DENGUE FEVER Q: What is dengue fever? A: Dengue fever is a viral illness spread by mosquitoes.

The disease commonly occurs mainly in tropical Asia, Africa, the Caribbean and the South Pacific, especially during the rainy season in areas infested with infected mosquitoes. Sometimes, persons arriving from other countries may enter the United States with dengue fever and infect local mosquitoes, as happened in Hawaii in 2001. Q: How do you get it? A: The dengue virus is spread through the bite of infected Aedes mosquitoes. Dengue is not spread directly from one person to another. Q: What are the symptoms of dengue fever? A: The symptoms of dengue fever include sudden onset of fever, severe headaches, eye, joint, and muscle pain, and rash. A rash may appear on the face and extend to the hands, arms, upper body and eventually the legs and feet from as early as 24-48 hours but usually around 3 to 4 days after the fever begins. Minor bleeding problems can also occur. The symptoms usually go away completely within 1 to 2 weeks. However, just as the fever goes away, some people may show warnings signs such as severe stomach pain, persistent vomiting, drowsiness, bleeding or blood clotting problems. When this happens, the illness is called dengue hemorrhagic fever. Dengue hemorrhagic fever is a very serious illness with abnormal bleeding and very low blood pressure (shock) and tends to be associated with those who have had previous dengue infection. Q: When do symptoms start? A: The symptoms usually start 5 to 6 days after being bitten by infected mosquitoes, but the onset can range from 2 to 14 days. Q: What is the treatment for dengue fever? A: There is no specific treatment for dengue fever. Bed rest, plenty of fluids, and acetaminophen (Tylenol) to treat fever and pain are recommended. Aspirin and NSAIDS (ibuprofen, naproxen) are not recommended as they can make bleeding problems worse. Sponging the ill persons skin with cool water may help to control the fever if it remains high despite acetaminophen. There is currently no vaccine for dengue fever. Q: If you get dengue fever once, can you get it again? A: Yes. There are four major types of dengue viruses. Having dengue fever with one type of dengue virus will not protect you from the other three types. Q: How can you keep from getting it? A: Avoid exposure to mosquitoes. Aedes mosquitoes are usually most active in the early morning hours after daybreak, in the late afternoon before dark, and any time during the day when indoors or in shady areas. Use mosquito netting over beds, and screens on windows and doorways. Use mosquito repellents and wear appropriate clothing such as long-sleeved shirts and long pants that reduce exposure to mosquito bites. Mosquitoes are drawn to dark colors; so if possible, wear white or light colored clothing when you are likely to be exposed to biting mosquitoes.

Dengue Fever Factsheet Q. What is dengue? A. Dengue (pronounced den gee) is a disease caused by any one of four closely related viruses (DEN-1, DEN-2, DEN-3, or DEN-4). The viruses are transmitted to humans by the bite of an infected mosquito. In the Western Hemisphere, the Aedes aegypti mosquito is the primary transmitter or vector of dengue viruses. It is estimated that there are over 100 million cases of dengue worldwide each year. Q. What is dengue hemorrhagic fever (DHF)? A. DHF is a more severe form of dengue. It can be fatal if unrecognized and not properly treated. DHF is caused by infection with the same viruses that cause dengue. With good medical management, mortality due to DHF can be less than 1 percent. Q. How are dengue and dengue hemorrhagic fever (DHF) spread? A. Dengue is transmitted to people by the bite of an Aedes mosquito that is infected with a dengue virus. The mosquito becomes infected with dengue virus when it bites a person who has dengue or DHF and after about a week can transmit the virus while biting a healthy person. Dengue cannot be spread directly from person to person. Q. What are the symptoms of the disease? A. The principal symptoms of dengue are high fever, severe headache, backache, joint pains, nausea and vomiting, eye pain, and rash. Generally, younger children have a milder illness than older children and adults. Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms that could occur with many other illnesses (e.g., nausea, vomiting, abdominal pain, and headache). This stage is followed by hemorrhagic manifestations, tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding. The smallest blood vessels (capillaries) become excessively permeable (leaky), allowing the fluid component to escape from the blood vessels. This may lead to failure of the circulatory system and shock, followed by death, if circulatory failure is not corrected. Q. What is the treatment for dengue? A. There is no specific medication for treatment of a dengue infection. Persons who think they have dengue should consult a physician. They should also rest, drink plenty of fluids, and use pain relievers with acetaminophen and avoid those containing aspirin. Q. Is there an effective treatment for dengue hemorrhagic fever (DHF)? A. As with dengue, there is no specific medication for DHF. It can however be effectively treated by fluid replacement therapy if an early clinical diagnosis is made. Hospitalization is frequently required in order to adequately manage DHF. Q. Where can outbreaks of dengue occur? A. Outbreaks of dengue occur primarily in areas where Aedes aegypti (sometimes also Aedes albopictus) mosquitoes live. This includes most tropical urban areas of the world. Dengue viruses may be introduced into areas by travelers who become infected while visiting the tropics where dengue commonly exists. In the America region, all dengue virus serotypes are now present. DEN-3 was reintroduced into Central America in 1994 and is now found in several countries in the region. Since this serotype has been absent from the Americas for almost 20 years, the population has a low level of immunity and the virus is expected to spread rapidly.

