Discover dengue symptoms, prevention tips, and treatments on Meri Sehat. Stay informed, and protect yourself. Learn more at Meri Sehat.

Dengue

Discover dengue symptoms, prevention tips, and treatments on Meri Sehat. Stay informed and protect yourself from dengue. Learn more about dengue treatment in Pakistan and other valuable information at Meri Sehat. Dengue is a serious mosquito-borne viral infection, and knowing how to identify its symptoms, preventive measures, and available treatments is crucial for your health and well-being. Visit Meri Sehat to get comprehensive and reliable information on dengue to safeguard yourself and your loved ones.

Discover dengue symptoms, prevention tips, and treatments in Pakistan. Stay informed, and protect yourself. Learn more at Meri Sehat.

Online Consultation

Iqra Mazhar

Overview

The fever-like illness that occurs in tropical and subtropical areas is called dengue fever. Normally, it causes flu-like symptoms and fever. The severe fever causes a sudden drop in blood pressure, serious bleeding, and death, and is named hemorrhagic fever.

Dengue fever is most common in Latin America, Southeast Asia, Africa, and the western Pacific islands. The disease has been spreading to some other new areas, e.g., outbreaks have been seen in the southern parts of the United States and Europe. Although, research projects on dengue fever vaccines are currently underway. However, the best prevention is offered through avoiding mosquito bites and enforcing measures to reduce their population.

Dengue presents on a wide spectrum and ranges from flu to severe flu-like symptoms in infected individuals. Severe dengue is very rare and can cause severe complications like organ impairment, severe bleeding, and/or plasma leakage. If not managed appropriately, severe dengue has a higher risk of death.&nbsp;

Dengue is caused by the Flaviviridae family, consisting of four distinct but closely related types. The person who has recovered from infection is believed to have lifelong immunity against that specific serotype, with partial temporary and cross-immunity to the other serotypes. Infections (secondary infection) by other serotypes can increase the risk of severe dengue.

About half of the world&#39;s population is now at risk of dengue. 100-400 million persons get infected annually. More than 80% are mild and asymptomatic<a href="#accordion">[5]</a>. To date, the maximum number of people were infected in 2019. Of the 3.1 million cases reported worldwide, around 25,000 were reported with severe dengue.&nbsp;

In Pakistan, dengue is endemic and considered a notification-priority disease. In December 2019, 53,498 cases and 95 deaths were reported due to dengue<a href="#accordion">[3]</a><a href="#accordion">[5]</a>. 
&nbsp;

Signs And Symptoms

Often, people experience no signs or symptoms of this infection or the symptoms may be mistaken for other illnesses (like flu, which usually begins 4-10 days after you have been bitten by the infected mosquito).

Dengue can present with the following signs and symptoms, along with high fever (104&deg;F):

<ul>
	<li><a href="https://merisehat.pk/disease/migraines-73">Headache</a></li>
	<li>Nausea</li>
	<li>Vomiting</li>
	<li>Muscle, bone, or joint pain</li>
	<li>Pain behind the eyes</li>
	<li>Swollen glands</li>
	<li>Aches and pains. It may include muscles or joints, eyes (typically behind the eyes), and bone pain</li>
</ul>

Often people recover in a week, but sometimes symptoms may worsen and become life-threatening i.e. they can develop severe dengue, dengue hemorrhagic fever, or dengue shock syndrome.

In severe dengue, your blood vessels become leaky and damaged, since the number of platelets in your bloodstream drops. This can lead to internal bleeding, shock, organ failure, and even death<a href="#accordion">[5]</a>. 
&nbsp;

<h5>These include:</h5>

&nbsp;

<ul>
	<li>
	<h5>Transmission By Mosquito Bite</h5>
	</li>
</ul>

Infected female mosquitoes transmit the virus to humans through their bites, mainly the&nbsp;Aedes aegypti&nbsp;mosquito. Other species of the Aedes genus can also act as vectors. 
&nbsp;

<ul>
	<li>
	<h5>Human-To-Mosquito Transmission</h5>
	</li>
</ul>

Mosquitoes can pick up the infection from people infected with viremic DENV. The carrier will have either symptomatic or asymptomatic dengue infection. People who have no symptoms (asymptomatic) are also carriers<a href="#accordion">[3]</a>.

