease.

Isolation of the patient (screening or

sleeping under the mosquito net)
METHODS OF
PREVENTION AND Epidemiological investigation
CONTROL
Case finding and reporting

Health education
 1. Eliminate vector by: 2. Avoid too many hanging 3. Residual spraying with
clothes inside the house insecticides
a. changing water and scrubbing sides
of lower vases once a week
b. destroy breeding places of
mosquito by cleaning surroundings
c. proper disposal
d. keep water containers covered.
Vision Mission
A dengue free Philippines Ensure healthy lives and promote well-
being for all at all ages
 1. Surveillance
 Case Surveillance through Philippine Integrated Disease
Surveillance and Response (PIDSR)
 Laboratory-based surveillance/ virus surveillance through
Research Institute for Tropical Medicine (RITM) Department
of Virology, as national reference laboratory, and sub-national
reference laboratories.
 Vector Surveillance through DOH Regional Offices and RITM
Department of Entomology

PROGRAM 2. Case Management and Diagnosis

 Dengue Clinical Management Guidelines training for

COMPONENTS hospitals.
 Dengue NS1 RDT as forefont diagnosis at the h ealth center/
RHU level.
 PCR as dengue confirmatory test available at the sub-
national and national reference laboratories.
 NAAT-LAMP as one of confirmatory tests will be available at
district hospitals, provincial hospitals and DOH retained
hospitals.
 3. Integrated Vector Management (IVM)
 Training on Vector Management, Training on
Basic Entomology for Sanitary Inspector,
Training on Integrated Vector Management
(IVM) for health workers.
 Insecticide Treated Screens (ITS) as dengue
control strategy in schools.

PROGRAM 4. Outbreak Response

 Continuous DOH augmentation of insectides

COMPONENTS such as adulticides and larvicides to LGUs for

outbreak response.
5. Health Promotion and Advocacy
 Celebration of ASEAN Dengue Day every June
15
 Quad media advertisement
S - earch and Destroy
Cover water containers
Replace water containers once a
week
Clean your sorroundings
Dispose all unusable items that
can collect and hold water
S-eek early consultations
S-elf Protection measures

Wear long pants and long

sleeved shirt
Use mosquito repellent
everyday
S - ay yes to fogging only
during outbreaks

Conducted in early mornings or late

afternoons, fogging is done to knock down
adult mosquitoes that may be
carrying dengue virus.