What is dengue fever? Dengue fever is also known as break-bone fever or dandy fever. It is caused by one of four very similar viruses. Each year, millions of cases of dengue fever occur worldwide. It is commonly found in the tropical and sub-tropical environments of Asia, East and West Africa, Polynesia, Micronesia and Tahiti. It may also be found in the Caribbean, northern South America and Central America. Although there are two types of mosquitoes capable of transmitting dengue fever found in some Ohio counties, the virus is not endemic in the state. A few (two to three) human cases are reported in Ohio each year, but most have a history of travel to infected areas. How is dengue fever transmitted? Dengue fever is transmitted through the bite of an infected mosquito, most often Aedes aegypti. No transmission occurs directly from person to person. What are the symptoms of dengue fever? Patients typically develop a high fever, severe headache, pain behind the eyes, painful joints and muscles, nausea, vomiting, and often a rash. These symptoms last about one week, but weakness and tiredness may persist for several weeks. Young, healthy people often have no or mild symptoms. Some patients with dengue fever go on to develop dengue hemorrhagic fever (DHF), a severe and sometimes fatal form of the disease. About the time the fever begins to subside, the patient may display problems with blood circulation. These can include abnormal bruising, blood in the urine or stool, bloody nose and/or bleeding gums. If untreated, these symptoms may lead to death. How long after exposure before symptoms appear? Symptoms typically develop within 3 to 14 days, usually in 4 or 7. How is dengue fever diagnosed? The virus can be isolated in a lab. or a test for specific antibodies can be performed on blood or other tissues. Can dengue fever be treated? There is no cure for the virus, so treatment is aimed at treating the symptoms. Fluids to maintain hydration and medications to reduce fever and eliminate pain are often prescribed. Aspirin should be avoided because it can decrease the bloods ability to clot. Severe cases and those that progress to dengue hemorrhagic fever require hospitalization with intensive monitoring and treatment.

Dengue and Dengue Hemorrhagic Fever

Frequently Asked Questions What is dengue? Dengue (pronounced den' gee) is a disease caused by any one of four closely related viruses (DEN1, DEN2, DEN3, or DEN4). The viruses are transmitted to humans by the bite of an infected mosquito. In the Western Hemisphere, Aedes aegypti is the most important transmitter or vector of dengue viruses, although a 2001 outbreak in Hawaii was transmitted by Aedes albopictus. It is estimated that there are over 100 million cases of dengue worldwide each year. What is dengue hemorrhagic fever (DHF)? DHF is a more severe form of dengue. It can be fatal if unrecognized and not properly treated. DHF is caused by infection with the same viruses that cause dengue. With good medical management, mortality due to DHF can be less than 1%. How are dengue and dengue hemorrhagic fever (DHF) spread? Dengue is transmitted to people by the bite of an Aedes mosquito that is infected with a dengue virus. The mosquito becomes infected with dengue virus when it bites a person who has dengue or DHF and after about a week can transmit the virus while biting a healthy person. Dengue cannot be spread directly from person to person. What are the symptoms of dengue/dengue hemorrhagic fever? The principal symptoms of dengue are high fever, severe headache, backache, joint pains, nausea and vomiting, eye pain, and rash. Generally, younger children have a milder illness than older children and adults. Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms that could occur with many other illnesses (e.g., nausea, vomiting, abdominal pain, and headache). This stage is followed by hemorrhagic manifestations, tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding. The smallest blood vessels (capillaries) become excessively permeable (leaky), allowing the fluid component to escape from the blood vessels. This may lead to failure of the circulatory system and shock, followed by death, if circulatory failure is not corrected. February 24, 2012 Page 2 If you have any concerns about your health, you should contact your healthcare provider. What is the treatment for dengue? There is no specific medication for treatment of a dengue infection. Persons who think they have dengue should use analgesics (pain relievers) with acetaminophen and avoid those containing aspirin. They should also rest, drink plenty of fluids, and consult a physician. What is the treatment for dengue hemorrhagic fever (DHF)? As with dengue, there is no specific medication for DHF. It can however be effectively treated by fluid replacement therapy if an early clinical diagnosis is made. Hospitalization is frequently required in order to adequately manage DHF. Physicians who suspect that a patient has DHF may want to consult the Dengue Branch at CDC, for more information. Is there a vaccine for dengue/dengue hemorrhagic fever? There is no vaccine to protect humans against Dengue virus infection. Where can outbreaks of dengue occur? Outbreaks of dengue occur primarily in areas where Aedes aegypti (sometimes also Aedes albopictus) lives. This includes most tropical urban areas of the world. Dengue viruses may be introduced into areas by travelers who become infected while visiting other areas of the tropics where dengue commonly exists. (See map at http://www.who.int/csr/disease/dengue/impact/en/). How concerned should I be about dengue in Georgia? Dengue is extremely rare in Georgia. Less than 5 cases of dengue are reported in Georgia each year. All cases had recent international travel history. There has never been a case of locallyacquired dengue reported in Georgia.

