DENGUE FEVER DENGUE FEVER and and

DENGUE HEMORRHAGIC DENGUE HEMORRHAGIC FEVERFEVER

DENGUE FEVERDENGUE FEVER the most common and most the most common and most

important mosquito-borne viral important mosquito-borne viral disease in the worlddisease in the world

found in both tropical and found in both tropical and subtropical regionssubtropical regions

transmitted by aedes aegyptitransmitted by aedes aegypti

Aedes AegyptiAedes Aegypti

primarily a daytime primarily a daytime feederfeeder

lays eggs and produces lays eggs and produces larvae preferentially in larvae preferentially in artificial containersartificial containers

highly urbanizedhighly urbanized

DENGUE VIRUSDENGUE VIRUS

An arbovirus. Dengue is transmitted An arbovirus. Dengue is transmitted though mosquito bitesthough mosquito bites

Causes dengue fever and dengue Causes dengue fever and dengue hemorrhagic feverhemorrhagic fever

Has four serotypes (den 1, den 2, Has four serotypes (den 1, den 2, den3, den4)den3, den4)

All serotypes can cause severe and All serotypes can cause severe and fatal disease fatal disease

All serotypes are immunologically All serotypes are immunologically related but do not provide cross-related but do not provide cross-protective immunity against each otherprotective immunity against each other

Dengue in the PhilippinesDengue in the Philippines

Quick Facts:Quick Facts:•Affects all regions in the Philippines, especially those which are highly populated•Region X (Mindanao) NCR, Region VII (Cebu) with the highest number of cases•28% increase in Dengue cases during the period of Jan to Sep ’05 vs Jan to Sep ’04•Ages of people with Dengue range from 1 to 95 yrs old with a median of 10 years old; 43% belong to 1-9 yr age group and 52% of dengue cases are males•26 – 81% of Dengue cases are unreported

SOURCES: www.doh.gov.ph/nec/dengue/dusept2005.pdf www.bayanihan.org/html/article.php/20060926152921347

REPLICATION AND TRANSMISSIONREPLICATION AND TRANSMISSION OF DENGUE VIRUSOF DENGUE VIRUS

Centers for Disease Control and PreventionCenters for Disease Control and Prevention Division of Vector-Borne Infectious DiseasesDivision of Vector-Borne Infectious Diseases

REPLICATION AND TRANSMISSIONREPLICATION AND TRANSMISSIONOF DENGUE VIRUSOF DENGUE VIRUS

Centers for Disease Control and PreventionCenters for Disease Control and Prevention Division of Vector-Borne Infectious DiseasesDivision of Vector-Borne Infectious Diseases

CLINICAL CHARACTERISTICSCLINICAL CHARACTERISTICS of DENGUE FEVERof DENGUE FEVER

FeverFever HeadacheHeadache Muscle and joint painMuscle and joint pain Nausea and vomitingNausea and vomiting RashRash Hemorrhagic manifestationHemorrhagic manifestation

PETECHIAEPETECHIAE

Centers for Disease Control and PreventionCenters for Disease Control and Prevention Division of Vector-Borne Infectious DiseasesDivision of Vector-Borne Infectious Diseases

DIAGNOSISDIAGNOSIS

Clinical evaluation in Dengue FeverClinical evaluation in Dengue Fever- blood pressure- blood pressure- evidence of bleeding in skin - evidence of bleeding in skin or or other sitesother sites- hydration status- hydration status- evidence of increase vascular - evidence of increase vascular permeability (effusions, permeability (effusions, ascites)ascites)- (+) torniquet test- (+) torniquet test

POSITIVE TORNIQUET TESTPOSITIVE TORNIQUET TEST

Centers for Disease Control and PreventionCenters for Disease Control and Prevention Division of Vector-Borne Infectious DiseasesDivision of Vector-Borne Infectious Diseases

