What is Dengue?

Dengue viruses are spread to people through the bite of an infected Aedes species (Ae. aegypti or Ae.
albopictus) mosquito. Almost half of the world’s population, about 4 billion people, live in areas with a
risk of dengue. Dengue is often a leading cause of illness in areas with risk.

Areas with Risk of Dengue

Dengue outbreaks are occurring in many countries of the world.

Dengue Vaccine

A dengue vaccine is approved for use in children aged 9 to 16 years with laboratory-confirmed previous
dengue virus infection and living in areas where dengue is endemic (common). Endemic areas include
some U.S. territories and freely associated states. The vaccine is not approved for use in U.S. travelers
who are visiting but not living in an area where dengue is common.

About Dengue

Dengue viruses are spread to people through the bite of an infected Aedes species (Ae. aegypti or Ae.
albopictus) mosquito. These mosquitoes also spread Zika, chikungunya, and other viruses.

Almost half of the world’s population, about 4 billion people, live in areas with a risk of dengue. Dengue
is often a leading cause of illness in areas with risk.

Each year, up to 400 million people are infected by a dengue virus. Approximately 100 million people get
sick from infection, and 40,000 die from severe dengue.

Dengue is caused by one of any of four related viruses: dengue virus 1, 2, 3, and 4. A person can be
infected with dengue multiple times in their life.

What We Know

a bottle of insect repellent

Prevent dengue by avoiding mosquito bites.

All four dengue viruses are spread primarily through the bite of an infected Aedes species (Ae. aegypti
and Ae. albopictus) mosquito. These mosquitoes also spread chikungunya and Zika viruses.

The mosquitoes that spread dengue are found in most tropical and subtropical regions of the world,
including many parts of the United States.

Ae. aegypti and Ae. albopictus bite during the day and night.

A dengue vaccine is now recommended for U.S. territories of American Samoa, Puerto Rico, and the U.S.
Virgin Islands, and freely associated states, including the Federated States of Micronesia, the Republic of
Marshall Islands, and the Republic of Palau.

Key Facts

1 in 4: About one in four people infected with dengue will get sick.
For people who get sick with dengue, symptoms can be mild or severe.

Severe dengue can be life-threatening within a few hours and often requires care at a hospital.

Symptoms

Mild symptoms of dengue can be confused with other illnesses that cause fever, aches and pains, or a
rash.

The most common symptom of dengue is fever with any of the following:

Nausea, vomiting

Rash

Aches and pains (eye pain, typically behind the eyes, muscle, joint, or bone pain)

Any warning sign

Symptoms of dengue typically last 2–7 days. Most people will recover after about a week.
Treatment

There is no specific medicine to treat dengue.

Treat the symptoms of dengue and see your healthcare provider.

If you think you have dengue

See a healthcare provider if you develop a fever or have symptoms of dengue. Tell him or her about your
travel.

Rest as much as possible.

Take acetaminophen (also known as paracetamol outside of the United States) to control fever and
relieve pain.

Do not take aspirin or ibuprofen!

Drink plenty of fluids to stay hydrated. Drink water or drinks with added electrolytes.

For mild symptoms, care for a sick infant, child, or family member at home.

Severe dengue

About 1 in 20 people who get sick with dengue will develop severe dengue.

Severe dengue can result in shock, internal bleeding, and even death.

If you have had dengue in the past, you are more likely to develop severe dengue.

Infants and pregnant women are at higher risk for developing severe dengue.

Symptoms of severe dengue

Warning signs of severe dengue

Watch for signs and symptoms of severe dengue. Warning signs usually begin in the 24–48 hours after
your fever has gone away.

Immediately go to a local clinic or emergency room if you or a family member has any of the following
symptoms.

Belly pain, tenderness

Vomiting (at least 3 times in 24 hours)

Bleeding from the nose or gums

Vomiting blood, or blood in the stool

Feeling tired, restless, or irritable

Treatment of severe dengue

If you have any warning signs, see a healthcare provider or go to the emergency room immediately.
Severe dengue is a medical emergency. It requires immediate medical care at a clinic or hospital.

Dengue Vaccine

Español (Spanish)

A dengue vaccine is approved for use in children aged 9–16 years with laboratory-confirmed previous
dengue virus infection and living in areas where dengue is endemic (occurs frequently or continuously).
Endemic areas include some U.S. territories and freely associated states. The vaccine is not approved for
use in U.S. travelers who are visiting but not living in an area where dengue is common.

The dengue vaccine is available in Puerto Rico and is part of the routine childhood immunization
schedule. Most health insurance plans cover routine vaccinations. The Vaccine for Children (VFC)
program also provides vaccines for children 18 years and younger who are uninsured, underinsured,
Medicaid-eligible, American Indian, or Alaska Native.

Transmission

Dengue viruses are spread to people through the bites of infected Aedes species mosquitoes (Ae.
aegypti or Ae. albopictus). These are the same types of mosquitoes that spread Zika and chikungunya
viruses.

These mosquitoes typically lay eggs near standing water in containers that hold water, like buckets,
bowls, animal dishes, flower pots, and vases.

