Dengue and Yellow Fever

Total Page:16

File Type:pdf, Size:1020Kb

Dengue and Yellow Fever GBL42 11/27/03 4:02 PM Page 262 CHAPTER 42 Dengue and Yellow Fever Dengue, 262 Yellow fever, 265 Further reading, 266 While the most important viral haemorrhagic tor (Aedes aegypti) as well as reinfestation of this fevers numerically (dengue and yellow fever) are insect into Central and South America (it was transmitted exclusively by arthropods, other largely eradicated in the 1960s). Other factors arboviral haemorrhagic fevers (Crimean– include intercontinental transport of car tyres Congo and Rift Valley fevers) can also be trans- containing Aedes albopictus eggs, overcrowding mitted directly by body fluids. A third group of of refugee and urban populations and increasing haemorrhagic fever viruses (Lassa, Ebola, Mar- human travel. In hyperendemic areas of Asia, burg) are only transmitted directly, and are not disease is seen mainly in children. transmitted by arthropods at all. The directly Aedes mosquitoes are ‘peri-domestic’: they transmissible viral haemorrhagic fevers are dis- breed in collections of fresh water around the cussed in Chapter 41. house (e.g. water storage jars).They feed on hu- mans (anthrophilic), mainly by day, and feed re- peatedly on different hosts (enhancing their role Dengue as vectors). Dengue virus is numerically the most important Clinical features arbovirus infecting humans, with an estimated Dengue virus may cause a non-specific febrile 100 million cases per year and 2.5 billion people illness or asymptomatic infection, especially in at risk.There are four serotypes of dengue virus, young children. However, there are two main transmitted by Aedes mosquitoes, and it is un- clinical dengue syndromes: dengue fever (DF) usual among arboviruses in that humans are the and dengue haemorrhagic fever (DHF). natural hosts. Dengue fever (‘breakbone fever’) has been around for many hundreds of years; Dengue fever dengue haemorrhagic fever (DHF) emerged as This is a classical fever–arthralgia–rash syn- an apparently new disease in South East Asia in drome (Chapter 40), with retro-orbital pain, the 1950s. photophobia, lymphadenopathy and, in about 50% of patients, a rash. This is usually macu- Epidemiology lopapular, but may be mottling or flushing. In Dengue has spread dramatically since the end of addition, there may be petechiae and other World War II, in what has been described as a bleeding manifestations including gum, nose or global pandemic. Virtually every country be- gastrointestinal haemorrhage, but these do not tween the tropics of Capricorn and Cancer is define it as DHF according to WHO criteria— now affected (Fig. 42.1). see below (Table 42.1).About one-third of pa- Factors implicated in the spread of dengue tients have a positive tourniquet test (a blood viruses include poor control of its principal vec- pressure cuff inflated to half way between 262 GBL42 11/27/034:02PMPage263 DISTRIBUTION OF DENGUEDISTRIBUTION AND YELLOW OF FEVER LTMPHATIC FILARIASIS Key Dengue Yellow fever Dengue 263 Fig. 42.1 Map showing the approximate distribution of dengue and yellow fever viruses. GBL42 11/27/03 4:02 PM Page 264 264 Chapter 42: Dengue and Yellow Fever DISTINGUISHING DF FROM DHF Plasma Platelets Circulatory Haemorrhagic leakage* (/µL) collapse manifestations DF No Variable Absent Variable DHF I Present < 100 000 Absent Positive tourniquet test (or easy bruising) DHF II Present < 100 000 Absent Spontaneous bleeding† with or without positive tourniquet test DHF III Present < 100 000 PP < 20 mmHg‡ Spontaneous bleeding and/or positive tourniquet test DHF IV Present < 100 000 Pulse and BP Spontaneous bleeding and/or undetectable positive tourniquet test BP,blood pressure; DF,dengue fever; DHF,dengue haemorrhagic fever; PP,pulse pressure. * Identified by haematocrit 20% above normal, or clinical signs of plasma leakage. † Skin petechiae, mucosal or gastrointestinal bleeding. ‡ Pulse pressure less than 20 mmHg, or hypotension for age. Table 42.1 World Health Organization criteria for or lethargic, and often have tender hepatomegaly distinguishing dengue fever (DF) and dengue or abdominal pain. haemorrhagic fever (DHF) grades I–IV.DHF grades III and IV are collectively known as dengue shock syndrome (DSS). DIFFERENTIAL DIAGNOSIS OF DENGUE systolic and diastolic pressure for 5min pro- duces 20 or more petechiae in a 2.5-cm square Fever with arthralgia or rash on the forearm). • Arboviruses: