10 Facts About Dengue: Symptoms, Treatment & More

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Last updated: 13 Jul 2022 | 7 min reading time

Dr Teo Yeow Kwan Jim

Respiratory Physician

The incidence of dengue worldwide has been growing in recent years. This viral infection exists in 129 countries, with 70% of them in Asia. Learn more about dengue fever, including common symptoms, treatment and prevention.

What is dengue fever?

Dengue fever is a mosquito-borne viral infection that continues to rapidly spread worldwide. It’s known to cause a wide spectrum of disease, ranging from an infection that is nearly or completely asymptomatic to severe flu-like symptoms. In less common cases, some people may develop severe dengue, which can be fatal when not managed appropriately.

Dengue is common in 129 countries, particularly in Asia where the tropical and sub-tropical climates are fertile grounds for the Aedes mosquito – the chief transmitter of the disease. According to the World Health Organisation, there are an estimated 100 – 400 million infections each year. As of late, Singapore has seen a steadily increasing number of dengue cases. In fact, the National Environment Agency warns of an increased risk of dengue cases in the warmer months ahead.

Dengue symptoms usually begin 4 – 6 days after infection and can last up to 10 days. Symptoms can range from mild to severe. The symptoms can be confused with other illnesses that cause fever, aches, pains, and rashes.

The most common symptoms of dengue are as follows:

• Sudden, high fever
• Nausea
• Vomiting
• Skin rash (which may appear 2 – 5 days after the onset of fever)
• Fatigue
• Severe headaches
• Backaches and severe body aches

There are also warning signs to watch out for which may indicate you have severe dengue. These warning signs generally begin 24 – 48 hours after the fever goes away. Severe dengue can be life-threatening within a few hours and typically require hospitalisation:

• Pain or tenderness in the stomach or abdomen
• Repeated vomiting with dehydration
• Vomiting blood or presence of blood in stools
• Feeling tired, restless, or irritable
• Low platelets with bleeding in stomach, joint, muscle, gums, nose and brain (dengue haemorrhage fever)
• Hypotension/drop in blood pressure (dengue shock syndrome)
• Giddiness and fainting spells

10 facts about dengue

Considering the worldwide prevalence of dengue, it’s imperative that you arm yourself with important facts relating to this viral disease. These are 10 things that you need to know about dengue to help you gear up against the disease:

1. Dengue fever is most common in sub-tropical and tropical areas

Dengue outbreaks occur in several countries, including the Americas, Africa, the Middle East, Asia, and the Pacific Islands. In fact, the only continent not affected by dengue is Antarctica.

Dengue outbreaks can occur anytime and anywhere as long as warm weather conditions favour mosquito survival and the mosquitoes are active.

The greatest risk for dengue occurs in the following areas which are known to have sub-tropical and tropical climates:

• Southeast Asia
• Southern China
• Indian subcontinent
• The Pacific Islands
• The Caribbean (except Cuba and the Cayman Islands)
• Africa
• Central and South America (except Chile, Paraguay, and Argentina)

2. Dengue is spread by a specific species of mosquito

Dengue is transmitted through the bite of the Aedes mosquito infected with a dengue virus. The Aedes aegypti mosquito is the main vector that causes dengue. However, dengue outbreaks have also been attributed to Aedes albopictus, Aedes polynesiensis, and several species of the Aedes scutellaris complex. The Aedes aegypti is most active during the day. They tend to bite approximately 2 hours after sunrise and in the evening before the sun sets.

3. Aedes mosquitoes breed in stagnant water

Mosquitoes thrive in urban areas close to human population. They prefer to breed in clean, stagnant water that is easily found in the household. All it takes is a very small amount of water for mosquitoes to lay their eggs. Examples where stagnant water can be found include water bottles, containers, discarded waste, or anything that is capable of holding water. Inside the home, adult mosquitoes can be found in dark areas such as closets, under beds, and behind curtains where they are protected from wind, rain, and potential predators.

4. Dengue is transmitted in different ways

There are a couple of ways that dengue is transmitted. The first is mosquito-to-human, in which an infected Aedes mosquito bites a human, effectively spreading the dengue virus. Mosquitoes, in turn, can become infected when they bite a person infected with the virus. These infected mosquitoes can then spread the virus to other people through bites.

The dengue virus can also be transmitted from pregnant mother-to-child. A pregnant woman already infected with dengue can pass on the virus to her foetus during pregnancy.

