Remember DENGUE is a

• Infected mosquitoes spread dengue from person to person. • Children and the elderly are at high risk. • There are 4 types called 1, 2, 3, & 4 . • Only one virus can make you sick at a time. • Multiple dengue infections can kill you with a severe bleeding . • People carry a dengue virus for life. • Symptom supportive care. • Dengue infections should receive nursing support care for fatigue, , dehydration, headache, body aches, and rest. • Dengue infection should be confirmed with a specific lab test. • Skilled nursing care is critical for Dengue Hemorrhagic Fever. • Dengue Shock Syndrome requires hospitalization. DENGUE Don’t Take It Home Awareness & Prevention Did you know.... Dengue is under-reported since flu-like symptoms mimic , , and Malaria. When you travel, you can be a human carrying FOR MISSION TRIPS dengue back home.

How? If you were both infected in a Dengue prone areas (see map) and infectious, a dengue free can bite you at home and you can start the dengue cycle!

Resources for Mission TravelERS Global Websites AUTHOR Church Volunteers CDC Travelers’ Health Website Eurosurveillance - Gettie Audain, DHSc, MPH, BSN, RN Medical Mission Teams www.cdc.gov/travel www.eurosurveillance.org [email protected] Student Volunteers Health Information for International Travel Travax EnCompass - www.travax.com DESIGN CDC “Yellow Book” Kristen Dorn - Humanitarian Aid Workers GIDEON - www.gideononline.com www.CameleonDesigns.com International Society of Travel Medicine Health Care Workers www.istm.org International SOS - References www.internationalsos.com International Travel and Health Gubler, D. J. (2011). Dengue, urbanization WHO “Green Book” Medical Advisory Service for Travelers and globalization: The unholy trinity Abroad (MASTA) - www.masta.org of the 21st century [4 Suppl]. Tropical State Department - www.travel.state.gov Medicine and Health, 39(4), 3-11. Armed Forces Medical Intelligence Center World Health Organization - www.afmic.detrick.army.mil Were, F. (2012). The dengue situation in www.who.int/int . Pediatrics and International Child Central Intelligence Agency Health, 32(S1), 18-20. www.cia.gov/cia/publications/factbook What is DENGUE Dengue (pronounced as ‘Den-gay’), is a communicable disease caused by a virus carried by a mosquito. The virus is not contagious it must be transported to humans by the bite of an infected mosquito. symptoms can vary from being unnoticed with no signs, to a fever with fatal bleeding conditions.

The dengue virus is part of the virus family of and genus . Flaviviridae related febrile include West Nile and yellow fever. Infected vectors transmit the virus by biting humans for a blood meal. Den-1 Den-2 Den-3 Den-1 Den-1 Den-1 Den-4 The two main carriers are female Aegypti and Aedes Den-1 Den-2 Den-2 Den-2 Albopictus. The mosquitos grow the virus in their gut. Each mosquito has Den-2 Den-3 Den-3 Den-3 Den-1 Den-3 Den-4 Den-4 different geographic, feeding, and survival habits. Once infected, adult Den-4 Den-4 Den-2 Den-3 DENGUE mosquitos have a lifespan of 2 to 4 weeks and lay virus carrying eggs. Den-4 Awareness & Prevention Den-1 The human of DENGUE Den-2 Infected humans spread the virus to non-infected mosquitos. A Den-3 FOR MISSION TRIPS first-time infection with any one of four virus types gives lifelong Den-4 protection. A second infection with any of the other 3 virus types can make you experience severe bleeding. The very young and elderly are more likely to be very sick. People with African ancestry show Yellow: Mild more resistance to severe dengue, yet lately, dengue infections are Orange: Moderate increasing in this population. WordPress.com - Creative Commons Sharealike license Red: Severe

Mosquito photos courtesy of Centers for Disease Control and Prevention, Atlanta, Georgia.

