Health Tips

Dengue fever

Dengue is a viral infection caused by one of the four types of viruses (DENV-1, DENV-2, DENV-3, DENV-4). They are related to each other, but are not exactly the same. Getting sick from one dengue virus does not protect a person from the others. A person can get dengue fever more than once.

Most of the dengue cases reported were from urban areas (70 – 80%) where there is a high density of its population and rapid development activities factors which favour dengue transmission.

There are 997 dengue cases reported this year, leading to a total of 10,954 cumulative reported dengue cases in 2022. This is an increase of 31.8% compared to 8,313 cases reported during the same period in 2021. Currently, five deaths due to dengue had been reported, compared to also five deaths during the same period in 2021. 

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How is dengue fever spread?

The viruses are transmitted through the bite of infected Aedes aegypti and Aedes albopictus female mosquitoes that feed both indoors and outdoors during the daytime (from dawn to dusk). Dengue viruses cannot be transmitted through person-to-person contact but an infected pregnant mother can pass on the infection to her child.

Standing water can act as breeding sites for mosquitoes, and therefore enhance the potential for exposure of the disaster-affected population and emergency workers to infections.

Symptoms of dengue fever

Symptoms usually happen 4 to 7 days after a bite from a female mosquito that carries dengue virus and last about 5 to 7 days. But they can happen up to 2 weeks later. Symptoms usually last 5 to 7 days. Dengue fever symptoms are different for every individual. They can be asymptomatic, mild or severe.The clinical course of dengue fever is generally classified into three phases as following:

Febrile phase: Individuals who are infected will develop sudden, high fever that can last anytime between 2 to 7 days, accompanied by other symptoms such as nausea, rash, body aches. During this period, your full blood count will show gradual reduction in total white cell as well as platelet count. 

Dengue fever should be suspected if an individual have high grade fever alongside two or more symptoms as follows: They can include:

• Flu-like symptoms such as sore throat, stuffy nose

• Headache

• Pain behind the eyes

• Joint and muscle pain

• Nausea and or vomiting

• Swollen glands

• Feeling tired, sometimes for days to weeks

• Rash – This can be flat or have small bumps. It might be itchy. A rash is more common in people who have not been infected with a dengue virus before.

Critical phase: Occur around day three of illness, but usually taken from the point of defervescence and last about 24 to 48 hours. During this phase, severe plasma leakage can happen whereby the fluid can leak and accumulate in extravascular spaces and patients can deteriorate and tip into severe dengue very quickly. While most patients get away with this phase without much of an issue, it is important to monitor closely for the presence of warning signs, so that it can be picked up and managed early - to avoid complications and death.

Following are some of the warning signs that doctors look for:

• Severe abdominal pain

• Persistent vomiting

• Difficulty in breathing

• Gum, nose bleeding, or generally easy bruising (Get bruises without bumping into anything)

• Lethargic and unable to perform daily activities

• Restlessness

• Enlarged liver on physical examination 

Recovery phase: All the fluids are reabsorbed back into the circulation during this phase, and generally speaking, you should start feeling better, with return of appetite, and resolution of most symptoms experienced. A small number of individuals will develop a classical generalised rashes during this period referred to as “islets of white in the sea of red”  

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Children and younger people often have less severe symptoms. People who had dengue fever in the past and got infected with a different dengue virus have the highest risk of severe symptoms, and the infection may progress into severe dengue. This complication can lead to a life-threatening condition called dengue shock syndrome. 

How is dengue fever treated?

There is no one particular treatment for the virus that causes dengue fever, but merely supportive care and symptomatic treatment. 

Some people are at risk of getting sicker from dengue fever compared to the rest. This includes:

• Pregnant women

• Babies

• Older people

• People with obesity

• People who have diabetes, kidney failure, or certain blood diseases

These individuals might need to go to the hospital if they get dengue fever. Doctors can watch closely for severe symptoms and treat them as early as possible, if they happen. People who live alone or far from a doctor's office or hospital might also need to stay in the hospital. That way, they can be treated right away if they get very sick.

If you have dengue fever, you might need to see a doctor or nurse every day until you get better. The doctor will do blood tests and check your blood pressure along with other clinical assessments daily. These check-ups are important because dengue fever can cause serious bleeding and hypotension (low blood pressure), if not picked up early enough can lead to dengue shock syndrome. . Doctors can look to see if this is happening, and treat it early if it does.

Is there anything I can do on my own to feel better?

Yes. People who are having mild symptoms of dengue without any warning signs, not as sick, can usually rest at home.  If the doctor says you do not need to go to the hospital, you can stay home, rest, and drink plenty of fluids. You can also take paracetamol (sample brand name: Panadol) to relieve fever and aches.

Do not take aspirin or NSAIDs, such as ibuprofen (sample brand names: Brufen, Nurofen). These medicines can increase the risk of bleeding in people with dengue fever. Never give aspirin or medicines that contain aspirin to children younger than 18 years. In children, aspirin can cause a serious problem called Reye syndrome.

 Very sick people (individuals with warning signs and also severe dengue)  should be treated in the hospital.  

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Prevention of dengue fever

The best way to prevent dengue fever is to avoid the mosquitoes that carry it and prevent the mosquitoes fro. You can:

• Stay inside during the day, when the mosquitoes that carry dengue fever are most active. Buildings with screens and air conditioning are safest.

• Wear shoes, long-sleeved shirts, long pants, and a hat when you go outside.

• Drain any standing water near your home, such as wading pools, buckets, and potted plants with saucers. Mosquitoes breed in standing water.

Medically reviewed by Ashwini Nair, MB BCh BAO.

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References:

1. Patient education: Dengue fever (The Basics) - UpToDate. Accessed May 31, 2022. https://www.uptodate.com/contents/dengue-fever-the-basics?search=dengue&topicRef=3025&source=related_link 

2. Update on the Dengue situation in the Western Pacific Region. Accessed May 31, 2022. https://www.who.int/docs/default-source/wpro---documents/emergency/surveillance/dengue/dengue-20220421.pdf?sfvrsn=fc80101d_119 

3. CPG Management of Dengue Infection In Adults 3rd Ed. 2015. https://www.moh.gov.my/moh/resources/penerbitan/CPG/CPG%20Dengue%20Infection%20PDF%20Final.pdf 

4. Dengue and severe dengue. Accessed June 11, 2022. https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

Written by

DOC2US Editorial Team