DENGUE FEVER

Dr Abu Zar Taizai

 DENGUE A MAJOR GLOBAL HEALTH PROBLEM

 Dengue in recent years has become a major

international public health concern. Dengue is
found in tropical and sub-tropical regions around
the world, predominantly in urban and semi-
urban areas.

 Dengue Haemorrhagic fever (DHF) a potentially

lethal complication was first recognized in the
1950s during the dengue epidemics in the
Philippines and Thailand, but today DHF affects
most Asian countries and has become a leading
cause of hospitalization and death among
children.
 The global prevalence of dengue has grown
dramatically in recent decades. The disease is
now endemic in more than 100 countries in
Africa, the Americas, the Eastern Mediterranean,
South-east Asia and the Western Pacific.

 South-east Asia and the Western Pacific are most

seriously affected.

 Before 1970 only nine countries had experienced

DHF epidemics, a number that had increased
more than four-fold by 1995.

 Some 2500 million people - two fifths of the

world's population - are now at risk from dengue.
WHO currently estimates there may be 50 million
cases of dengue infection worldwide every year.
 In 2001 alone, there were more than
609000 reported cases of dengue in the
Americas, of which 15000 cases were
Dengue Haemorrhagic Fever. This is greater
than double the number of dengue cases
which were recorded in the same region in
1995.

 Not only is the number of cases increasing

as the disease is spreading to new areas,
but explosive outbreaks are occurring.

 In 2001, Brazil reported over 390000 cases

including more than 670 cases of DHF.
Distribution Western Hemisphere
Distribution of dengue, Eastern Hemisphere
 An estimated 500,000 cases of DHF require
hospitalization each year, of whom a very large
proportion are children. At least 2.5% of cases die,
although case fatality could be twice as high.
 Without proper treatment, DHF case fatality rates can
exceed 20%. With modern intensive supportive
therapy, such rates can be reduced to less than 1%.
 The spread of dengue is attributed to expanding
geographic distribution of the four dengue viruses
and of their mosquito vectors, the most important of
which is the predominantly urban species Aedes
aegypti.
 A rapid rise in urban populations is bringing greater
numbers of people into contact with this vector,
especially in areas that are favourable for mosquito
breeding, e.g. where household water storage is
common and where solid waste disposal services are
inadequate
 In Asia and Amrecas the Aedes aegypti
breeds primarily in man-made containers
like:

 Earthenware jars,
 Metal drums and
 Concrete cisterns used for domestic water
storage.
 Discarded plastic food containers
 Used automobile tires and other items that
collect rainwater.

 In Africa it also breeds extensively in natural

habitats such as tree holes and leaf axils.
 In recent years, Aedes albopictus, a
secondary dengue vector in Asia, has
become established in the United States,
several Latin American and Caribbean
countries, in parts of Europe.

 The rapid geographic spread of this species

has been largely attributed to the
international trade in used tyres.
Dengue Syndrome
 Dengue fever and dengue hemorrhagic fever
(DHF) are viral diseases transmitted by
Aedes mosquitoes, usually Aedes aegypti.
 There are four types of this virus (serotypes
1 to 4) and are closely related to one
another.
 Recovery from infection by one provides
lifelong immunity against that serotype but
confers only partial and transient protection
against subsequent infection by the other
three.
 There is good evidence that sequential
infection increases the risk of more serious
disease resulting in DHF.
 Dengue viruses are capable of infecting humans
and causing disease. These infections may be
symptomatic, or may lead to:

1. “Classical” dengue fever

2. Dengue Haemorrhagic fever without shock

3. Dengue Haemorrhagic fever with shock

 DENGUE VIRUS INFECTION

Asymptomatic Symptomatic

Dengue
Haemorrhagic fever
Undiffrentiated fever Dengue fever
(viral syndrome) (syndrome)
(Plasma
Dengue Fever leakage)

Dengue Shock
Syndrome (DSS)
No Shock
Dengue
Haemorrhagic fever
CLASSICAL DENGUE FEVER
 Reservoir both man and mosquito

The mosquito becomes infective by feeding on

the patient from the day before onset to the 5th
day of illness.
After an extrinsic incubation period of 8-10
days the mosquito becomes infective and is able
to transmit infection.
The illness is characterized by an incubation
period of 3-10 days.
1. Onset is sudden with chills and high fever.
Temperature rises quickly as high as 104° F (40°
C), with relative bradycardia and hypotension.
2. Reddened eyes

3. Intense muscles and joint pains

4. A flushing or pale pink rash comes over the face and

then disappears. The glands (lymph nodes) in the neck
and groin are often swollen

5. Fever lasts 2-4 days rarely more than 7 days.

6. Recovery is complete

7. Case fatality is very low

Dengue Haemorrhagic Fever

Dengue hemorrhagic fever is a more severe form of the

viral illness. Caused by more than one dengue viruses.
It is due to double infection with dengue virus. The first
infection sensitizes the patient and the second appears
to produce immunological catastrophe.

