Dengue Fever: Texts

Text A

Dengue: virus, fever and mosquitoes

Dengue fever is a viral disease spread only by certain mosquitoes – mostly Aedes aegypti or
“dengue mosquitoes” which are common in tropical areas around the world.

There are four types of the dengue virus that cause dengue fever – Dengue Type 1, 2, 3 and 4. People
become immune to a particular type of dengue virus once they’ve had it, but can still get sick from the
other types of dengue if exposed. Catching different types of dengue, even years apart, increases the
risk of developing severe dengue. Severe dengue causes bleeding and shock, and can be life
threatening.

Dengue mosquitoes only live and breed around humans and buildings, and not in bush or rural areas.
They bite during the day – mainly mornings and evenings. Dengue mosquitoes are not born with
dengue virus in them, but if one bites a sick person having the virus in their blood, that mosquito can
pass it on to another human after about a week. This time gap for the virus to multiply in the mosquito
means that only elderly female mosquitoes transmit dengue fever. The mosquitoes remain infectious for
life, and can infect several people. Dengue does not spread directly from person to person.

Text B

Signs and Symptoms

Classic dengue fever, or “break bone fever,” is characterised by acute onset of high fever 3–14 days after
the bite of an infected mosquito. Symptoms include frontal headache, retro-orbital pain, myalgias,
arthralgias, hemorrhagic manifestations, rash, and low white blood cell count. The patient also may
complain of weight loss and nausea. Acute symptoms, when present, usually last about 1 week, but
weakness, malaise, and weight loss may persist for several weeks. A high proportion of dengue infections
produce no symptoms or minimal symptoms, especially in children and those with no previous history of
having a dengue infection.
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Text C

Steps to take when seeing a suspected case of dengue fever

Step 1: Notify your nearest Public Health Unit immediately upon clinical
suspicion.

Step 2: Take a comprehensive travel history and determine whether the

case was acquired overseas or locally.

Step 3: Note the date of onset of symptoms to identify the correct

diagnostic test, as suitable laboratory tests depend on when the blood
sample is collected during the illness.

• Another useful test is full blood count. Cases often have leukopenia
and/or thrombocytopenia.

The table below shows which test to order at which stage of illness:

TEST TYPE PCR NSI IgM IgG

ELISA

Days after
onset of 0-5 days 0-9 days From day 5 From day 8
symptoms onwards onwards

Step 4: Provide personal protection advice.

• The patient should stay in screened accommodation and have someone

stay home to look after them.

• The patient should use personal insect repellent particularly during

daylight hours to avoid mosquito bites.

• All household members should use personal insect repellent during

daylight hours.

• Advise family members or associates of the case who develop a fever

to present immediately for diagnosis.
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Text D

Prior to discharge:

• Tell patients to drink plenty of fluids and get plenty of rest.

• Tell patients to take antipyretics to control their temperature. Children with dengue are at risk for
febrile seizures during the febrile phase of illness.

• Warn patients to avoid aspirin and anti-inflammatory medications because they increase the risk of
haemorrhage.

• Monitor your patients’ hydration status during the febrile phase of illness. Educate patients and parents
about the signs of dehydration and have them monitor their urine output.

• Assess hemodynamic status frequently by checking the patient’s heart rate, capillary refill,
pulse pressure, blood pressure, and urine output. If patients cannot tolerate fluids orally, they may need
IV fluids.

• Perform hemodynamic assessments, baseline hematocrit testing, and platelet counts.

• Continue to monitor your patients closely during defervescence. The critical phase of dengue begins
with defervescence and lasts 24–48 hours.

END OF PART A