Monograph on Engue/ Den E Haemorrhagic Feve
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we 528 93MO c.2 egional Publication, SEARO No. 22 • Monograph on engue/ Den e Haemorrhagic Feve ,.- ~ - . \ : ' :, . ' I I ~~ ' .•li ,\ frl, · ., ~- I •_. ;. World Health Organization Regional Office for South-East Asia New Delhi Monograph on Dengue/Dengue Haemorrhagic Fever WHO regrets the delay in publishing this monograph. Regional Publication, SEARO No. 22 Monograph on Dengue/ Dengue Haemorrhagic Fever Compiled by Prasert Thongcharoen, MD World Health Organization Regional Office for South-East Asia New Delhi ISBN 92 9022 124 0 © World Health Organization 1993 Pub1ications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation, in part or in toto, of publications issued by the WHO Regional Office for South-East Asia, application should be made to the Regional Office for South-East Asia, World Health House, Indraprastha Estate, New Delhi 110002, India. 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 Secretariat 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. Printed in India CONTENTS Page Preface .................................................................. v Foreword ............................... Vll Authors ................................................................ ix Chapter 1 Epidemiology of Dengue and Dengue Haemorrhagic Fever ..................... 1 1. Dengue haemorrhagic fever and dengue shock syndrome - Introduction, historical and epidemiological background - Prasen Thongcharoen and Sujani Jatanasen . ...... 1 2. Dengue and dengue haemorrhagic fever in the Americas - D.!. Gubler ................................................... 9 3. Dengue haemorrhagic fever in South-East Asian countries- Sujani Jatanasen and Prasen Thongcharoen ......................... 23 4. Epidemiology of dengue in the Western Pacific Region - S.K Lam, T. Pang and T. Umenai ................................ 31 5. Dengue in Africa -Michel Comet . ................................ 39 Chapter 2 Clinical Manifestations of Dengue/Dengue Haemorrhagic Fever - Suchitra Nimmannitya . ......... 48 Chapter 3 Management of Dengue and Dengue Haemorrhagic Fever - Suchitra Nimmannitya ..................................................... 55 Chapter 4 Clinical Laboratory Investigations - Pimpan Leangpibul and Prasert Thongcharoen .................. ..................................... 62 iii Page Chapter 5 Pathology of Dengue Haemorrhagic Fever - Natth Bhamarapravati ........... 72 Chapter 6 Pathophysiology and Pathogenesis of Dengue Haemorrhagic Fever - Scott B. Halstead . .......... 80 Chapter 7 Dengue Viruses - Prasert Thongcharoen, Chantapong Wasi and Pilaipan Puthavathana . ............................................... 104 Chapter 8 Vector Ecology and Bionomics- C.P. Pant and L.S. Self..................... 121 Chapter 9 Vector Control and Intervention - Yang H Bang and Robert J. Tonn ......... 139 Chapter 10 Dengue Vaccine Development- Natth Bhamarapravati ..................... 161 iv Preface DENGUE virus infections are signif~eant causes of morbidity and mortality in many areas ofthe world, including South-East Asia and Central and South America. The dengue virus is believed to cause two forms of clinical syndrome, namely classical dengue fever and dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS). Dengue fever is a self-limiting disease and represents the majority of cases of dengue infection. In some situations it manifests life-threatening syndromes, such as the haemorrhagic and shock syndrome, which is generally known as DHF/DSS. Besides epidemiological studies, pathogenetic mechanisms of DHF/DSS have been one of the most important issues in dengue research. Studies in South-East Asia have revealed that DHF/DSS is much more commonly observed among patients with secondary infections than among patients with primary infections. This has led to the postulation that DHF/DSS is caused by immunopathological mechanisms. Indeed, aU four types of dengue virus have been found to be associated with DHF!DSS. A prevalence of Aedes aegypti and Aedes albopictus together with the circulation of dengue viruses of more than one type in any particular area tends to be associated with outbreaks ofDHF!DSS. Some investigators attribute DHF!DSS to the virulence of dengue virus itself. Therefore, the pathogenesis of DHF/DSS remains unclear. Clinical and pathological studies have shown that the major changes during infection involve the vascular system, as manifested by an increase in the permeability of the general vasculature leading to hypovolaemia and