Written by Roxanne Royce from Colorado Travel Health
www.coloradotravelhealth.com.
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INCIDENCE IN INDIA
India reports approximately 2,000 cases annually, but because their disease surveillance is insufficient, even confirming an estimate is difficult. The Integrated Disease Surveillance Project (IDSP) revealed that in Gujarat, India alone the total number of patients treated for dengue in 2009 was 1605.
(In Sri Lanka 6638 cases and 42 deaths have been reported since the beginning of 2010).
TRANSMISSION
Dengue fever is a virus spread from person-to-person by infected mosquitoes. It is the most common worldwide arboviral illness (virus spread by arthropods). It is a significant public health problem placing more than one third of the world’s population at risk. Locally acquired infections have also emerged recently in Texas, Hawaii and the Middle East.
SIGNS AND SYMPTOMS
Just one mosquito can cause an infection and after an incubation period ranging from 3-14 days, a sudden high fever develops along with two or more of the following symptoms: headache, retro-orbital pain (pain behind the eye), muscle or joint pain (causing so much discomfort one’s bones can feel like they are breaking hence giving the illness the name, “Breakbone Fever”), rash, hemorrhagic manifestation or leucopenia. The rash usually manifests as the fever resolves and lasts 2-4 days. Some people also present with flushed faces (usually during the first 24-48 hours), nausea and vomiting.
DENGUE HEMORRHAGIC FEVER
As the fever subsides (usually 3-7 days following the onset of fever) approximately 1% of patients will progress to a more serious condition called dengue hemorrhagic fever (DHF). By definition this means there is evidence of vascular (blood vessel) leakage. Symptoms include all of the following: a fever persisting for 2-7 days, hemorrhagic manifestations; thrombocytopenia (platelet count <100,000/mm 3); and evidence of increased vascular permeability. Dengue Shock Syndrome (DSS) can also occur when one also has hypotension (low blood pressure), narrow pulse pressure (≥ to 20 mm Hg), or frank shock.
DIAGNOSIS
Diagnosis of dengue or dengue hemorrhagic fever can be confirmed by laboratory testing.
TREATMENT
Although there is no specific treatment for dengue infections, measures to control dehydration and fever (with acetaminophen) along with bed rest are often instituted. Patients should also watch for signs of DHF or DSS as the fever subsides 3-7 days after onset of symptoms. These warning signs include an abrupt change from a fever to hypothermia, severe abdominal pain, persistent vomiting, bleeding, difficulties breathing or altered mental status.
PREVENTION
There is not yet a vaccine so prevention includes avoiding mosquito bites with insect repellant, protective clothing, and appropriate accommodations. DEET (of a 20-35% concentration) or Picaradin can be applied to ones skin. Clothing with good coverage should be warn (especially in the early morning and late afternoon hours) and it can be treated with Permethrin. Accommodations with well screened windows, air-conditioning and bed nets are optimal. The responsible mosquito (Aedes Aegypti) typically live indoors and are found in dark, cool places including under beds, closets, behind curtains and in bathrooms. Insecticides can be targeted in those areas.
There are not yet any vaccines to prevent infection with dengue virus and the most effective protective measures are those that avoid mosquito bites. When infected, early recognition and prompt supportive treatment can substantially lower the risk of developing severe disease.
References
CDC. Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF). [Cited 2010 April 30]. Available from: http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx
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