Dengue fever

Dengue fever (pronounced "Den-gee" with a hard G) is a viral tropical disease spread by mosquito bites. In 2020, the World Health Organization reported an estimate of 390 million infections per year, of which 96 million had some degree of severity. Despite a risk of infection existing in 129 countries, 70% of the actual burden is in Asia.

Dengue deaths per million persons in 2012

  0

  1

  2

  3

  4–8

  9-561

Dengue is a major public health problem throughout South-East Asia and South Asia. It is also found in Queensland, Australia, the tropical South Pacific, Africa, tropical parts of North and South America, including the Caribbean and mainland Central America. Estimates of the prevalence of the disease vary widely, but all show it increasing steadily since the late 20th century.

Dengue is not infectious between people. It is spread to humans mainly by the Aedes aegypti mosquito, which is found in tropical regions of the world. The Aedes albopictus mosquito can also carry it; that one tolerates cold better and has been involved in the spread of the disease to Europe and North America. These mosquitoes also carry the similar viruses that cause Yellow fever, Zika fever, Chikungunya, the West Nile disease, and several types of encephalitis.

There are five strains of the virus. After recovering from an infection, a person has long-term immunity to that strain and may for a few months be resistant to other strains.

The main preventive measures are to decrease the ability of mosquitoes to breed and to avoid mosquito bites. Vaccines are now available in some countries; see below.

About 80% of people infected with the virus have no symptoms, or only a mild fever and tiredness. Mild cases without rash may be easily misdiagnosed as a cold. Dengue is also easily confused with Zika fever or Chikungunya which are caused by related viruses carried by the same type of mosquito, found in similar geographic regions, and have similar symptoms.

For the unlucky 20% who get full-blown dengue fever, the first symptoms are usually a sudden fever (often over 40°C, 104°F) accompanied by strong joint and muscle pains; in the 19th century it was known as breakbone fever due to these pains. This is usually soon followed by a bright red rash, most often starting on the legs but sometimes the arms and it may spread to the chest, back, and face. Splitting headaches, nausea, vomiting and abdominal pain are also common. This stage of the disease is quite unlikely to kill, but the patient may wish it would.

Symptoms usually appear 4-10 days after being bitten by an infected mosquito. The acute symptoms typically last a few days or a week, but milder flu-like symptoms often persist beyond that; many people are miserable for weeks and for some it takes several months to fully recover. Death is rare, and generally only occurs in those that progress to dengue hemorrhagic fever.

A few cases become dengue hemorrhagic fever (DHF), in which blood vessels become more porous and start to leak fluids; fortunately this is fairly rare. The most common symptom is bleeding from the nose, mouth, and gums, but accumulation of fluids in the abdomen or lungs, bleeding in the intestinal tract, vaginal bleeding, or bleeding under the skin are also possible. There can be a fever of 42°C (108°F) or higher, which is an emergency in itself.

There are five strains of the dengue virus and DHF occurs more often in people who have recovered from an infection with one strain but then get re-infected with a different strain. The reason for this is not known for certain; one theory is that the immune system, instead of fighting the second strain, gets confused and just makes lots of antibodies against the first.

The fatality rate for DHF with proper treatment is below 1%, but it is a life-threatening illness which usually requires hospitalization, and often some time in an intensive care ward. Part of the problem is dehydration and the usual treatments for that can be used, but other treatment is generally required as well. This often involves major interventions – transfusions, other intravenous fluids, sometimes oxygen to compensate for blood or lung problems, perhaps medication to reduce bleeding, and so on. The main goal is to prevent the patient from progressing to dengue shock syndrome, and this can usually be achieved.

The deadliest form of the disease is dengue shock syndrome (DSS) in which so much fluid is lost that pulse rate and blood pressure drop precipitously. This is a critical emergency; it is lethal in 90% of cases unless correctly and very promptly treated, and once the disease has progressed to this point there is significant risk of death even with good treatment.

There is no treatment that can attack the virus or cure the disease, only ones to alleviate symptoms such as pain, fever or nausea, or to deal with dehydration and blood loss. For mild cases, rest and fluids may be enough, but check with a doctor about other treatment.

In areas with dengue, if you get some of the symptoms described above (especially after being bitten by a mosquito) see a doctor. The presence of dengue can be confirmed with a blood test, and some of the misery can be avoided with supportive care. Not all cases need hospitalization, but some will be too ill for work or travel for anything from a few days to a few weeks.

WARNING: If dengue fever is a possibility, do not self-medicate without medical advice. Some common over-the-counter medicines such as aspirin and ibuprofen, commonly sold as headache remedies, may increase the risk of DHF. Any medication containing acetylsalicyclic acid or nonsteroidal anti-inflammatory agents should be avoided. Paracetamol (acetominophen) may be used to manage the fever and pain.

Dengue hemorrhagic fever is a life-threatening illness; if you show any DHF symptoms, see a doctor immediately. If a local hospital has a good emergency room, go directly there.

Treating dengue hemorrhagic fever requires the resources of a modern hospital. If you are out in the boondocks and come down with dengue fever, consider evacuating immediately to somewhere with such a hospital. If your case does develop into DHF, then you will urgently need treatment but might be in no shape to travel.

If you get dengue fever during a long trip, talk to your doctor about your prognosis. The disease leaves some people debilitated (about like flu) for anything up to several months, and if you are one of the unlucky ones you may need to alter your travel plans: postpone strenuous activities and go lie on a beach or take it easy in some other way until you recover fully. Some people may even need to cut a trip short and go home to recover.

Preventive measures to control and avoid dengue fever focus on avoiding mosquito bites and include:

• Prevention or elimination of standing water sources, such as pools of water that collect in containers, flower pots, discarded tires or coconut shells, etc. Mosquitoes breed in any standing water in a matter of days.
• Use of permethrin-treated fabrics, which kill insects that land on them, for clothing and mosquito net.
• Use of mosquito net especially for the place you sleep in even if mosquitoes "can't enter" the house. Make sure that the net doesn't have any holes, and there are no gaps between the net and the environment.
• Use of insect repellent (icaridin or DEET are the main agents that have been shown to be most effective) as well as wearing clothing that covers exposed skin.
• Houses constructed in such a way as to reduce the entry of mosquitoes. (e.g. screens on the windows a/c instead of open windows/ventilators...)

Most electronic bug zappers are not effective against mosquitoes since mosquitoes are not attracted to light. There are some models which emit carbon dioxide or octenol (found in the breath of mammals) so they do attract mosquitoes.

See mosquitoes for more detailed discussion.

As of mid-2023, two dengue vaccines have been approved for some uses in some countries, but neither is approved in all places or for all recipients. Several other dengue vaccines are at various stages of development.

• Denvaxia. This was the first vaccine to prevent dengue; it was approved in Brazil, Mexico and the Philippines late in 2015. It needs three shots spaced six months apart, and cost in the Philippines as of 2016 was about US $100 per shot. However, there are complications; the manufacturer now recommends it only be used in people who have previously had dengue at least once, or are assumed to have had dengue as they are from a very high-risk region. The Philippine government withdrew their approval in 2017 and restored it in 2019. It was approved in the United States in 2019, but only for high-risk situations rather than for general use. 
• Qdenga. This vaccine was approved in Indonesia, Brazil and the European Union in late 2022. It needs two shots three months apart, and cost will vary by country, about US $40 per shot in Indonesia, $110 in Germany. Qdenga can be given to those who have never had an infection. 

The above information is accurate as of mid-2023. Check with your own doctor or a local clinic for more definite information.

• Centers for Disease Control: Dengue
• WHO Fact Sheet