June 24, 2023

1400H - 1500H
Via Zoom

Empowerment
objective - for
DENGUE laypeople to have an
AWARENESS essential
understanding of
DENGUE in their
health management.
 June 24, 2023
1400H - 1500H
Via Zoom
Welcome all!

MUTE yourself but always

show your video picture.
Empowerment
Sign in your name, FB
objective - for account, or email address in
DENGUE laypeople to have an the Chat Box! Include names
of companions attending.
AWARENESS essential
understanding of Use the Chat Box to ask
questions and make
DENGUE in their comments while the PEP TALK
is on.
health management.
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show your face in video.
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 ROJOSON’S REQUEST:

Empowerment FEEDBACK TO THIS

objective - for PEP TALK!
DENGUE laypeople to have an
Pls. type in your
AWARENESS essential feedback in the chat
understanding of box during the open
DENGUE in their forum and before we
health management. adjourn!

Thank you!
 LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
Empowerment START PEP TALK
objective - for PROPER IN 2
DENGUE laypeople to have an MINUTES!
AWARENESS essential
Pls. turn on your
understanding of
video!
DENGUE in their Show your face!
health management.
 ROJoson PEP Talk
Empowerment
objective - for I have a Patient
DENGUE Empowerment
laypeople to have an
Program in which I
AWARENESS essential like to empower the
understanding of lay people or
DENGUE in their patients to take
health management. control in the
management of
their health.
I started the PEP Talk
on May 15, 2021.
There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer depending on
our enthusiasm,
discipline and
perseverance.
 us
My PEP TALK today is
entitled:
Empowerment DENGUE
objective - for Awareness
DENGUE laypeople to have an
AWARENESS essential In consonance with
understanding of DOH Health
Awareness Calendar
DENGUE in their
health management. National Dengue
Awareness Month
(June)
 Contents
• When and what is National DENGUE Awareness Month in the Philippines?
• What is the current disease burden of DENGUE in the Philippines?
DENGUE • What is a DENGUE?
AWARENESS • How is DENGUE virus transmitted?
• How to avoid / control DENGUE infection?
• What are the usual symptoms of DENGUE?
• What are the clinical categories of DENGUE?
• What is the DENGUE CASE CLASSIFICATION AND LEVEL OF SEVERITY?
• What are the phases of DENGUE infection?
• What are the diagnostic tests for DENGUE?
• What are the treatment for DENGUE?
• Is there immunity from DENGUE? Vaccine against DENGUE?
• What are ROJoson’s Patient Empowerment advice on the DENGUE?
 When and what is National Dengue Awareness
Month in the Philippines?
DENGUE
AWARENESS
 When and what is National Dengue Awareness
Month in the Philippines?
DENGUE
National Dengue Awareness Month is observed
AWARENESS
every June by virtue of Proclamation No. 1204 on
April 21, 1998 by then President Fidel V. Ramos.
Rainy season in the
Dengue has been considered by the DOH as an
Philippines usually
all-year round disease which rises in incidence
starts in June.
during the rainy season due to presence of more
breeding places for the disease-causing aedes
- reason for June as
aegypti type of mosquitoes.
the National Dengue
Awareness Month.
 When and what is National Dengue Awareness Month in the
Philippines?
DENGUE
National Dengue Awareness Month
AWARENESS
Purposes:
- To raise awareness among the citizens on the importance of
prevention of dengue and educate them on how to manage
so as to reduce morbidity and mortality from the disease.
- To strengthen the National Dengue Prevention and Control
Program thereby reducing the morbidity, mortality, and
social and economic burden generated by dengue
outbreaks and epidemics.
 When and what is National Dengue Awareness
Month in the Philippines?
DENGUE
To address the Dengue problem, the Philippine
AWARENESS
government established the National Dengue
Prevention and Control Program in 1993.

The program consists of case and vector

surveillance, case diagnosis and management,
integrated vector management, outbreak
response, health promotion and advocacy, and
research.
 What is the current disease burden of DENGUE in
the Philippines?
DENGUE FEVER
AWARENESS
 What is the current disease burden of DENGUE in
the Philippines?
Incidence rate of
DENGUE FEVER
dengue was highest
AWARENESS Dengue is the fastest spreading vector-borne among children of 5–
disease in the world endemic in 100 countries.
14 years of age, with
Philippines: over 80% of dengue-
The five year average cases of dengue is 185,008; related deaths
five year average deaths is 732; and five year occurring among
average Case Fatality Rate is 0.39 (2012-2016 individuals of less
data). than 20 years of age.
 Over 220,000 dengue
What is the current disease burden of DENGUE in cases were recorded
the Philippines? in 2022
DENGUE FEVER compared to 78,000
AWARENESS in 2021.