Chikungunya, O’nyong nyong, sindbis,West Nile, Ross River, Oropouche, sandfly fevers, Colorado tick fever. Dengue hemorrhagic fever • Other viruses: rubella, measles, herpes, Initially,patients have a non-specific febrile illness, enteroviruses. which may include a petechial rash.Then on the • Bacteria: meningococcus, typhoid. third to seventh day of illness, as the fever sub- • Spirochaetes: leptospirosis, Lyme disease, sides, there is a massive increase in vascular per- relapsing fevers. meability (this is the major pathophysiological • Rickettsiae: tick and endemic typhus, Rocky process). This leads to plasma leakage from the Mountain spotted fever. • Parasites: malaria. blood vessels into the tissue, causing an elevated haematocrit, oedema and effusions. In addition, Fever with haemorrhage there is thrombocytopenia and haemorrhagic • Arboviruses: yellow fever, Crimean–Congo manifestations. If a positive tourniquet test is the haemorrhagic fever, Rift Valley fever, Omsk only such manifestation, then this is defined as haemorrhagic fever. DHF grade I (Table 42.1). If there is spontaneous • Other viruses: hantaviruses, fulminant hepatitis (A–E); Lassa; South American bleeding this is grade II. In grade III, the plasma haemorrhagic fevers, Ebola, Marburg. leakage is sufficient to cause shock (defined in •Any severe sepsis with disseminated children as a pulse pressure <20mmHg). In grade intravascular coagulation (DIC). IV, the blood pressure is unrecordable. Collec- • Drug reactions. tively,grades III and IV are known as dengue shock syndrome (DSS). Patients with DHF are restless Box 42.1 Differential diagnosis of dengue. GBL42 11/27/03 4:02 PM Page 265 Yellow fever 265 Investigations 2 Viral strain differences — e.g. increased viru- Leucopenia and thrombocytopenia are com- lence of South-East Asian strains of dengue-2 mon. In the first few days of illness dengue virus virus. can be isolated from serum or detected by poly- merase chain reaction (PCR). After the fever Prevention subsides, IgM and then IgG antibodies can be de- Prevention is by control of Aedes mosquitoes. tected by ELISA. New enzyme immunoassay Methods include treating stored water with lar- kits allow rapid diagnosis in the field. A lateral vicides (e.g. temephos), educating people to re- chest X-ray may show a pleural effusion in DHF. move collections of water around the house (e.g. in rubbish), and spraying with insecticide Management during epidemics. Dengue fever Future developments include tetravalent Most cases are self-limiting. Oral fluids should vaccines (effective against all four dengue be encouraged, and paracetamol given. Patients serotypes), which are in development, for ex- may have a maculopapular recovery rash and ample, live attenuated vaccines and recombi- prolonged lethargy and depression after recov- nant copy DNA infectious clone vaccines. ery are common. Dengue haemorrhagic fever Ye llow fever For grades I and II DHF,oral fluids should be en- couraged, vital signs closely monitored, as well Epidemiology as haematocrit and platelet count, which may Yellow fever virus is naturally transmitted warn of deterioration to grades III and IV. For between primates by various mosquitoes in jun- grades III and IV (dengue shock syndrome), cen- gle cycles in Central America and Africa (Fig. tral venous pressure (CVP) should be moni- 42.1). Aedes aegypti transmits the virus to tored if possible. Intravenous crystalloid (10– humans in urban cycles. The disease has re- 20mL/kg/h)should be given, followed by intra- emerged in South America since the 1970s, venous colloid if shock persists. Patients should when the Aedes eradication programme was re- be watched carefully for fluid overload, and infu- laxed. There are an estimated 200000 cases, sions reduced accordingly. with 30000 deaths annually. Other severe manifestations of Clinical features dengue infection The illness is biphasic and often mild. Severe These include hepatitis, or fulminant hepatic disease is characterized by jaundice, fulminant failure (Reye-like syndrome) as well as neuro- hepatic failure and gastrointestinal bleeding. logical complications (metabolic encephalopa- Faget’s sign is the failure of the heart rate to in- thy, cerebral oedema or, occasionally, viral crease with a rising temperature and is indica- encephalitis). tive of cardiac damage. Elevated liver function tests, leucopenia, thrombocytopenia and clot- Pathogenesis of dengue ting abnormalities may occur.Liver histology re- haemorrhagic fever veals Councilman bodies, which also occur in Current evidence suggests two mechanisms Crimean–Congo haemorrhagic fever and Rift may be important: Valley fever. 