haemorrhage. Thrombocytopenia and abnormal coagulation are involved in haemorrhagic diathesis. All of these accumulated facts lead to the need for proper management and better care. Although the case-fatality rate has been reduced from almost ten per cent to less than one per cent, preventive measures through vector control and vaccine development are presently the major concerns. In the past 30 years, research in epidemiology, vector bionomics and control, dengue virology, clinical manifestation, immunopathogenesis and vaccine development has been well documented. v This monograph is the result of the efforts of a number of contributors involved in various aspects of the study of dengue infections. Despite the delay in printing, the information in this monograph wiU hopefully help investigators update their cu"ent research interests. Appreciation is attributed not only to the contributors, but also to Dr U Ko Ko, the South-East Asia Regional Director of the World Health Organization, and to Dr C.K. Sanyakom, Dr N.K. Shah, Dr S. Pattanayak and Dr S. ]atanasen of the same offzce, who have made this monograph available. Prasert Thongcharoen, M.D. vi Foreword DENGUE Fever is one of the most rapidly expanding diseases of the tropics, with over two billion people at risk of infection and millions of cases occurring every year. The severe form of the disease, dengue haemorrhagic fever (DHF), is a leading cause of hospitalization and death among children in the South-East Asia, Western PacifiC and Americas Regions. In view of the gigantic public health problem created by DHF, the interest ofpolicy makers, scientists and administrators in the prevention and control of the disease has increased many-fold. This publication contains information on Vector Control and Ecology, Dengue Viruses, Pathophysiology, Pathology and Pathogenesis of DHF, Management of Dengue, Clinical Manifestations and Epidemiology of DHF, and Development of DHF Vaccines. Eminent experts and renowned scientists have shared their experiences for the mutual benefu of aU concerned in the control of DHF. It is hoped that the descriptive and statistical information contained in this publication wiU, along with practical advice for sustained action at policy and programme levels, be ofsome assistance in understanding and meeting the challenges presented by the prevention and control of DHF. DrUKoKo Regional Director vii Authors Bang Yong H., WHO Regional Office for South-East Asia, New Delh~ India. Bhamarapravati Natth, WHO Collaborating Centre for Research in Immunopathology of Dengue Haemorrhagic Fever, Department of Pathology, Ramathibodi Hospita~ Mahidol University, Bangkok, Thailand. Comet Miche~ Institut Francais de Recherche Scientifique pour le Developement en Cooperation (ORSTOM), Nice, France. Gubler Duane J., Division of Vector Borne Infectious Diseases, National Center for Infectious Disea.~es, Colorado, USA. Halstead Scott B., Health Sciences Division, Rockefeller Foundation, New York, USA. Jatanasen Sujarli, WHO Regional Office for South-East Asia, New Delh~ India. Lam Sai Kit, Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Malaysia. Leangpibul Pimpan, Department of Clinical Microbiology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand. Nimmannitya Suchitra, Children's Hospita~ Bangkok, Thailand. Pang Tikld, Institute for Advanced Studies, University of Malaya, Kuala Lumpur, Malaysia. Pant C.P., Division of Vector Biology and Contro~ WHO, Geneva, Switzerland. Puthavathana Pilaipan, Department of Microbiology, Faculty of Medicine, Siriraj Hospita~ Mahidol University, Bangkok, Thailand. Self L.S., WHO Regional Office for the Western Pacific, Manila, Philippines. Thangcharoen Praserl, Department of Microbiology, Faculty of Medicine, Siriraj Hospita~ Mahidol University, Bangkok, Thailand. Tonn Roberl J., Division of Vector Biology and Control, WHO, Geneva, Switzerland. Umenai T., WHO Regional Office for the Western Pacific, Manila, Philippines. Wasi Chantapong, Department ofMicrobiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. ix Chapter 1 Epidemiology of Dengue and Dengue Haemorrhagic Fever 1. Dengue Haemorrhagic Fever and Dengue Shock Syndrome - Introduction, Historical and Epidemiological Background by Prasert Thongclulroen, M.D Sujarti ]atanasen, M.D. 1.1 Introduction and the body became hot; the head ached and the knees. Recovery was quite gained by transpiration The exact date when dengue fever was first and baths. It was an extraordinary event". recognized in the world is still obscure. Descriptions Since then, several outbreaks have been reported found in the early