182 percent higher in

2022

722 deaths in 2022

vs 282 deaths in 2021
 What is the current disease burden of DENGUE in the
Philippines?
DENGUE
Philippines (Bulletin from DOH)
AWARENESS
As of 29 April 2023, epidemiological week 17, a total of 39,947
cases have been reported. The number of cases is 43% higher
compared to the same period in 2022 (n=27,928).

From 1 January to 29 April 2023, there have been 127 deaths

(CFR 0.3%), which is the same as 127 deaths (CFR 0.3%)
reported in the epidemiological week 16; which is lower than
166 deaths (CFR 0.6%) for the same period in 2022.
 What is the current disease burden of DENGUE in
the Philippines?
DENGUE
Dengue is present nationwide.
AWARENESS
In 2022: Deaths in 2022:
• Central Luzon - 44,030 cases • Central Visayas -
• National Capital Region - 25,855 cases 103
• Calabarzon (Cavite, Laguna, Batangas, Rizal • Central Luzon – 99
and Quezon) - 19,374 cases • Western Visayas –
85
• Mostly in CHILDREN.
• Mostly, CHILDREN.
 What is the current disease burden of DENGUE in the
Philippines?
DENGUE
Dengue is a national health problem. It is endemic in the
AWARENESS
Philippines.

It can cause death.

Though affecting mostly CHILDREN, it can affect even adults.

With everybody’s help, we have to reduce the morbidity,

mortality, and social and economic burden generated by
dengue outbreaks and epidemics.
 What is a DENGUE?

DENGUE
AWARENESS
 What is a DENGUE?

DENGUE Dengue is a viral infection caused by the dengue

virus (DENV), transmitted to humans through the
AWARENESS
bite of infected mosquitoes, principally the
Aedes aegypti (others – Aedes albopictus).
 What is a DENGUE?

DENGUE There are four serotypes of the dengue virus –

DENV1, DENV2, DENV3, and DENV4.
AWARENESS
First infection with one of the four serotypes
usually is non-severe or asymptomatic, while
second infection with one of other serotypes
may cause severe dengue.
 How is DENGUE VIRUS transmitted?

DENGUE
AWARENESS
 How is Dengue virus transmitted?

• Dengue virus circulating in the

blood of humans is ingested by
female mosquitoes during
feeding.
DENGUE • The virus then infects the
AWARENESS mosquito mid-gut and
subsequently spreads
systemically over a period of 8-
12 days.
• The virus can be transmitted to
other humans during
subsequent probing or feeding.
• Thereafter the mosquito
remains infective for the rest of
its life.
HUMAN-TO-MOSQUITO-TO-HUMAN CYCLE OF TRANSMISSION
 How is Dengue virus transmitted?

DENGUE TRANSMISSION
AWARENESS
Dengue virus is transmitted by day biting Aedes
aegypti (principally) and Aedes albopictus
mosquitoes.
 How is Dengue virus transmitted?

DENGUE Aedes aegypti mosquito breeds in clean water

which are accumulated in containers such as in
AWARENESS
flower vases, tires, bottles and cans.

Those containers can be the breeding places of

mosquitoes.

Usually those containers could collect water

especially during rainy season.
 How to avoid DENGUE infection?

To prevent the spread of DENGUE, do the Using self-protective

DENGUE measures such as
following measure:
AWARENESS wearing long sleeves
• cover all containers used in storing water
• change water in flower vases every 2 days and pants
• clean and rub the edge of the water
containers to remove eggs of mosquitoes Using mosquito net
• drain water from the gutter and mosquito
• make a hole in the tires to prevent collection repellent
of water
• collect and throw bottles and cans that are
possible breeding places of mosquitoes
 DENGUE
AWARENESS
 What are the usual symptoms of DENGUE?