CLINICAL CASE DEFINITION CLINICAL CASE DEFINITION DENGUE HEMORRHAGIC FEVERDENGUE HEMORRHAGIC FEVER

4 necessary criteria4 necessary criteria Fever or recent history of acute Fever or recent history of acute

feverfever Hemorrhagic manifestationHemorrhagic manifestation Low platelet count - 100,000/mmLow platelet count - 100,000/mm3 3

or lessor less Objective evidence of leaky Objective evidence of leaky

capillaries capillaries

Pleural EffusionPleural Effusion

Centers for Disease Control and PreventionCenters for Disease Control and Prevention

Division of Vector-Borne Infectious DiseasesDivision of Vector-Borne Infectious Diseases

HEMORRHAGIC MANIFESTATIONSHEMORRHAGIC MANIFESTATIONS

OF DENGUEOF DENGUE HEMORRHGIC FEVERHEMORRHGIC FEVER Skin hemorrhages Skin hemorrhages

- purpura, petechia, ecchymoses- purpura, petechia, ecchymoses Gingival bleedingGingival bleeding Nasal bleedingNasal bleeding Gastrointestinal bleedingGastrointestinal bleeding - hematemesis, melena, - hematemesis, melena,

hematocheziahematochezia HematuriaHematuria Increase menstrual flowIncrease menstrual flow

DANGER SIGNS OF DHFDANGER SIGNS OF DHF

Abdominal pain – intense & sustainedAbdominal pain – intense & sustained Persistent vomitingPersistent vomiting Abrupt change from fever to Abrupt change from fever to

hypothermia with sweating & hypothermia with sweating & prostrationprostration

Restless or somnolenceRestless or somnolence

4 GRADES OF DHF4 GRADES OF DHF

Grade 1Grade 1- - fever & non specific constitutional s fever & non specific constitutional s

& & sx sx - positive torniquet test - positive torniquet test

Grade 2Grade 2- grade 1 + spontaneous bleeding- grade 1 + spontaneous bleeding

Grade 3Grade 3- signs of circulatory failure- signs of circulatory failure

Grade 4Grade 4- profound shock- profound shock

LABORATORY TESTLABORATORY TEST Clinical laboratory testsClinical laboratory tests

- CBC - CBC - liver function tests- liver function tests- Chest X-ray - Chest X-ray - Urinalysis - Urinalysis

VIRUS ISOLATIONVIRUS ISOLATION CELL CULTURECELL CULTURE

Centers for Disease Control and PreventionCenters for Disease Control and Prevention Division Division of Vector-Borne Infectious Diseasesof Vector-Borne Infectious Diseases

VIRUS ISOLATIONVIRUS ISOLATION CELL CULTURECELL CULTURE

Centers for Disease Control and PreventionCenters for Disease Control and PreventionDivision of Vector-Borne Infectious DiseasesDivision of Vector-Borne Infectious Diseases

VIRUS-ISOLATIONVIRUS-ISOLATIONMOSQUITO-INOCULATIONMOSQUITO-INOCULATION

Centers for Disease Control and PreventionCenters for Disease Control and PreventionDivision of Vector-Borne Infectious DiseaseDivision of Vector-Borne Infectious Disease

TreatmentTreatment FluidsFluids RestRest Antipyretics – avoid Antipyretics – avoid

aspirin/NSAIDaspirin/NSAID Monitor blood pressure, hct, Monitor blood pressure, hct,

platelet count, PT, PTT and level platelet count, PT, PTT and level of consciousnessof consciousness

May need transfusion May need transfusion

Undifferentiated fever

Classical DengueFever

DengueHemorrhagicFever

Dengue

N A T I O N A L E P I D E M I O L O G Y C E N T E R

N A T I O N A L E P I D E M I O L O G Y C E N T E R

N A T I O N A L E P I D E M I O L O G Y C E N T E R

4S1)Search and Destroy, mosquito breeding places2)Self protection measures3)Seek early treatment4)Say “NO” to fogging

They Hide, We Seek

N A T I O N A L E P I D E M I O L O G Y C E N T E R

Thou Shalt Protect

N A T I O N A L E P I D E M I O L O G Y C E N T E R

Mistakes to Avoid

N A T I O N A L E P I D E M I O L O G Y C E N T E R