1 Antibody-dependent enhancement — antibod- ies against one dengue virus serotype (from a Control previous infection) enhance the entry of a sec- Yellow fever control consists of use of the ond dengue virus into macrophages, leading to a highly effective 17D live attenuated vaccine. more severe infection. Vector control is as for dengue fever. GBL42 11/27/03 4:02 PM Page 266 266 Chapter 42: Dengue and Yellow Fever flaviviruses. J Infect 2001; 42: 104–15. [Includes im- Further reading portant tick-borne viruses.] World Health Organization. Dengue Haemorrhagic Gibbons RV, Vaughan DW. Dengue—an escalating Fever: Diagnosis, Treatment and Control. Geneva: problem. Br Med J 2002; 324: 1563–6. World Health Organization, 1997. [Very useful Solomon T, Mallewa MJ. Dengue and other emerging manual on dengue haemorrhagic fever.].
Recommended publications
  • Arizona Arboviral Handbook for Chikungunya, Dengue, and Zika Viruses
    ARIZONA ARBOVIRAL HANDBOOK FOR CHIKUNGUNYA, DENGUE, AND ZIKA VIRUSES 7/31/2017 Arizona Department of Health Services | P a g e 1 Arizona Arboviral Handbook for Chikungunya, Dengue, and Zika Viruses Arizona Arboviral Handbook for Chikungunya, Dengue, and Zika Viruses OBJECTIVES .............................................................................................................. 4 I: CHIKUNGUNYA ..................................................................................................... 5 Chikungunya Ecology and Transmission ....................................... 6 Chikungunya Clinical Disease and Case Management ............... 7 Chikungunya Laboratory Testing .................................................. 8 Chikungunya Case Definitions ...................................................... 9 Chikungunya Case Classification Algorithm ............................... 11 II: DENGUE .............................................................................................................. 12 Dengue Ecology and Transmission .............................................. 14 Dengue Clinical Disease and Case Management ...................... 14 Dengue Laboratory Testing ......................................................... 17 Dengue Case Definitions ............................................................ 19 Dengue Case Classification Algorithm ....................................... 23 III: ZIKA ..................................................................................................................
    [Show full text]
  • Dengue Fever and Dengue Hemorrhagic Fever (Dhf)
    DENGUE FEVER AND DENGUE HEMORRHAGIC FEVER (DHF) What are DENGUE and DHF? Dengue and DHF are viral diseases transmitted by mosquitoes in tropical and subtropical regions of the world. Cases of dengue and DHF are confirmed every year in travelers returning to the United States after visits to regions such as the South Pacific, Asia, the Caribbean, the Americas and Africa. How is dengue fever spread? Dengue virus is transmitted to people by the bite of an infected mosquito. Dengue cannot be spread directly from person to person. What are the symptoms of dengue fever? The most common symptoms of dengue are high fever for 2–7 days, severe headache, backache, joint pains, nausea and vomiting, eye pain and rash. The rash is frequently not visible in dark-skinned people. Young children typically have a milder illness than older children and adults. Most patients report a non-specific flu-like illness. Many patients infected with dengue will not show any symptoms. DHF is a more severe form of dengue. Initial symptoms are the same as dengue but are followed by bleeding problems such as easy bruising, skin hemorrhages, bleeding from the nose or gums, and possible bleeding of the internal organs. DHF is very rare. How soon after exposure do symptoms appear? Symptoms of dengue can occur from 3-14 days, commonly 4-7 days, after the bite of an infected mosquito. What is the treatment for dengue fever? There is no specific treatment for dengue. Treatment usually involves treating symptoms such as managing fever, general aches and pains. Persons who have traveled to a tropical or sub-tropical region should consult their physician if they develop symptoms.