5. You can get the dengue virus more than once

It is possible that you can get the dengue virus more than once. The virus responsible for causing dengue is called dengue virus (DENV). There are 4 DENV serotypes (DENV-1, DENV-2, DENV-3, and DENV-4), which means it is possible to be infected 4 times. While recovery from infection is believed to provide lifelong immunity against that serotype, cross-immunity to the other stereotypes is only partial and temporary. It’s also important to note that a second infection carries a higher risk of developing severe dengue which can be fatal.

6. Dengue is diagnosed through a blood test

Diagnosing dengue fever can be difficult, because its signs and symptoms can be easily confused with those of other diseases such as malaria, leptospirosis, and typhoid fever. As part of diagnosing your illness, your doctor may ask you about your medical and travel history. Be sure to let your doctor know of international trips and travel dates. Doctors can also diagnose dengue infection with a blood test to check for the virus or antibodies to it. They may also order blood tests for similar viruses such as zika or chikungunya.

7. Dengue is preventable, but a cure has not yet been developed

There is currently no specific medicine to treat dengue. If you suspect you have dengue fever, you may manage symptoms such as fever, muscle aches and pains with medication containing acetaminophen or paracetamol. It’s also imperative that you get plenty of rest, drink lots of fluids, and see a doctor immediately.

8. Medication to avoid when suffering from dengue

There is medication that needs to be avoided when you’re stricken by dengue. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin should be avoided because they thin the blood. As dengue can cause risk of haemorrhage, NSAIDs may increase bleeding risk and worsen the condition.

9. Dengue can be easily prevented

Making a few home and lifestyle adjustments can help prevent dengue, as all four dengue virus serotypes are spread primarily through the bite of an infected mosquito.

Tips to prevent dengue:

• Apply mosquito repellent, even at home
• Spray insecticide in dark corners of your home, including under the bed, behind the sofa, and behind curtains
• Wear long-sleeved shirts and trousers when outdoors
• Consider air conditioning at home, if available
• Ensure that all windows and door screens are secure and free of holes
• Use mosquito nets if sleeping areas are not screened
• Get rid of stagnant water at home and change water in vases/bowls on alternate days

10. Dengue can be fatal when left untreated

While many dengue infections are mild, it can cause acute flu-like illness which can develop into severe dengue. Severe dengue, also known as dengue shock syndrome (DSS), is a potentially lethal complication and will require hospitalisation and management by medical professionals. Dengue shock symptoms occur after 2 – 6 days if the patient remains untreated.

Dengue shock syndrome symptoms include:

• Fainting
• Cold/clammy hands and feet
• A weak pulse
• Blueness around the mouth

Without proper treatment, the mortality rate for severe dengue increases to 20%. There is a vaccine (Dengvaxia®) available for people who have been infected by dengue before. The course of the vaccination consists of 3 injections, spaced out over the course of a year. Most clinics offer the vaccine, but do consult your doctor before taking the vaccination.

If you are experiencing any of the severe dengue symptoms mentioned above, seek medical attention immediately at your nearest clinic or accident & emergency department.

Dengue and severe dengue, Retrieved 3/6/2020 from https://www. who.int/health-topics/dengue-and-severe-dengue

Dengue Fever, Retrieved 3/6/2020 from https://www.webmd.com/a-to-z-guides/dengue-fever-reference#2

Dengue: Symptoms and Treatment, Retrieved 3/6/2020 from https://www.cdc.gov/dengue/symptoms/index.html

Everything you need to know about Dengue fever, Retrieved 3/6/2020 from https://www.medicalnewstoday.com/articles/179471

All You Need to Know About Dengue, Retrieved 3/6/2020 from https://www.mountelizabeth.com.sg/healthplus/article/all-you-need-to-know-about-dengue

Dengue: Prevention, Retrieved 3/6/2020 from https://www.cdc.gov/dengue/prevention/

Dengue, Retrieved 3/6/2020 from https://medlineplus.gov/dengue.html#cat_93

Dengue Control, Retrieved 3/6/2020 from https://www.who.int/denguecontrol/faq/en/index6.html

Dengue: Transmission, Retrieved 3/6/2020 from https://www.cdc.gov/dengue/transmission/index.html

Dengue and severe dengue, Retrieved 3/6/2020 from https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

529 dengue cases reported last week; NEA warns of higher dengue risk in homes during circuit breaker period, Retrieved 3/6/2020 from https://www. channelnewsasia.com/news/singapore/higher-dengue-risk-529-cases-last-week-nea-12745924

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Spraying to control mosquitoes in the Dominican Republic

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Key facts

• Chikungunya is a disease transmitted to humans by mosquitoes in Africa, Asia, and the Americas; sporadic outbreaks have been reported in other regions.
• Dengue and Zika have similar symptoms to chikungunya, making chikungunya easy to misdiagnose.
• Chikungunya causes fever and severe joint pain, which is often debilitating and varies in duration; other symptoms include joint swelling, muscle pain, headache, nausea, fatigue and rash.
• There is currently no approved vaccine or specific treatment for chikungunya virus infections.
• Due to the challenges in reporting and diagnosis, the number of people affected by chikungunya is underestimated.
• Severe symptoms and deaths from chikungunya are rare and usually related to other coexisting health problems.