Transfer of infection from human to mosquito can occur up to 2 days before the appearance of symptoms<a href="#accordion">[4]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Maternal Transmission</h5>
	</li>
</ul>

The primary transfer of DENV among humans is carried out through mosquito vectors. There is evidence to believe the possibility of maternal transmission (from a pregnant mother to her baby). If the mother contracts a DENV infection during pregnancy, it can result in pre-term birth, fetal distress, and low birthweight of the newborn. 
&nbsp;

<ul>
	<li>
	<h5>Other Transmissions&nbsp;</h5>
	</li>
</ul>

Transmissions via blood products are rare but can occur. Transfusions and organ donation are also reported transmissions. Similarly, transmissions of the virus within mosquitoes have also been reported<a href="#accordion">[5]</a>. 
&nbsp;

Causes

Four types of dengue viruses exist. You can&#39;t get dengue fever directly from an infected person, only through mosquito bites.

These viruses are common in mosquitoes found around human lodgings. The mosquito picks up the virus when it bites a person infected with dengue. This infected mosquito transfers the virus to other healthy people during a blood meal. The virus then spreads into the bloodstream of the healthy person and causes an infection.

After you have recovered from a certain type of virus, you will acquire long-term immunity against that particular virus, but not against the other three dengue viruses. It means you are at risk of being infected despite recovery.&nbsp;

Repeated infections can also increase the risk of developing severe <a href="https://merisehat.pk/disease/dengue-hemorrhagic-fever-dengue-shock-syndrome">dengue fever</a>. 
&nbsp;

Diagnosis

Your medical and travel history could be useful in diagnosing dengue along with the following tests:&nbsp; 
&nbsp;

<h5>Nucleic Acid Amplification Tests (NAATs)</h5>

<ul>
	<li>NAATs are the preferred method of laboratory diagnosis in suspected dengue cases patients. This test is ideally performed on serum specimens collected at least within 7 days of symptom onset. The presence of the virus by rRT-PCR or NS1 antigen is considered a confirmation of dengue in patients with a compatible clinical and travel history.</li>
</ul>

<h5 dir="ltr">&nbsp;</h5>

<h5 dir="ltr">Serologic Tests</h5>

<ul>
	<li>IgM antibody testing can identify additional infections and can be detected with MAC-ELISA &ge;4 days after fever onset. This is a very useful test in patients presenting &gt;1 week after fever onset.</li>
</ul>

<h5 dir="ltr">&nbsp;</h5>

<h5 dir="ltr">Cross-Reactive Flaviviruses</h5>

<ul>
	<li>If the infection is likely to have occurred in a place where other potentially cross-reactive flaviviruses circulate, both molecular and serologic diagnostic testing for dengue and other flaviviruses should be performed.</li>
	<li>People infected with or vaccinated against other flaviviruses (such as yellow fever or Japanese encephalitis) may produce cross-reactive flavivirus antibodies, yielding false-positive serologic dengue diagnostic test results.</li>
</ul>

&nbsp;

<h4>"Curious about your blood pressure? Head on over to the <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> and check your reading today."</h4>

Treatment

Timely detection and early medical care could reduce the fatality associated with dengue. While there is no specific treatment for dengue or severe dengue<a href="#accordion">[5]</a>, over-the-counter (OTC) drugs, acetaminophen (Tylenol, etc) can help to reduce muscle pain and fever. However, other&nbsp;OTC&nbsp;pain relievers (aspirin, ibuprofen, Advil, Motrin IB) and naproxen sodium (Aleve) are contraindicated in dengue patients as they can increase internal bleeding.&nbsp;

Severe dengue fever requires supportive care in a hospital, blood pressure monitoring, electrolyte replacement through intravenous (IV) fluids, and transfusions to replace blood loss.

Immediately, call your doctor if you have the following signs and symptoms<a href="#accordion">[1]</a>:

<ul>
	<li>Few or no tears</li>
	<li>Dry mouth or lips</li>
	<li>Decreased urination</li>
	<li>Lethargy /confusion</li>
	<li><a href="https://merisehat.pk/disease/cold-flu">Cold</a>/clammy extremities 
	&nbsp;</li>
</ul>

Lifestyle Modifications When You Get Dengue

<ul>
	<li>Use Tylenol (acetaminophen) for pain relief and fever&nbsp;</li>
	<li>Do not take NSAIDs or aspirin&nbsp;</li>
	<li>Rest&nbsp;as much as possible</li>
	<li>Drink plenty of fluids and liquids&nbsp;to stay hydrated</li>
	<li>For mild symptoms of dengue, look after the sick&nbsp;child, infant,&nbsp;or family member&nbsp;at home</li>
</ul>

&nbsp;

Severe dengue fever can cause organ damage and internal bleeding. A severe drop in blood pressure to dangerous levels due to heavy internal bleeding can lead to shock and death. Hence, it is vital to seek with your health care provider immediately. Pregnant women who contract dengue can transmit the virus to their babies, which will unfortunately place them at a higher risk of premature birth, fetal distress, or low birth weight. 
&nbsp;