    [Show full text]
  • Communicable Disease Toolkit Liberia
    WHO/CDS/2004.24 COMMUNICABLE DISEASE TOOLKIT LIBERIA 1. COMMUNICABLE DISEASE PROFILE World Health Organization 2004 Communicable Disease Working Group on Emergencies, WHO/HQ The WHO Regional Office for Africa (AFRO) WHO Office, Liberia © World Health Organization 2004 All rights reserved. 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. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Further information is available at: CDS Information Resource Centre, World Health Organization, 1211 Geneva 27, Switzerland; fax: (+41) 22 791 4285, e-mail: [email protected] Communicable Disease Toolkit for LIBERIA 2004: Communicable Disease Profile. ACKNOWLEDGMENTS Edited by Dr Michelle Gayer, Dr Katja Schemionek, Dr Monica Guardo, and Dr Máire Connolly of the Programme on Communicable Diseases in Complex Emergencies, WHO/CDS. This Profile is a collaboration between the Communicable Disease Working Group on Emergencies (CD-WGE) at WHO/HQ, the Division of Communicable Disease Prevention and Control (DCD) at WHO/AFRO and the Office of the WHO Representative for Liberia.
    [Show full text]
  • Dengue Fact Sheet
    State of California California Department of Public Health Health and Human Services Agency Division of Communicable Disease Control Dengue Fact Sheet What is dengue? Dengue is a disease caused by any one of four closely related dengue viruses (DENV- 1, DENV-2, DENV-3, and DENV-4). Where does dengue occur? Dengue occurs in many tropical and sub-tropical areas of the world, particularly sub- Saharan Africa, the Middle East, Southeast Asia, and Central and South America. With the exception of Mexico, Puerto Rico, small areas in southern Texas and southern Florida, and some regions of Hawaii, dengue transmission does not occur in North America. Worldwide there are an estimated 50 to 100 million cases of dengue per year. How do people get dengue? People get dengue from the bite of an infected mosquito. The mosquito becomes infected when it bites a person who has dengue virus in their blood. It takes a week or more for the dengue organisms to mature in the mosquito; then the mosquito can transmit the virus to another person when it bites. Dengue is transmitted principally by Aedes aegypti (yellow fever mosquito) and Aedes albopictus (Asian tiger mosquito). These mosquitoes are not native to California, but infestations have been identified in multiple counties in California. Dengue virus cannot be transmitted from person to person. What are the symptoms of dengue? There are two types of illness that can result from infection with a dengue virus: dengue and severe dengue. The main symptoms of dengue are high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash, bruising, and may include mild bleeding from the nose or mouth.
    [Show full text]
  • Your Child Or Family Member May Have Dengue Fever According to Their Clinical History and Physical Examination
    Your child or family member may have dengue fever according to their clinical history and physical examination. If it is dengue, serious complications of the disease can develop. If the complications are recognized early, and a doctor is consulted, it may save the patient’s life. Your doctor can order more tests to see if the patient needs to be hospitalized. The doctor can also order specific tests for dengue, but those tests will take longer than a week for the results to come back. How to Care for the Patient While They Have a Fever: Bed rest. Let patient rest as much as possible. Control the fever. Give acetaminophen or paracetamol (Tylenol) every 6 hours (maximum 4 doses per day). Do not give ibuprofen (Motrin, Advil) aspirin, or aspirin containing drugs. Sponge patient’s skin with cool water if fever stays high. Prevent dehydration which occurs when a person loses too much fluid (from high fevers, vomiting, or poor oral intake). Give plenty of fluids and watch for signs of dehydration. Bring patient to clinic or emergency room if any of the following signs develop: Decrease in urination (check number of wet diapers or trips to the bathroom) Few or no tears when child cries Dry mouth, tongue or lips Sunken eyes Listlessness or overly agitated or confused Fast heart beat (more than 100/min) Cold or clammy fingers and toes Sunken fontanel in infant DO WHILE THE PATIENT HAS FEVER DO WHILE THE PATIENT Prevent spread of dengue within your house. Place patient under bed net or use insect repellent on the patient while they have a fever.