Overview

Chikungunya is a mosquito-borne viral disease caused by the chikungunya virus (CHIKV), an RNA virus in the alphavirus genus of the family Togaviridae. The name chikungunya derives from a word in the Kimakonde language, meaning “to become contorted”.

Distribution and outbreaks

CHIKV was first identified in the United Republic of Tanzania in 1952 and subsequently  in other countries Africa and Asia (1). Urban outbreaks were first recorded in Thailand in 1967 and in India in the 1970s (2). Since 2004, outbreaks of CHIKV have become more frequent and widespread, caused partly due to viral adaptations allowing the virus to be spread more easily by Aedes albopictus mosquitoes. CHIKV has now been identified in over 110 countries in Asia, Africa, Europe and the Americas. Transmission has been interrupted on islands where a high proportion of the population is infected and then immune; however, transmission often persists in countries where large parts of the population have not yet been infected.

All regions with established populations of Aedes aegypti or Aedes albopictus mosquitoes have now experienced local mosquito-borne transmission.

Transmission

Chikungunya virus is transmitted by mosquitoes, most commonly Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus, which can also transmit dengue and Zika viruses. These mosquitoes bite primarily during daylight hours. They lay eggs in containers with standing water. Both species feed outdoors, and Ae. aegypti also feeds indoors.

When an uninfected mosquito feeds on a person who has CHIKV circulating in their blood, the mosquito can ingest the virus. The virus then replicates in the mosquito over several days, gets to its salivary glands, and can be transmitted into a new human host when the mosquito bites them. The virus again begins to replicate in this newly infected person and reaches high concentrations in their blood, at which point they can further infect other mosquitoes and perpetuate the transmission cycle.

Symptoms

In symptomatic patients, CHIKV disease onset is typically 4–8 days (range 2–12 days) after the bite of an infected mosquito. It is characterized by an abrupt onset of fever, frequently accompanied by severe joint pain. The joint pain is often debilitating and usually lasts for a few days but may be prolonged, lasting for weeks, months or even years. Other common signs and symptoms include joint swelling, muscle pain, headache, nausea, fatigue and rash. Since these symptoms overlap with other infections, including those with dengue and Zika viruses, cases can be misdiagnosed. In the absence of significant joint pain, symptoms in infected individuals are usually mild and the infection may go unrecognized.

Most patients recover fully from the infection; however, occasional cases of eye, heart, and neurological complications have been reported with CHIKV infections. Patients at extremes of the age spectrum are at higher risk for severe disease. Newborns infected during delivery and older people with underlying medical conditions may become severely ill and CHIKV infection can increase the risk of death.

Once an individual is recovered, available evidence suggests they are likely to be immune from future infections (4).

Diagnostics

Chikungunya virus may be detected directly in blood samples collected during the first week of illness using tests such as reverse transcriptase–polymerase chain reaction (RT–PCR).

Other tests can detect a person’s immune response to chikungunya virus infection. These are typically used after the first week of infection to test for antibodies to the virus. The antibody levels are typically detectable by the first week after illness onset and can still be detected for about 2 months.  

Treatment and vaccines

The clinical management includes addressing fever and joint pain with anti-pyretics and optimal analgesics, drinking plenty of fluids and general rest. There is no specific antiviral drug treatment for CHIKV infections.

Paracetamol or acetaminophen are recommended for pain relief and reducing fever until dengue infections are ruled out, as non-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk of bleeding.

While there are several vaccines currently in different stages of development (as of Dec 2022) they are yet to be licensed. There is no commercial vaccine available to protect against chikungunya virus infection.

Prevention and control 

Prevention of infection by avoiding mosquito bites is the best protection. Patients suspected of having CHIKV infection should avoid getting mosquito bites during the first week of illness to prevent further transmission to mosquitoes, who may in turn infect other people. 

The main method to reduce transmission of CHIKV is through control of the mosquito vectors. This requires mobilization of communities, who are critical in reducing mosquito breeding sites through emptying and cleaning containers that contain water on a weekly basis, disposing of waste, and supporting local mosquito control programmes.