How can I prevent myself from being infected with dengue? For travelers to areas with dengue, as well as people living in areas with dengue, the risk of being bitten by mosquitoes indoors is reduced by utilization of air conditioning or windows and doors that are screened. Proper application of mosquito repellents containing 20% to 30% DEET as the active ingredient on exposed skin and clothing decreases the risk of being bitten by mosquitoes. The risk of dengue infection for international travelers appears to be small, unless an epidemic is in progress. February 24, 2012 Page 3 Whom should I contact for more information? For general information about dengue and surveillance for mosquitoborne diseases in Georgia, call your county health department or the Georgia Department of Public Health at 4046572588. You may also visit the Georgia Department of Public Health website at http://health.state.ga.us/epi/vbd/mosquito.asp For national dengue virus data, visit the CDC website at http://www.cdc.gov/dengue/ or contact: Centers for Disease Control and Prevention, Dengue Branch 2 Calle Caada San Juan, Puerto Rico 009203860 Telephone: (787) 7062399; FAX: (787) 7062496.

What is dengue fever? Dengue and Dengue Haemorrhagic Fever (DHF) are caused by four closely related viral strains. The virus is transmitted to humans through the bites of infected mosquitoes (Aedes aegypti and

Aedes albopticus). Infection with one of the viral strains does not guarantee immunity from the other three. When a person who has already fought one strain of the disease contracts another of the viral strains, it can cause severe forms of DHF or Dengue Shock Syndrome (DSS). Who is infected with dengue fever? The global prevalence of Dengue has risen dramatically, and is now endemic in more than 100 countries in Africa, the Americas, and the Eastern Mediterranean. The most serious outbreaks are found in Southeast Asia and the Western Pacific. The World Health Organization (WHO) estimates that 50 million cases occur each year, requiring 500,000 hospitalizations. Approximately two fifths of the worlds population is at risk for Dengue.1 Since 1986, the incidence of DHF has quadrupled. Where is dengue fever endemic? The disease occurs mainly in tropical Asia, Africa and the Caribbean, and is most common during rainy seasons in areas infested with infected mosquitoes. A global pandemic of dengue began in Southeast Asia after World War II and has intensified during the last 15 years. Most cases occur at low altitudes in urban areas. Epidemics are most common in countries lacking effective mosquito control, or that have inadequate water, sewage, and waste-management problems. The denguetransmitting mosquitoes Aedes aegypti and Aedes albopticus , are on the increase and have been detected in Mexico and South Texas during the last 10 years. What are the symptoms? Dengue fever is characterized by the sudden onset of fever, lethargy, painful headaches, nausea and vomiting, eye, joint, and muscle pain, and rash, leading to the nickname break-bone fever. The onset of symptoms begins about five to six days after the mosquito bite occurs, and symptoms generally last between one to two weeks. DHF is a potentially lethal complication. Patients will develop a sudden rise in temperature accompanied with internal bleeding, and hypovolaemic shock. The average fatality rate for DHF is five percent.2 Why is this a recent epidemic? According to the Centers for Disease Control and Prevention, in most countries, the public health infrastructure has deteriorated. Funds are allocated only for emergency responses to epidemics, rather than for the development of programs to prevent epidemic transmission, such as detection programs. As a result, an epidemic has often reached or passed transmission before it is detected. It is believed that rapid urbanization, increased travel and trade, and the lack of effective mosquito control efforts contribute to the spread of the disease. Are there any available treatments? While there are no specific treatments for dengue available yet, supportive treatments include bed rest, fluid administration and analgesia. There is no available vaccine for dengue, although vaccines are currently in development.

B. Dengue Fever (DF) Fever and two or more of the below: a) Retro-orbital/ocular pain

b) Headache c) Rash d) Myalgias e) Arthralgias f) Leukopenia g) Hemorrhagic symptoms not meeting the definition of DHF C Dengue Hemorrhagic Fever (DHF) Meets criteria for Dengue Fever plus: a) Thrombocytopenia (less than 100,000 cells per mm2) b) Evidence of plasma leakage manifested by hemo-concentration (increase in hematocrit >20% of normal for age or a decrease< 20% after rehydration) or pleural effusion, ascites, or hypoproteinemia. D Dengue Shock Syndrome (DSS) Meets all of the criteria for DHF plus: signs of shock; i.e., rapid pulse, narrow pulse pressure, and, most importantly, poor end organ perfusion.8