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Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever

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Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever C o m p r e h e n s Dengue fever (DF) is the fastest emerging arboviral infection spread by Aedes aegypti i v mosquitoes with major public health consequences for millions of people around the e G world, and in particular the South-East Asia and Asia-Pacific Regions of the World u i Health Organization (WHO). Of the 2.5 billion people globally at risk of DF and its d e severe forms dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) l i n South-East Asia accounts for approximately 1.3 billion or 52%. e s f As the disease spreads to new geographical areas, the frequency of the o r outbreaks has increased along with a rapidly changing disease epidemiology. In P r response to resolution of the Forty-sixth World Health Assembly urging Member e v States to strengthen national programmes for control of DF/DHF, several documents e n were developed by regional offices of WHO, including South-East Asia. t i o In 1999 the WHO Regional Office for South-East Asia published the Regional n a Comprehensive Guidelines for Guidelines for the Prevention and Control of DF/DHF. Since then new strategies and n d developments in the control of dengue fever, DHF and DSS have come to light. The C Regional Guidelines were extensively revised, updated and expanded with the focus o n Prevention and Control of on new and additional topics of current relevance to the populations of Member t r o States of the Region. They were then rechristened the Comprehensive Guidelines for l o the Prevention and Control of Dengue and Dengue Haemmorhagic Fever. f D This revised and expanded edition of the Comprehensive Guidelines is e and n Dengue intended to provide guidance to national and local-level programme managers and g u public health officials of Member States, as well as other stakeholders, including e health practitioners, laboratory personnel and multisectoral partners, on strategic a n planning, implementation, monitoring and evaluation, and strengthening the d Dengue Haemorrhagic Fever D response to dengue prevention and control in their countries. Scientists and e researchers involved in vaccine and antiviral drug development will also find crucial n g baseline information in this document. u e H a e m Revised and expanded edition o r r h a g i c F e v e r R e v i s e d ISBN 978 92 9022 394 8 a n d e x World Health House p a Indraprastha Estate, n Mahatma Gandhi Marg, d e New Delhi-110002, India d Website: www.searo.who.int 9 7 8 9 2 9 0 2 2 3 9 4 8 e d i t i o n Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever Revised and expanded edition WHO Library Cataloguing-in-Publication data World Health Organization, Regional Office for South-East Asia. Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever. Revised and expanded edition. (SEARO Technical Publication Series No. 60) 1. Dengue – epidemiology - prevention and control - statistics and numerical data. 2. Dengue Hemorrhagic Fever – epidemiology - prevention and control – statistics and numerical data. 3. Laboratory Techniques and Procedures – methods. 4. Blood Specimen Collection – methods. 5. Insect Repellents. 6. Guidelines. ISBN 978-92-9022-387-0 (NLM classification: WC 528) © World Health Organization 2011 All rights reserved. Requests for publications, or for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – can be obtained from Publishing and Sales, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India (fax: +91 11 23370197; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. This publication does not necessarily represent the decisions or policies of the World Health Organization. Printed in India Contents Preface .........................................................................................................................vii Acknowledgements ........................................................................................................ix Abbreviations and Acronyms ..........................................................................................xi 1. Introduction ............................................................................................................ 1 2. Disease Burden of Dengue Fever and Dengue Haemorrhagic Fever .........................3 2.1 Global .......................................................................................................... 3 2.2 The WHO South-East Asia Region ............................................................... 5 3. Epidemiology of Dengue Fever and Dengue Haemorrhagic Fever ............................ 9 3.1 The virus ...................................................................................................... 9 3.2 Vectors of dengue .........................................................................................9 3.3 Host ........................................................................................................... 12 3.4 Transmission of dengue virus ...................................................................... 12 3.5 Climate change and its impact on dengue disease burden .......................... 14 3.6 Other factors for increased risk of vector breeding ...................................... 14 3.7 Geographical spread of dengue vectors ...................................................... 15 3.8 Future projections of dengue estimated through empirical models .............. 15 4. Clinical Manifestations and Diagnosis .................................................................... 17 4.1 Clinical manifestations ................................................................................ 17 4.2 Clinical features ..........................................................................................18 4.3 Pathogenesis and pathophysiology ............................................................. 22 4.4 Clinical laboratory findings of DHF ............................................................. 23 4.5 Criteria for clinical diagnosis of DHF/DSS.................................................... 24 4.6 Grading the severity of DHF ....................................................................... 25 4.7 Differential diagnosis of DHF ......................................................................25 Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever iii 4.8 Complications ........................................................................................... 26 4.9 Expanded dengue syndrome (unusual or atypical manifestations) ................27 4.10 High-risk patients ....................................................................................... 27 4.11 Clinical manifestations of DF/DHF in adults ............................................... 28 5. Laboratory Diagnosis ............................................................................................. 31 5.1 Diagnostic tests and phases of disease .........................................................31 5.2 Specimens: Collection, storage and shipment ............................................ 32 5.3 Diagnostic methods for detection of dengue infection ............................... 34 5.4 Immunological response and serological tests ............................................. 37 5.5 Rapid diagnostic test (RDT) ........................................................................39 5.6 Haematological tests ...................................................................................40 5.7 Biosafety practices and waste disposal ........................................................ 40 5.8 Quality assurance ....................................................................................... 40 5.9 Network of laboratories .............................................................................. 40 6. Clinical Management of Dengue/ Dengue Haemorrhagic Fever ............................. 41 6.1 Triage of suspected dengue patients at OPD ............................................... 42 6.2 Management of DF/DHF cases in hospital observation wards/on admission ................................................................................................... 45 7. Disease Surveillance: Epidemiological and Entomological
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