During outbreaks, insecticides may be sprayed to kill flying adult mosquitoes, applied to surfaces in and around containers where the mosquitoes land, and used to treat water in containers to kill the immature larvae. This may also be performed by health authorities as an emergency measure to control the mosquito population.

For protection during outbreaks of chikungunya, clothing which minimizes skin exposure to the day-biting vectors is advised. Window and door screens should be used to prevent mosquitoes from entering homes. Repellents can be applied to exposed skin or to clothing in strict accordance with product label instructions. Repellents should contain DEET, IR3535 or icaridin. 

Insecticide-treated mosquito nets should be used against day-biting mosquitoes by persons who sleep during the daytime, for example young children, sick patients or older people.

People travelling to areas of active CHIKV transmission should apply basic precautions including the use of insect repellents, wearing long sleeves and pants and ensuring rooms are fitted with screens to prevent mosquitoes from entering.

WHO response

WHO supports countries to conduct surveillance and control of arboviruses through the implementation of the Global Arbovirus Initiative.

WHO responds to chikungunya in the following ways:

• supporting countries in the confirmation of outbreaks through its collaborating network of laboratories;
• providing technical support and guidance to countries for the effective management of mosquito-borne disease outbreaks;
• reviews the development of new tools, including insecticide products and application technologies;
• formulating evidence-based strategies, policies and outbreak management plans;
• providing technical support and guidance to countries for the effective management of cases and outbreaks;
• supporting countries to improve their reporting systems;
• providing training on clinical management, diagnosis and vector control at the regional level with some of its collaborating centres;
• publishing guidelines and handbooks on epidemiological surveillance, laboratory, clinical case management and vector control for Member States; and
• advancing integrated multidisciplinary approaches across arboviral diseases through the implementation of the Global Arbovirus Initiative.

WHO encourages countries to develop and maintain the capacity to detect and confirm cases, manage patients and implement social communication strategies to reduce the presence of the mosquito vectors.

 

References 

1. Staples JE, Breiman RF, Powers AM. Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clin Infect Dis. 2009;49(6):942-948. doi:10.1086/605496
2. Wimalasiri-Yapa BMCR, Stassen L, Huang X, et al. Chikungunya virus in Asia – Pacific: a systematic review. Emerg Microbes Infect. 2019;8(1):70-79. doi:10.1080/22221751.2018.1559708
3. Russo G., et al., Chikungunya fever in Africa: a systematic review. Pathog Glob Health. 2020;114(3):136-144. doi:10.1080/20477724.2020.1748965
4. Auerswald H, Boussioux C, In S, et al. Broad and long-lasting immune protection against various Chikungunya genotypes demonstrated by participants in a cross-sectional study in a Cambodian rural community. Emerg Microbes Infect. 2018;7(1):13.
5. Pan American Health Organization Preparedness and Response for Chikungunya Virus: Introduction in the Americas Washington, D.C.

Second WHO model list of essential in vitro diagnostics

 

 

New troubles for Russians in Thailand: suspected of spreading dengue fever

14.03.2023 at 10:16

Society

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The tropical paradise beloved by Russians seems to have begun a serious campaign for the survival of our long-steers, which even included the local fauna. In Russian-language chats devoted to rest and wintering in Tai, every day, there is unpleasant news – either “visa-driver” roundups, or exotic ailments with frightening symptoms.

Photo: Global Look Press

According to the Thai press, another guest from the Russian Federation was arrested on the Thai island of Koh Phangan for an expired visa. The violator was detained while buying groceries in a supermarket, now he is waiting in Thai dungeons to first appoint the amount of the fine by the court, and then deportation to his homeland. The police of the Kingdom of Siam reports that things are getting better in catching foreign “illegals”: since the beginning of the year, they have managed to detain several guests from Russia with visa violations, as well as driving cars and mopeds without a driver’s license at all or with rights issued in the Russian Federation, which are in Thailand not valid.

– Visaran (travel outside the country to extend a visa. – Auth. ) is a costly event, even if the bus is only to the border and back, our winterers from Koh Phangan explain. – And so that there is no delay, you can go every 45 days, they do not renew on the spot. The rights issued in the Russian Federation do not suit them even for a bike, and it is impossible to get local ones, only to buy, which again is expensive. They put cars with scanners at the entrance to budget supermarkets that read the faces and license plates of the rented vehicles.

Russian Pangans secretly admit that they have already figured out how to cover their face and number to protect themselves from the Thai recognition system, but here is a new misfortune – dengue.

