Tropical Vector Borne Disease:

Dengue Fever

Judith Pinkham (Ph.D. Student)Walden University

PUBH 8165Instructor: Dr. Fredric Grant

Summer 2013World Health Organization (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Retrieved from: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

Stakeholders Government:

Federal and State Ministries of Health Local Health Departments Primary Healthcare Departments Environmental officials

Citizens of the affected countries Non-Governmental Organizations (NGOs)

Community based organizations Community groups and coalitions

Major Donor Agencies World Health Organization (WHO) USAID

US Public International travelers who may or plan to travel to the

affected countries.

What is Dengue Fever?Mosquito-borne infection found in tropical

and sub-tropical regions around the worldAlternative names for Dengue Fever

Break –bone fever Victims often have contortions due to the intense

joint and muscle painDandy fever

World Health Organization (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Retrieved from: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

HistoryHistory

Originated from monkeys and spread to humans between 100-800 years ago.

First documented in the 1950s in Philippines and Thailand

Re-emerged in 1981 in Caribbean and Latin America

Center for Disease Control and Prevention (2012). Dengue Homepage. Retrieved from: http://www.cdc.gov/Dengue/epidemiology/index.html

CausesRNA virus of the family Flaviviridae; genus

Flavivirus is responsible There are four strains or serotypes of the

virus that cause dengue; DEN-1DEN-2DEN-3DEN -4

Gould EA, Solomon T (February 2008). "Pathogenic flaviviruses". The Lancet 371 (9611): 500–9. Retrieved from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60238-X/fulltextWorld Health Organization (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Retrieved from: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf

Signs and Symptoms

• Acute febrile infection of sudden onset with manifestation of 3 stages

• Febrile phase (1st-4th )• Sudden-onset fever• Muscle and joint pains• Rash• diarrhea

• Critical phase (4th -7th day)• Hypertension• Gastrointestinal bleeding

• Recovery phase (7th – 10th ) • Seizures• Itching• Fatigue• Peeling of skin

Chen LH, Wilson ME (October 2010). "Dengue and chikungunya infections in travelers". Curr. Opin. Infect. Dis. 23 (5): 438–44. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/20581669Wolff K, Johnson RA (eds.) (2009). "Viral infections of skin and mucosa". Fitzpatrick's color atlas and synopsis of clinical dermatology (6th ed.). New York: McGraw-Hill

Medical. pp. 810–2.Rodenhuis-Zybert IA, Wilschut J, Smit JM (August 2010). "Dengue virus life cycle: viral and host factors modulating infectivity". Cell. Mol. Life Sci. 67 (16): 2773–86.

Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/20372965Simmons CP, Farrar JJ, Nguyen vV, Wills B (April 2012). "Dengue". N Engl J Med 366 (15): 1423–32.Retrieved from: http://www.nejm.org/doi/full/10.1056/NEJMra1110265

TransmissionTransmitted by Aedes mosquitoesAedes albopictus/Aegypti are generally

associated with the spread of dengue feverBiting around the ankles and knees close to

the ground in the daytimeOnly female mosquitoes will bite; mostly in

the daytime.Humans act as carriers to uninfected

mosquitoes during blood meal

World Health Organization. (2012). Dengue and severe dengue. Retrieved from: http://www.who.int/mediacentre/factsheets/fs117/en

Advice to TravelersMosquito feeding time

2-3 hours after day break3-4 hours before night fall

Mosquitoes feed indoors and outdoorsAlways take preventative measure

Gubler, D., (1998). Dengue and dengue hemorrhagic fever . Clinical Microbiology Reviews, July 1998, p.480-496. Retrieved from: http://cmr.asm.org/content/11/3/480.full  World Health Organization (2013). Global Alert and Response. “Impact of Dengue". Retrieved from: http://www.who.int/neglected_diseases/diseases/en/

DiagnosisDifficult to differentiate from other viral

infectionsDevelop fever within two weeks of being in

the tropics or sub tropicsLow white blood cell countConfirmation by laboratory testing

Polymerase Chain Reaction (PCR)Antibody titerComplete blood count (CBC)

Ranjit S, Kissoon N (January 2011). "Dengue hemorrhagic fever and shock syndromes". Pediatr. Crit. Care Med. 12 (1): 90–100. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/20639791World Health Organization (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Retrieved from: http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdfHalstead, edited by Scott B. (2008). Dengue. London: Imperial College Press. p. 180Halstead, Scott (2008). Volume 5 of Tropical medicine. Imperial College Press. p. 429.

TreatmentNo approved treatments available

ImmunizationsTreatments for fever symptoms

FluidsRestAcetaminophen

Avoid certain medicationsAspirinIbuprofenNaproxen sodium

Mayo Clinic. (2012). Dengue Fever. Retrieved from : http://www.mayoclinic.com/health/dengue-fever/DS01028/DSECTION=treatments-and-drugs

PreventionNo approved vaccine or drugs availablePreventive measures should be taken

Application of mosquito repellants DEET Oil of Eucalyptus

Protective clothingMosquito bed netsEmpty, clean or cover any standing water that

can be a mosquito- breeding site

Center for Disease Control and Prevention, (2009). Travelers’ Health: Dengue fever & Dengue hemorrhaging fever. Retrieved from: http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx

Epidemiological background of DengueOne of seventeen neglected tropical diseasesDisease burden estimated 1600 disability –

adjusted life years (DALY) per million population

Mortality rate Without treatment is 1-5%Severe illness is 26%

Endemic in over 110 countries50-390 cases globally per year

Half million hospitalizations25000 deaths

Guzman MG, Halstead SB, Artsob H, et al. (December 2010). "Dengue: a continuing global threat". Nat. Rev. Microbiol. 8 (12 Suppl): S7–S16. Retrieved from: http://www.nature.com/nrmicro/journal/v8/n12_supp/full/nrmicro2460.html

IncidenceIncreased by 30 folds between 1960-2010Geographical distribution

Around equator2.5 billion people at riskIn the US 3-8% of those who travel in endemic

areas have illness 2nd most common next to malaria to be

diagnosed in US travelers to endemic areas

Chen LH, Wilson ME (October 2010). "Dengue and chikungunya infections in travelers". Curr. Opin. Infect. Dis. 23 (5): 438–44. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/20581669Center for Disease Control and Prevention, (2009). Travelers’ Health: Dengue fever & Dengue hemorrhaging fever. Retrieved from: http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx

Public Health InterventionsVector ControlInsecticide applicationCommunity participationVaccine developmentActive monitoring and surveillanceIntegration of evidence based strategies and

policiesCreating awareness and education

World Health Organization. (2012). Dengue and severe dengue. Retrieved from: http://www.who.int/mediacentre/factsheets/fs117/en

Questions

ReferencesBhatt S, Gething PW, Brady OJ, et al. (April 2013). "The global distribution and burden of dengue". Nature 496 (7446): 504–7. Retrieved from:

http://www.nature.com/nature/journal/v496/n7446/full/nature12060.htmlCenter for Disease Control and Prevention (2012). Dengue Homepage. Retrieved from: http://www.cdc.gov/Dengue/epidemiology/index.htmlCenters for Disease Control and Prevention (2012) New CDC test for dengue approved". Retrieved from:

http://www.cdc.gov/media/releases/2012/p0620_dengue_test.htmlCenter for Disease Control and Prevention, (2009). Travelers’ Health: Dengue fever & Dengue hemorrhaging fever. Retrieved from:

http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspxCenter for Disease Control and Prevention. (2012) "Chapter 5 – dengue fever (DF) and dengue hemorrhagic fever (DHF)". 2010 Yellow Book.Retrieved

from: http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/dengue-fever-and-dengue-hemorrhagic-feverChen LH, Wilson ME (October 2010). "Dengue and chikungunya infections in travelers". Curr. Opin. Infect. Dis. 23 (5): 438–44. Retrieved from:

https://www.ncbi.nlm.nih.gov/pubmed/20581669Gould EA, Solomon T (February 2008). "Pathogenic flaviviruses". The Lancet 371 (9611): 500–9. Retrieved from:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60238-X/fulltextGubler, D., (1998). Dengue and dengue hemorrhagic fever . Clinical Microbiology Reviews, July 1998, p.480-496. Retrieved from:

http://cmr.asm.org/content/11/3/480.fullGuzman MG, Halstead SB, Artsob H, et al. (December 2010). "Dengue: a continuing global threat". Nat. Rev. Microbiol. 8 (12 Suppl): S7–S16.

Retrieved from: http://www.nature.com/nrmicro/journal/v8/n12_supp/full/nrmicro2460.htmlHalstead, edited by Scott B. (2008). Dengue. London: Imperial College Press. p. 180Halstead, Scott (2008). Volume 5 of Tropical medicine. Imperial College Press. p. 429.Mayo Clinic. (2012). Dengue Fever. Retrieved from : http://www.mayoclinic.com/health/dengue-fever/DS01028/DSECTION=treatments-and-drugsRanjit S, Kissoon N (January 2011). "Dengue hemorrhagic fever and shock syndromes". Pediatr. Crit. Care Med. 12 (1): 90–100. Retrieved from:

https://www.ncbi.nlm.nih.gov/pubmed/20639791Rodenhuis-Zybert IA, Wilschut J, Smit JM (August 2010). "Dengue virus life cycle: viral and host factors modulating infectivity". Cell. Mol. Life Sci.

67 (16): 2773–86. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/20372965Simmons CP, Farrar JJ, Nguyen vV, Wills B (April 2012). "Dengue". N Engl J Med 366 (15): 1423–32.Retrieved from:

http://www.nejm.org/doi/full/10.1056/NEJMra1110265Varatharaj A (2010). "Encephalitis in the clinical spectrum of dengue infection". Neurol. India 58 (4): 585–91. Retrieved from:

http://www.neurologyindia.com/article.asp?issn=0028-3886;year=2010;volume=58;issue=4;spage=585;epage=591;aulast=VaratharajWolff K, Johnson RA (eds.) (2009). "Viral infections of skin and mucosa". Fitzpatrick's color atlas and synopsis of clinical dermatology (6th ed.).

New York: McGraw-Hill Medical. pp. 810–2.World Health Organization (2009). Dengue Guidelines for Diagnosis, Treatment, Prevention and Control. Retrieved from:

http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdfWorld Health Organization. (2012). Dengue and severe dengue. Retrieved from: http://www.who.int/mediacentre/factsheets/fs117/en

World Health Organization (2013). Neglected Tropical Diseases. "The 17 neglected tropical diseases". Retrieved from: http://www.who.int/neglected_diseases/diseases/en/

  World Health Organization (2013). Global Alert and Response. “Impact of Dengue". Retrieved from: http://www.who.int/neglected_diseases/diseases/en/