These mosquitoes prefer to bite people, and live both indoors and outdoors near people.

Mosquitoes that spread dengue, chikungunya, and Zika bite during the day and night.

Mosquitoes become infected when they bite a person infected with the virus. Infected mosquitoes can
then spread the virus to other people through bites.

From mother to child

A pregnant woman already infected with dengue can pass the virus to her fetus during pregnancy or
around the time of birth.

To date, there has been one documented report of dengue spread through breast milk. Because of the
benefits of breastfeeding, mothers are encouraged to breastfeed even in areas with risk of dengue.

Dengue in pregnancy

Through infected blood, laboratory, or healthcare setting exposures

Rarely, dengue can be spread through blood transfusion, organ transplant, or through a needle stick
injury.

Key Facts

Dengue outbreaks occur in many countries of the world, including in the Americas, Africa, the Middle
East, Asia, and the Pacific Islands.
Anyone who lives in or travels to an area with risk of dengue is at risk for infection. Before you travel,
find country-specific travel information to help you plan and pack.

Almost half of the world’s population, about 4 billion people, live in areas with a risk of dengue. Dengue
is often a leading cause of illness in areas with risk.

Dengue has emerged as a worldwide problem since the 1960s. The disease is common in many popular
tourist destinations in the Caribbean (including Puerto Rico), Central and South America, Southeast Asia,
and the Pacific Islands. In the United States, local cases and limited spread of dengue does occur
periodically in some states with hot, humid climates and Aedes mosquitoes.

Testing

See your healthcare provider if you have symptoms of dengue and live in or have recently traveled to an
area with risk of dengue.

If you have recently traveled to an area with risk of dengue, tell your healthcare provider.

A blood test is the only way to confirm the diagnosis.

Your healthcare provider may order blood tests to look for dengue or other similar viruses like Zika or
chikungunya.

Key facts

Dengue is a viral infection caused by the dengue virus (DENV), transmitted to humans through the bite of
infected mosquitoes.

About half of the world's population is now at risk of dengue with an estimated 100–400 million
infections occurring each year.

Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas.

While many DENV infections are asymptomatic or produce only mild illness, DENV can occasionally cause
more severe cases, and even death.

Prevention and control of dengue depend on vector control. There is no specific treatment for
dengue/severe dengue, and early detection and access to proper medical care greatly lower fatality rates
of severe dengue.

Overview

Dengue (break-bone fever) is a viral infection that spreads from mosquitoes to people. It is more
common in tropical and subtropical climates.

Most people who get dengue won’t have symptoms. But for those that do, the most common symptoms
are high fever, headache, body aches, nausea and rash. Most will also get better in 1–2 weeks. Some
people develop severe dengue and need care in a hospital.

In severe cases, dengue can be fatal.

You can lower your risk of dengue by avoiding mosquito bites especially during the day.

Dengue is treated with pain medicine as there is no specific treatment currently.

Symptoms

Most people with dengue have mild or no symptoms and will get better in 1–2 weeks. Rarely, dengue
can be severe and lead to death.

If symptoms occur, they usually begin 4–10 days after infection and last for 2–7 days. Symptoms may
include:

high fever (40°C/104°F)

severe headache

pain behind the eyes

muscle and joint pains

nausea

vomiting

swollen glands

rash.

Individuals who are infected for the second time are at greater risk of severe dengue.

Severe dengue symptoms often come after the fever has gone away:

severe abdominal pain

persistent vomiting

rapid breathing

bleeding gums or nose

fatigue

restlessness

blood in vomit or stool

being very thirsty

pale and cold skin

feeling weak.

People with these severe symptoms should get care right away.
After recovery, people who have had dengue may feel tired for several weeks.

Diagnostics and treatment

Most cases of dengue fever can be treated at home with pain medicine. Preventing mosquito bites is the
best way to avoid getting dengue.

There is no specific treatment for dengue. The focus is on treating pain symptoms.

Acetaminophen (paracetamol) is often used to control pain. Non-steroidal anti-inflammatory drugs like
ibuprofen and aspirin are avoided as they can increase the risk of bleeding.

There is a vaccine called Dengvaxia for people who have had dengue at least once and live in places
where the disease is common.

For people with severe dengue, hospitalization is often needed.

Global burden

The incidence of dengue has grown dramatically around the world in recent decades, with cases
reported to WHO increased from 505 430 cases in 2000 to 5.2 million in 2019. A vast majority of cases
are asymptomatic or mild and self-managed, and hence the actual numbers of dengue cases are under-
reported. Many cases are also misdiagnosed as other febrile illnesses (1).

One modelling estimate indicates 390 million dengue virus infections per year of which 96 million
manifest clinically (2). Another study on the prevalence of dengue estimates that 3.9 billion people are at
risk of infection with dengue viruses.

The disease is now endemic in more than 100 countries in the WHO Regions of Africa, the Americas, the
Eastern Mediterranean, South-East Asia and the Western Pacific. The Americas, South-East Asia and
Western Pacific regions are the most seriously affected, with Asia representing around 70% of the global
disease burden.