Manifestations include:

 Headache, high fever (continuous and lasting 2-7 days)

 Rash, and evidence of hemorrhage in the body
(Petechiae)
 Bleeding in the nose or gums,
 Black stools, or easy bruising are all possible signs of
hemorrhage.
 This form of dengue fever can be life-threatening or
even fatal.
 Symptoms

Skin rash
 THERE IS NO DRUG FOR DENGUE.

 To prevent dengue fever, you must prevent the

breeding of its carrier, the Aedes mosquitoes.

Treatment

Because dengue is caused by a virus, there is no specific

medicine or antibiotic to treat it.

For typical dengue, the treatment is purely concerned

with relief of the symptoms (symptomatic).

Rest and fluid intake for adequate hydration is

important.
Immunization

 Vaccine development for dengue and DHF is

difficult because any of four different viruses may
cause disease.

 Nonetheless, progress is being made in the

development of vaccines that may protect against
all four dengue viruses. Such products may
become available for public health use within
several years.
 The mosquito flourishes during rainy seasons
but can breed in water-filled flower pots,
plastic bags, and cans year-round.
 One mosquito bite can inflict the disease.
 Under optimal conditions, the egg of an Aedes
mosquito can hatch into a larva in less than a
day.
 The larva then takes about four days to
develop in a pupa, from which an adult
mosquito will emerge after two days.
 Three days after the mosquito has bitten a
person and taken in blood, it will lay eggs, and
the cycle begins again.
Facts about the mosquito

 Only the female aedes mosquito bites as it

needs the protein in blood to develop its
eggs.

 The mosquito becomes infective

approximately 7 days after it has bitten a
person carrying the virus.

 This is the extrinsic incubation period,

during which time the virus replicates in the
mosquito and reaches the salivary glands.
 Peak biting is at dawn and dusk.

 The average lifespan of an Aedes mosquito

in Nature is 2 weeks.

 The mosquito can lay eggs about 3 times in

its lifetime, and about 100 eggs are
produced each time.

 The eggs can lie dormant in dry conditions

for up to about 9 months, after which they
can hatch if exposed to favourable
conditions, i.e. water and food.
Potential Breeding Sites
Prevention

 The application of appropriate insecticides to

larval habitats.

 During outbreaks, emergency control measures

may also include the application of insecticides
as:

 space sprays to kill adult mosquitoes using

portable or truck-mounted machines or even
aircraft.

 However, the killing effect is only transient,

variable in its effectiveness because the aerosol
droplets may not penetrate indoors to
microhabitats where adult mosquitoes are hiding.
Dengue Prevention Checklist

 To prevent the spread of dengue fever, we

must first prevent the breeding of its vector,
the Aedes mosquitoes.

 The Aedes mosquito is easily identifiable by

its distinctive black and white stripes on
their body. It prefers to breed in clean,
stagnant water easily found in our homes.

 We can get rid of the Aedes mosquito by

frequently checking and removing stagnant
water in our premises.
 CHECKLIST
At all times

 Turn
pails and watering cans over and store
them under shelter.
 Remove water in plant pot plates. Clean
and scrub the plate thoroughly to
remove mosquito eggs. Avoid the use
of plant pot plates, if possible.
 Loosen soil from potted plants to prevent
the accumulation of stagnant water on the
surface of the hardened soil.

 Do not block the flow of water in scupper

drains.
 Cover rarely used gully traps. Replace the
gully trap with non-perforated ones and
install anti-mosquito valves.
 No tray or receptacles should be placed beneath and
or/ on top of any air-conditioning unit so as not to
create a condition favourable for mosquito breeding.

Every other day

Change water in flower vases. Clean and scrub the

inner sides of vases. Wash roots of flowers and plants
thoroughly as mosquito eggs can stick to them easily.
Once a week

 Clear fallen leaves and stagnant water in your

scupper drains and garden.
These leaves could collect water or cause
blockages to the drains, thus resulting in the
build-up of stagnant water.

 Clear any stagnant water in your air cooler unit.

Once a month

Add prescribed amounts of sand granular

insecticide into vases, gully traps and roof gutters,
even if they are dry.
 Thanks

 DENGUE FEVER

 Dr Abu Zar Taizai