    [Show full text]
  • Medical Management of Biological Casualties Handbook
    USAMRIID’s MEDICAL MANAGEMENT OF BIOLOGICAL CASUALTIES HANDBOOK Sixth Edition April 2005 U.S. ARMY MEDICAL RESEARCH INSTITUTE OF INFECTIOUS DISEASES FORT DETRICK FREDERICK, MARYLAND Emergency Response Numbers National Response Center: 1-800-424-8802 or (for chem/bio hazards & terrorist events) 1-202-267-2675 National Domestic Preparedness Office: 1-202-324-9025 (for civilian use) Domestic Preparedness Chem/Bio Helpline: 1-410-436-4484 or (Edgewood Ops Center – for military use) DSN 584-4484 USAMRIID’s Emergency Response Line: 1-888-872-7443 CDC'S Emergency Response Line: 1-770-488-7100 Handbook Download Site An Adobe Acrobat Reader (pdf file) version of this handbook can be downloaded from the internet at the following url: http://www.usamriid.army.mil USAMRIID’s MEDICAL MANAGEMENT OF BIOLOGICAL CASUALTIES HANDBOOK Sixth Edition April 2005 Lead Editor Lt Col Jon B. Woods, MC, USAF Contributing Editors CAPT Robert G. Darling, MC, USN LTC Zygmunt F. Dembek, MS, USAR Lt Col Bridget K. Carr, MSC, USAF COL Ted J. Cieslak, MC, USA LCDR James V. Lawler, MC, USN MAJ Anthony C. Littrell, MC, USA LTC Mark G. Kortepeter, MC, USA LTC Nelson W. Rebert, MS, USA LTC Scott A. Stanek, MC, USA COL James W. Martin, MC, USA Comments and suggestions are appreciated and should be addressed to: Operational Medicine Department Attn: MCMR-UIM-O U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) Fort Detrick, Maryland 21702-5011 PREFACE TO THE SIXTH EDITION The Medical Management of Biological Casualties Handbook, which has become affectionately known as the "Blue Book," has been enormously successful - far beyond our expectations.
    [Show full text]
  • Florida Arbovirus Surveillance Week 13: March 28-April 3, 2021
    Florida Arbovirus Surveillance Week 13: March 28-April 3, 2021 Arbovirus surveillance in Florida includes endemic mosquito-borne viruses such as West Nile virus (WNV), Eastern equine encephalitis virus (EEEV), and St. Louis encephalitis virus (SLEV), as well as exotic viruses such as dengue virus (DENV), chikungunya virus (CHIKV), Zika virus (ZIKV), and California encephalitis group viruses (CEV). Malaria, a parasitic mosquito-borne disease is also included. During the period of March 28- April 3, 2021, the following arboviral activity was recorded in Florida. WNV activity: No human cases of WNV infection were reported this week. No horses with WNV infection were reported this week. No sentinel chickens tested positive for antibodies to WNV this week. In 2021, positive samples from two sentinel chickens has been reported from two counties. SLEV activity: No human cases of SLEV infection were reported this week. No sentinel chickens tested positive for antibodies to SLEV this week. In 2021, no positive samples have been reported. EEEV activity: No human cases of EEEV infection were reported this week. No horses with EEEV infection were reported this week. No sentinel chickens tested positive for antibodies to EEEV this week. In 2021, positive samples from one horse and 14 sentinel chickens have been reported from four counties. International Travel-Associated Dengue Fever Cases: No cases of dengue fever were reported this week in persons that had international travel. In 2021, one travel-associated dengue fever case has been reported. Dengue Fever Cases Acquired in Florida: No cases of locally acquired dengue fever were reported this week. In 2021, no cases of locally acquired dengue fever have been reported.