You have a greater risk of developing dengue fever if: 
&nbsp;

<ul>
	<li>You Are Living In Or Travelling To Tropical Areas:&nbsp;As tropical and subtropical areas are at greater risk of dengue, so your risk to be exposed to these types of viruses will be higher. The risk of dengue is higher in areas like Southeast Asia, Africa, the western Pacific islands, and Latin America.</li>
	<li>You Had Dengue Fever Previously:&nbsp;If you were infected with dengue, you are at a high risk of developing severe dengue fever. 
	&nbsp;</li>
</ul>

These include:

<h5>&nbsp;</h5>

<h5>1. Vaccine</h5>

The dengue fever vaccine (Dengvaxia) is recommended in areas where dengue fever is common. Dengvaxia protects people aged 6 to 45 years who have had a previous dengue virus infection. The vaccine is given three times in one year.

This vaccine is recommended only for those persons who have documented records of dengue, or if their blood test indicates a previous infection history, called seropositivity.&nbsp;

Dengvaxia is not available in the United States of America. But in 2019, the U.S. Food and Drug Administration approved this vaccine for people aged 9 to 16 years, who have a history of dengue fever and live in the U.S. territories of American Samoa, Guam, Puerto Rico, and Virgin Islands (where dengue fever is common). 
&nbsp;

<h5>2. Prevent Mosquito Bites</h5>

The World Health Organization stresses that vaccination alone can&rsquo;t control or prevent dengue. Prevention of mosquito bites and reducing mosquito breeding sites is the effective way to control dengue.

If you live in an area where dengue is common, or are traveling to such an area, then the following measures can help reduce the risk of mosquito bites:

<ul>
	<li>Stay In Well-Screened Or Air-Conditioned Housing:&nbsp;The dengue-carrying mosquitoes are most active from dawn to dusk, avoid going out at these hours.&nbsp;&nbsp;</li>
	<li>Use Protective Clothing:&nbsp;Wear a long-sleeved shirt, shoes, long pants, and socks.</li>
	<li>Use Mosquito Repellents:&nbsp;Apply&nbsp;Permethrin on your clothing, bed netting, and camping gear shoes. Apply mosquito repellants containing at least 10% of DEET on the skin.</li>
	<li>Prevention Of Mosquito Breeding Sites:&nbsp;The dengue virus-carrying mosquitoes breed in standing water around homes. They can also breed in stagnant environments at&nbsp;your home, e.g., standing water can collect in things like trays of refrigerators, automobile tires, or pots of plants, etc. The mosquito population can be reduced by eliminating their breeding habitats. For example, empty and clean containers that can hold water like flower vases and pet bowls. Keep standing water containers covered.</li>
	<li>Proper Disposal Of&nbsp;Solid Waste&nbsp;</li>
	<li>Spray Outdoor Water Storage Containers With Proper Insecticides</li>
	<li>Educate The Community on the risks of mosquito-borne diseases and engage them in preventive measures.</li>
	<li>Effectiveness Of Control Interventions Could Be Monitored: This can be done&nbsp;by active surveillance of mosquito populations, which would aid in finding the most suitable prevention strategy in different areas.</li>
	<li>Clinical And Environment Surveillance: This can be used to interpret vector surveillance.</li>
</ul>

&nbsp;

The research is ongoing among many groups of collaborators to search for tools and innovative strategies to understand and hamper the transmission of viruses<a href="#accordion">[5]</a>.

&nbsp;

Key Points

<ul>
	<li>Dengue is a priority notification disease in Pakistan, and any presenting cases should be notified to the relevant health authorities.</li>
	<li>Dengue can be avoided by removing the breeding sites of mosquitos, which is standing water.</li>
	<li>Active community engagement to eradicate breeding grounds is necessary.</li>
	<li>Vaccination is available for people who have been previously infected. 
	&nbsp;</li>
</ul>

[1] Mayoclinic.org. 2022. Diseases and Conditions - Mayo Clinic.

[2] Dengue. Centers for Disease Control and Prevention.

[3] Duong, V., et al., Asymptomatic humans transmit dengue virus to mosquitoes. Proceedings of the National Academy of Sciences of the USA, 2015. 112(47): p. 14688–14693.

[4] Nguyen, N.M., et al., Host and viral features of human dengue cases shape the population of infected and infectious Aedes aegypti mosquitoes. Proceedings of the National Academy of Sciences of the United States of America, 2013. 110(22): p. 9072-9077.