There are four genetically different serotypes; DENV 1, 2, 3, & 4. vector Each virus type can cause severe disease. Dengue hemorrhagic fever is a Originated from West Africa. Worldwide primary Known as the Asian tiger mosquito. First travel to complication of the disease that can be fatal. Dengue shock syndrome follows as dengue vector. A carrier for the West Nile virus, yellow United States via ship of trade to Texas in 1985. Infected the most severe type if experienced without supportive care. In Africa, the Aedes fever, and virus. Prefers standing water eggs spread from Asia to Africa, the Americas, Europe species are A. aegypti, A. albopictus, A. africanus, and A. luteocephalus Each near people to lay eggs. Sneaky daytime biters. Female and Texas, USA by the international trade of tires. A type of mosquito has different geographic, feeding, and survival habits. Once prefers to feed on humans for a blood meal to produce very adaptable vector for dengue, yellow fever, west infected, mosquitos remain infected for their entire life, passing the virus to eggs. infected eggs. Bites inside homes and outside in crowded areas. Nile, and chikungunya. Larvae eggs adapted to a little bit of water and shares A. aegypti larvae. Mostly an outside garden mosquito. Aggressive biter. Prefers types of DENGUE water-filled containers around outside of households. Days of Illness 1 2 3 4 5 6 7 8 9 10

40° C - Sudden-onset Fever Temperature - Headache - Low Blood Pressure - Stable Vital Signs - Mouth and Nose Bleeding - Excess Lung Fluid Febrile critical - Excess Recovery - Bleeding Stops Shock Reabsorption - Muscle and Joint Pains Symptoms of DENGUE - Improved Appetite Bleeding Fluid Overload - Vomiting Abdominal Fluid Potential Clinical Issues Organ Phase Phase Phase - Sense of Well Being Dehydration - Gastrointestinal Impairment - Rash - Diarrhea Bleeding

Platelets Laboratory Changes Hematocrit Who is at Risk for Viraemia IgG / IgM Serology and Virology Personal protection is the Key! 3. Skin: Lather your exposed skin with repellent • Dengue Hemorrhagic Fever has high lotion like DEET. Repellents & Insecticides DENGUE rates of illness and death. 4. Clothing: Cover all exposed skin with Clothing & Skin: Use materials containing • repellent treated clothing. Everyone, since mosquitoes are • Affordable blood lab tests don’t specify DEET (N-diethyl-m-toluamide), Picaridin. Febrile Critical Recovery 5. Night time: Use repellent treated nets to all around. Urban mosquitoes are Phases of Illness virus types or if the infection is primary Patio Insecticides ( and cover the bed completely. aggressive and bite multiple people. or secondary. Repellent): Permethrin. 6. Barriers: Buildings should be tightly screened Non-natives have less natural resistance. • Dengue is often under-reported since its • Primary infections should receive Barriers and sealed to prevent mosquitoes from flu-like symptoms often look like West support care for fever, dehydration, • Bed Nets (DEET impregnated), long entering. How do i headache, body aches, and rest. Children First-time infections can be Nile Virus, Yellow Fever and Malaria. sleeve shirts and pants. 7. Police the area: All water breeding sources should be treated or drained. disabling or fatal. The for Yellow Fever is not • Primary infection should be confirmed Seal buildings and repair screens. TREAT / PREVENT • • 8. Police the area: Contain your garbage, drain treatment for dengue. with a specific lab test. your cans. Elderly Secondary infections are DENGUE • The drugs to prevent Malaria are not for • DHF may require skilled nursing care. Don’t TAKE IT HOME….Think Prevention! 9. Police the area: Cover all rain barrels with often fatal. dengue. • DSS requires hospitalization. 1. Use repellents, insecticides, & barriers. screens or lids. 2. When: Protect your skin from bites morning, 10. Police the area: Look for beverage cans and There are no drugs or for What Do I Need To Know? • noon, and night, use a repellent often. bottles as trash outside & help to clean up! Travelers Usually diagnosed by lab dengue, only prevention! tests upon returning home.