CRISBERT I. CUALTEROS, M.D. - Travel Health Service Dengue
   
DR. CRISBERT I. CUALTEROS
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  Clinical Practice Guidelines

CRISBERT I. CUALTEROS, M.D. Family and Medicine
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Dengue Fever
 Aedes albopictus
Aedes albopictus
(Acknowledgement: Pest Control Advisory Section, Food and Environmental Hygiene Department)

What is Dengue fever?

Dengue Fever is an acute viral disease characterized by sudden onset of fever for 3-5 days, with intense headache, joint and muscle pain, pain behind the eyes, nausea, gastrointestinal disturbances and rash. Minor bleeding, such as gum and nose bleeding, may occur at any time during the febrile phase. Children usually have a milder disease than adults. The incubation period is 3 to 14 days. Recovery may be followed by prolonged fatigue and depression. Occasionally, the disease may progress to Dengue Heamorrhagic Fever (DHF) with bleeding and shock, leading to death. Travellers to tropical countries, especially in Southeast Asia and Latin America, may be at risk of dengue infection. Epidemics usually occur during and shortly after the rainy season.


How does it spread?

Dengue virus is transmitted to human by mosquitoes, especially Aedes aegypti and Aedes albopictus. This is a day-biting species with increased biting activities for 2 hours after sunrise and several hours before sunset. Patients are usually infective for mosquitoes from shortly before to the end of the febrile period, an average of about 6-7 days. It cannot be directly transmitted from person to person.


How can you prevent it?

At present, there is no effective vaccine for dengue, so travellers must rely on preventing mosquito bites to combat infection (especially during their high biting activity time). The personal protection measures against mosquito bites are as follows:

  • Wear long-sleeved shirts and trousers;
  • Rest in air-conditioned or well-screened rooms;
  • Use aerosol insecticide indoor and use bednets if sleeping areas are not air-conditioned or screened.
  • Use insect repellents containing DEET (for children keep DEET concentration below 20%) on exposed skin;
  • If travelling in endemic rural areas, carry a portable bed-net and apply permethrin on it as well as to clothes.


How is it treated?

Anyone returning from travel to a dengue-infected area and then falling sick within one month, especially with bleeding signs, should seek medical assistance immediately. High fever should be treated by sponging and the appropriate use of paracetamol. Do not take aspirin because they can lead to bleeding and cause stomach irritation. There is no specific treatment available for treating DHF. Supportive measures have to be provided in hospital.

 

Dengue,2003

Dengue fever reporting in different areas of the world, 2007

Countries/Areas 07 Reported number 08 Reported number 08 Update Source
Asia Bangladesh      ;  
Bhutan      ;  
Cambodia 40,000 (407)   13 Jan ProMED
China        
Mainland 544 7 11 Mar P.R. China MoH
Hong Kong 58** 14** 29 May HKSAR DH
Macau 14 2** 27 May Macao Health Bureau
Taiwan 3,553 218 21 May Taiwan CDC
India       ADSNet
Indonesia 160,000(1,101) 2,396*(41) 13 May ProMED
Japan 89 16** 28 Apr Taiwan CDC
Lao   581(3) 25 May ProMED
Malaysia 31,279(67) 9,889* (26) 14 Apr ProMED
Myanmar 11,577(98)     ProMED
Nepal       ProMED
Pakistan 1,527*(11)     ProMED
Philippines 24,689(283) 9,555*(111) 19 Mar ProMED
Saudi Arabia 342 16 30 Jan ProMED
Singapore 8,826(3) 2,120 26 May Singapore MoH
Sri Lanka 47 34(3) 18 Feb ProMED
Thailand 62,999 (90) 13,943(16) 26 May Taiwan CDC
Timor-Leste      ;  
Vietnam 80,000(68) 10,000 25 Mar Singapore MoH
Yemen      ;  
North America Mexico 40,599(10) 10,680 14 May PAHO
USA 488   23 Jan PAHO
South America Argentina 173 28 14 May PAHO
Bolivia 6,677 (1) 730(0) 14 May PAHO
Brazil 561,495 (225) 230,829*(130) 14 May ProMED
Colombia 42,536 (19) 9,061(3) 14 May PAHO
Ecuador 10,753(5) 1,894 14 May PAHO
French Guiana 661   23 Jan PAHO
Paraguay 28,182 (17) 1,953 14 May PAHO
Peru 6,907 (2) 6,434 14 May PAHO
Venezuela 82,000(42) 206,041 14 May PAHO
Central America and Caribbean Sea Barbados 255   24 Oct ; ProMED
Costa Rica 26,440(8) 2,299 14 May PAHO
Dominican Republic 9,349 (46) 598(3) 14 May PAHO
El Salvador 12,360 1,507 14 May PAHO
Guatemala 5,886 (4)   12 Jan PAHO
Honduras 33,508(8) 2,254 14 May PAHO
Nicaragua 1,564 (11) 105(1) 14 May PAHO
Panama 3,402 101 7 Apr PAHO
Puerto Rica 11,012(9) 1,168 14 May PAHO
Trinidad and Tobago 31 608 6 Mar ProMED
Guadeloupe 19,200(3)   7 Apr ProMED
Martinique 5,082(4)   23 Jan PAHO
Jamaica 1,443(18) 106 7 Apr PAHO
Oceania Australia 322 192 31 May Australia MoH
Palau   16 26 Feb ; ProMED
Cook Islands 700     ProMED
Micronesia 6*     ProMED

Figures in bracket: reported death numbers.
** Imported cases
* Cases in parts of the country

Abbreviations:
ADSNet Association of South East Asian Nations Infectious Diseases Outbreak Surveillance Network
CDC Centre for Disease Control
DoH Department of Health
MoH Ministry of Health
PAHO Pan American Health Organisation
ProMED   Program for Monitoring Emerging Diseases
WHO World Health Organization

 

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