    [Show full text]
  • Mosquito-Born Dengue Fever Threat Spreading in the Americas
    NRDC Issue Paper July 2009 Fever Pitch Mosquito-Borne Dengue Fever Threat Spreading in the Americas Authors Kim Knowlton, Dr.P.H. Gina Solomon, M.D., M.P.H. Miriam Rotkin-Ellman, M.P.H. Natural Resources Defense Council About NRDC The Natural Resources Defense Council (NRDC) is an international nonprofit environmental organization with more than 1.2 million members and online activists. Since 1970, our lawyers, scientists, and other environmental specialists have worked to protect the world’s natural resources, public health, and the environment. NRDC has offices in New York City, Washington, D.C., Los Angeles, San Francisco, Chicago, Montana, and Beijing. Visit us at www.nrdc.org. Acknowledgments The authors would like to thank Zev Ross and Hollie Kitson of ZevRoss Spatial Analysis, Ithaca, New York, for conducting the mapping, and to Sashti Balasundaram for dengue case data research. Dr. Chester G. Moore of Colorado State University generously provided access to mosquito occurrence data. We would also like to thank Cindy and Alan Horn for their support of NRDC’s Global Warming and Health Project. We are grateful to the following peer reviewers who provided invaluable comments on this report: Chester Moore, Colorado State University; Kristie L. Ebi, ESS, LLC; Joan Brunkard, U.S. Centers for Disease Control and Prevention; Mary Hayden, National Center for Atmospheric Research Institute for the Study of Society and Environment. NRDC Director of Communications: Phil Gutis NRDC Marketing and Operations Director: Alexandra Kennaugh NRDC Publications Director: Lisa Goffredi NRDC Publications Editor: Anthony Clark Production: Jon Prinsky Copyright 2009 by the Natural Resources Defense Council.
    [Show full text]
  • Viral Hemorrhagic Fevers and Bioterrorism
    What you need to know about . Viral Hemorrhagic Fevers and Bioterrorism What are viral hemorrhagic fevers? How are viral hemorrhagic fevers Viral hemorrhagic fevers (VHFs) are a spread? group of illnesses caused by several distinct In nature, viruses causing hemorrhagic fever families of viruses. In general the term typically are passed from mice, rats, fleas “viral hemorrhagic fever” describes severe and ticks to humans. People can be infected problems affecting several organ systems when they come in contact with urine, fecal in the body. Typically, the entire system of ma�er, saliva or other body fluids from blood vessels is damaged, and the body has infected rodents. Fleas and ticks transmit the problems regulating itself. Symptoms o�en viruses when they bite a person or when a include bleeding, but the bleeding itself is person crushes a tick. Hosts for some viruses rarely life-threatening. VHFs are caused by such as Ebola and Marburg are not known. viruses of four families: Some viruses such as Ebola, Marburg and Lassa can be spread from person to person • Arenavirus including Lassa fever and by direct contact with infected blood or Argentine, Bolivian, Brazilian and organs or indirectly through contact with Venezuelan hemorrhagic fevers; objects such as syringes or needles that are • Filovirus including Ebola and Marburg; contaminated with infected body fluids. • Bunyavirus including Hantavirus and Ri� Valley Fever; What are the symptoms? • Flavivirus including yellow fever and Symptoms vary with the different virus dengue fever. families, but first signs o�en include sudden fever, weakness, muscle pain, tiredness, Can viral hemorrhagic fevers be used headache and sore throat.