Dengue is spreading to new areas including Europe, and explosive outbreaks are occurring. Local
transmission was reported for the first time in France and Croatia in 2010 and imported cases were
detected in 3 other European countries.

The largest number of dengue cases ever reported globally was in 2019. All regions were affected, and
dengue transmission was recorded in Afghanistan for the first time. The American Region reported 3.1
million cases, with more than 25 000 classified as severe. A high number of cases were reported in
Bangladesh (101 000), Malaysia (131 000) Philippines (420 000), Vietnam (320 000) in Asia.

Dengue continues to affect Brazil, Colombia, the Cook Islands, Fiji, India, Kenya, Paraguay, Peru, the
Philippines, the Reunion Islands and Vietnam as of 2021.

Transmission

Transmission through the mosquito bite

The virus is transmitted to humans through the bites of infected female mosquitoes, primarily the Aedes
aegypti mosquito. Other species within the Aedes genus can also act as vectors, but their contribution is
secondary to Aedes aegypti.

After feeding on a DENV-infected person, the virus replicates in the mosquito midgut before
disseminating to secondary tissues, including the salivary glands. The time it takes from ingesting the
virus to actual transmission to a new host is termed the extrinsic incubation period (EIP). The EIP takes
about 8–12 days when the ambient temperature is between 25–28°C. Variations in the extrinsic
incubation period are not only influenced by ambient temperature; several factors such as the
magnitude of daily temperature fluctuations, virus genotype, and initial viral concentration can also alter
the time it takes for a mosquito to transmit the virus. Once infectious, the mosquito can transmit the
virus for the rest of its life.

Human-to-mosquito transmission

Mosquitoes can become infected by people who are viremic with DENV. This can be someone who has a
symptomatic dengue infection, someone who is yet to have a symptomatic infection (they are pre-
symptomatic), but also people who show no signs of illness as well (they are asymptomatic).

Human-to-mosquito transmission can occur up to 2 days before someone shows symptoms of the
illness, and up to 2 days after the fever has resolved.

The risk of mosquito infection is positively associated with high viremia and high fever in the patient;
conversely, high levels of DENV-specific antibodies are associated with a decreased risk of mosquito
infection. Most people are viremic for about 4–5 days, but viremia can last as long as 12 days.

Maternal transmission

The primary mode of transmission of DENV between humans involves mosquito vectors. There is
evidence however, of the possibility of maternal transmission (from a pregnant mother to her baby). At
the same time, vertical transmission rates appear low, with the risk of vertical transmission seemingly
linked to the timing of the dengue infection during the pregnancy. When a mother does have a DENV
infection when she is pregnant, babies may suffer from pre-term birth, low birthweight, and fetal
distress.

Other transmission modes

Rare cases of transmission via blood products, organ donation and transfusions have been recorded.
Similarly, transovarial transmission of the virus within mosquitoes have also been recorded.

Risk factors

Previous infection with DENV increases the risk of the individual developing severe dengue.

Urbanization (especially unplanned), is associated with dengue transmission through multiple social and
environmental factors: population density, human mobility, access to reliable water source, water
storage practice etc.
Community’s risks to dengue also depend on population’s knowledge, attitude and practice towards
dengue, as well as the implementation of routine sustainable vector control activities in the community.

Consequently, disease risks may change and shift with climate change in tropical and subtropical areas,
and vectors might adapt to new environment and climate.

Prevention and control

The mosquitoes that spread dengue are active during the day.

Lower the risk of getting dengue by protecting yourself from mosquito bites by using:

clothes that cover as much of your body as possible

mosquito nets if sleeping during the day, ideally nets sprayed with insect repellent

window screens

mosquito repellents (containing DEET, Picaridin or IR3535)

coils and vaporizers.

If you get dengue, it’s important to:

rest

drink plenty of liquids

use acetaminophen (paracetamol) for pain

avoid non-steroidal anti-inflammatory drugs, like ibuprofen and aspirin

watch for severe symptoms and contact your doctor as soon as possible if you notice any.

So far one vaccine (Dengvaxia) has been approved and licensed in some countries. However, only
persons with evidence of past dengue infection can be protected by this vaccine. Several additional
dengue vaccine candidates are under evaluation.

WHO response

WHO responds to dengue in the following ways:

supports countries in the confirmation of outbreaks through its collaborating network of laboratories;

provides technical support and guidance to countries for the effective management of dengue
outbreaks;

supports countries in improving their reporting systems and capture the true burden of the disease;

provides training on clinical management, diagnosis and vector control at the country and regional level
with some of its collaborating centres;

formulates evidence-based strategies and policies;

support countries in the development of dengue prevention and control strategies and adopting the
Global Vector Control Response (2017–2030)

reviews and recommend the development of new tools, including insecticide products and application
technologies;

gathers official records of dengue and severe dengue from over 100 Member States; and

publishes guidelines and handbooks for surveillance, case management, diagnosis, dengue prevention
and control for Member States.