– I caught a cold here, the air conditioner in the bus blew, – shares a Russian-speaking panganka. – I came to the pharmacy for aspirin, and they shy away. They say your eyes are red, it’s dengue, aspirin will kill you. Go to the doctor. I went, money for PCR was ripped off, dengue was not found. But they said I was at risk. Like all foreigners who live in Thailand for a long time, and not in hotels, but in the private sector. Like, the Thais themselves are accustomed, but they spread people like me – not accustomed.

Meanwhile, in the Krasnoyarsk Territory, according to the region’s chief sanitary doctor, the 5th case of tropical dengue fever has been recorded since the beginning of the year, in all cases brought by tourists who returned from Thai resorts. At the same time, the Thai Department of Disease Control sounded the alarm about the outbreak of dengue at the beginning of summer: then the situation in Bangkok was stabilized, and the epicenter of the infection moved to the resort of Phuket, where it took on tourists. At this, the Thai health authorities fell silent, passing the word to their tourism industry, and she limited herself to a reminder that guests should go outside in closed clothes (in Thai resorts in winter up to +30 heat, not to mention the summer season), sleep under an anti-mosquito netting and do not use deodorants, shower gels and soaps (!), since it is their smells that attract killer mosquitoes. And since the implementation of these tips in the sweltering heat turns a Thai vacation into a very dubious pleasure, the “reminder” was soon edited so that it became clear: the better (more expensive) your hotel, the more protected you are from dengue.

– Many cases of dengue? – I ask a question directly in the medical office in Phuket Patong (something like a mini-clinic where you can take tests, get first aid and referral to the hospital).

– There are cases, but if you are talking about tourists, most do not even understand what they are sick with, thinking they have a cold, – the Thai doctor answers. – Dengue is detected by a PCR test, it costs money, so no one is in a hurry to do it. And the symptoms are similar to a cold or flu: a week of ailments, of which 3-4 days are high fever, runny nose, redness of the eyes and pain in them, pain in the joints and muscles, sometimes a rash. And after 7-9days passes by itself, there is no special treatment.

– And we are told that this is one of the most dangerous tropical fevers! And how do you know that there are cases, since no one goes to the tests ?!

– Severe dengue occurs only in those who are infected with different types of dengue virus, and there are only 4 of them. The first time always occurs in the usual flu-like form and forms immunity for a period of about 2 years. The other three forms of the disease, more rare, give immunity for up to 3 months. That is, in order for a person to get the most severe and dangerous – hemorrhagic – form of dengue, he must be ill with all 4 types, and then become infected again, and the most rare form. It is clear that under such conditions, only locals or foreigners living in Thailand for a long time can have a severe form, and somewhere near stagnant water, next to garbage that is not disposed of for a long time.

– Do you survive? – I ask Russian winterers from the Thai islands, believing that it is they who are attracted to “dengue-mosquitoes”, as well as “visa-driver” raids – living in bungalows, and even in the houses of Thais on the edge of the jungle, teeming with “killer insects” , and household waste, even in the heat, is taken out no more than once a day. All the same, Thai resorts, except for a modest rent for a bungalow and a bike, have no benefit: they don’t spend money, otherwise they work illegally.

“They want to promote us at least for a PCR test,” a Russian-speaking pangan woman comments on condition of anonymity. – Like, now you can’t get sick without an analysis, otherwise suddenly dengue and you will spread the infection for 10 days.

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Authors:

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90,000 Five Novosibirsk citizens traveling abroad were diagnosed with Dengue fever

Komsomolskaya Pravda

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Society

Anastasia Khromykh

June 21, 2023 5:19

One person contracted malaria

P Five residents of the Novosibirsk region who traveled abroad caught dengue fever. Photo: Maria LENTS

Five residents of the Novosibirsk region who traveled abroad caught dengue fever. This was reported in the regional Rospotrebnadzor.

– During the past period of 2023, five cases of dengue fever and one case of malaria were detected in citizens who visited foreign countries, the publication says.

Dengue fever is an acute viral infection transmitted by blood-sucking insects. The illness lasts an average of two to seven days. Among the main symptoms are fever, muscle and joint pain, weakness, nausea, in some cases a rash appears on the body.

Last year there were four imported cases of malaria, three cases of dengue fever, and six cases of acute intestinal infections.

In order not to spoil your holiday, Rospotrebnadzor advised you to take precautions. So, it is worth drinking only clean water, thoroughly washing fruits and vegetables, eating only proven food and not experimenting with exotic products.

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