    [Show full text]
  • Dengue Fever/Severe Dengue Fever/Chikungunya Fever! Report on Suspicion of Infection During Business Hours
    Dengue Fever/Severe Dengue Fever/Chikungunya Fever! Report on suspicion of infection during business hours PROTOCOL CHECKLIST Enter available information into Merlin upon receipt of initial report Review background information on the disease (see Section 2), case definitions (see Section 3 for dengue and for chikungunya), and laboratory testing (see Section 4) Forward specimens to the Florida Department of Health (DOH) Bureau of Public Health Laboratories (BPHL) for confirmatory laboratory testing (as needed) Inform local mosquito control personnel of suspected chikungunya or dengue case as soon as possible (if applicable) Inform state Arbovirus Surveillance Coordinator on suspicion of locally acquired arbovirus infection Contact provider (see Section 5A) Interview case-patient Review disease facts (see Section 2) Mode of transmission Ask about exposure to relevant risk factors (see Section 5. Case Investigation) History of travel, outdoor activities, and mosquito bites two weeks prior to onset History of febrile illness or travel for household members or other close contacts in the month prior to onset History of previous arbovirus infection or vaccination (yellow fever, Japanese encephalitis) Provide education on transmission and prevention (see Section 6) Awareness of mosquito-borne diseases Drain standing water at least weekly to stop mosquitoes from multiplying Discard items that collect water and are not being used Cover skin with clothing or Environmental Protection Agency (EPA)-registered repellent such as DEET (N,N-diethyl-meta-toluamide) Use permethrin on clothing (not skin) according to manufacturer’s directions Cover doors and windows with intact screens to keep mosquitoes out of the house Enter additional data obtained from interview into Merlin (see Section 5D) Arrange for a convalescent specimen to be taken (if necessary) Dengue/Chikungunya Guide to Surveillance and Investigation Dengue Fever/Severe Dengue/Chikungunya 1.
    [Show full text]
  • Combatting Malaria, Dengue and Zika Using Nuclear Technology by Nicole Jawerth and Elodie Broussard
    Infectious Diseases Combatting malaria, dengue and Zika using nuclear technology By Nicole Jawerth and Elodie Broussard A male Aedes species mosquito. iseases such as malaria, dengue and transcription–polymerase chain reaction (Photo: IAEA) Zika, spread by various mosquito (RT–PCR) (see page 8). Experts across the Dspecies, are wreaking havoc on millions of world have been trained and equipped by lives worldwide. To combat these harmful the IAEA to use this technique for detecting, and often life-threatening diseases, experts tracking and studying pathogens such as in many countries are turning to nuclear and viruses. The diagnostic results help health nuclear-derived techniques for both disease care professionals to provide treatment and detection and insect control. enable experts to track the viruses and take action to control their spread. Dengue and Zika When a new outbreak of disease struck in The dengue virus and Zika virus are mainly 2015 and 2016, physicians weren’t sure of spread by Aedes species mosquitoes, which its cause, but RT–PCR helped to determine are most common in tropical regions. In most that the outbreak was the Zika virus and not cases, the dengue virus causes debilitating another virus such as dengue. RT–PCR was flu-like symptoms, but all four strains of the used to detect the virus in infected people virus also have the potential to cause severe, throughout the epidemic, which was declared life-threatening diseases. In the case of the Zika a public health emergency of international virus, many infected people are asymptomatic concern by the World Health Organization or only have mild symptoms; however, the virus (WHO) in January 2016.
    [Show full text]
  • Dengue Fever (Breakbone Fever, Dengue Hemorrhagic Fever)
    Division of Disease Control What Do I Need to Know? Dengue Fever (breakbone fever, dengue hemorrhagic fever) What is Dengue Fever? Dengue fever is a serious form of mosquito-borne disease caused one of four closely related viruses called Flaviviruses. They are named DENV 1, DENV 2, DENV 3, or DENV 4. The disease is found in most tropical and subtropical areas (including some islands in the Caribbean, Mexico, most countries of South and Central America, the Pacific, Asia, parts of tropical Africa and Australia). Almost all cases reported in the continental United States are in travelers who have recently returned from countries where the disease circulates. Dengue is endemic to the U.S. territories of Puerto Rico, the Virgin Islands, and Guam and in recent years non-travel related cases have been found in Texas, Florida, and Hawaii. Who is at risk for Dengue Fever? Dengue fever may occur in people of all ages who are exposed to infected mosquitoes. The disease occurs in areas where the mosquitos that carry dengue circulate, usually during the rainy seasons when mosquito populations are at high numbers. What are the symptoms of Dengue Fever? Dengue fever is characterized by the rapid development of fever that may last from two to seven days, intense headache, joint and muscle pain and a rash. The rash develops on the feet or legs three to four days after the beginning of the fever. Some people with dengue develop dengue hemorrhagic fever (DHF). Symptoms of DHF are characteristic of internal bleeding and include: severe abdominal pain, red patches on skin, bleeding from nose or gums, black stools, vomiting blood, drowsiness, cold and clammy skin and difficulty breathing.
    [Show full text]