DENGUE
AWARENESS
 What are the usual symptoms of DENGUE? An overwhelming 75
– 90% of patients
DENGUE is a disease entity with different clinical acquire dengue
DENGUE
presentations and often with unpredictable without any
AWARENESS symptoms, not even
clinical evolution and outcome.
fever.
Clinical categories:
DENGUE is
Asymptomatic DENGUE
sometimes referred
Symptomatic DENGUE
to as BREAKBONE
Mild (DENGUE Fever)
FEVER because of the
Severe (DENGUE Hemorrhagic Fever;
severe muscle, bone,
DENGUE shock syndrome)
and joint pain it can
cause.
 What are the usual symptoms of DENGUE?

DENGUE DENGUE is a disease entity with different clinical

presentations and often with unpredictable
AWARENESS
clinical evolution and outcome.

Clinical categories:
Asymptomatic DENGUE
Symptomatic DENGUE
Mild (DENGUE Fever)
Severe (DENGUE Hemorrhagic Fever;
DENGUE shock syndrome)
 What are the usual symptoms of DENGUE?
DENGUE is
sometimes referred
DENGUE to as BREAKBONE
AWARENESS FEVER because of the
severe muscle, bone,
and joint pain it can
cause.
 What are the usual 7 symptoms of
DENGUE infection?
DENGUE • Fever
• Muscle and joint pain
AWARENESS
• Skin rash
• Bleeding nose and gums
• Vomiting
• Diarrhea
• Headache
 What is the DENGUE CASE CLASSIFICATION AND
LEVEL OF SEVERITY?
DENGUE
AWARENESS
 What is the DENGUE CASE CLASSIFICATION AND
LEVEL OF SEVERITY?
DENGUE
AWARENESS

Dengue illness is categorized according to level of severity as

• dengue without warning signs
• dengue with warning signs
• severe dengue
 What is the DENGUE CASE CLASSIFICATION AND
LEVEL OF SEVERITY?
DENGUE
Dengue without warning warnings can be further
AWARENESS
classified according to signs and symptoms and
laboratory tests as

• suspect dengue
• probable dengue
• confirmed dengue
 What is the DENGUE CASE CLASSIFICATION AND
LEVEL OF SEVERITY?
DENGUE
1.dengue without warning signs​​
AWARENESS
      a.1 suspect dengue
- a previously well individual with acute febrile
illness of 1-7 days duration plus two of the
following: headache, body malaise, retro-orbital
pain, myalgia, arthralgia, anorexia, nausea,
vomiting, diarrhea, flushed skin, rash (petechial,
Hermann’s sign)
 What is the DENGUE CASE CLASSIFICATION AND
LEVEL OF SEVERITY?
DENGUE
1.dengue without warning signs​​
AWARENESS
        a.2 probable dengue
-  a suspect dengue case plus laboratory test:
Dengue NS1 antigen test and at least CBC
(leukopenia with or without thrombocytopenia)
or dengue IgM antibody test (optional) 
 What is the DENGUE CASE CLASSIFICATION AND
LEVEL OF SEVERITY?
DENGUE
1.dengue without warning signs​​
AWARENESS
             a.3 confirmed dengue
- a suspect or probable dengue case with positive
result of viral culture and/or Polymerase Chain
Reaction (PCR) and/or Nucleic Acid Amplification
Test- Loop Mediated Amplification Assay (NAAT-
LAMP) and/ or Plaque Reduction Neutralization
Test (PRNT)
 What is the DENGUE CASE CLASSIFICATION AND
LEVEL OF SEVERITY?
DENGUE
b. dengue with warning signs Showing the
AWARENESS importance of close
• a previously well person with acute febrile
illness of 1-7 days plus any of the following: monitoring of
abdominial pain or tenderness, persistent patients with
vomiting, clinical signs of fluid accumulation DENGUE
(ascites), mucosal bleeding, lethargy or
restlessness, liver enlargement, increase in
haematocrit and/or decreasing platelet count.
 What is the DENGUE CASE CLASSIFICATION AND LEVEL OF SEVERITY?

c. severe dengue
DENGUE severe plasma leakage leading to
AWARENESS •shock (DSS)
•fluid accumulation with respiratory distress

s​ evere bleeding
•as evaluated by clinician

severe organ impairment

•Liver: AST or ALT ≥ 1000
•CNS: e.g. seizures, impaired consciousness
•Heart and other organs (i.e. myocarditis, renal failure)
 What is a DENGUE?

DENGUE
AWARENESS
 What are the phases of DENGUE infection?

DENGUE
AWARENESS
 What are the phases of DENGUE infection?

DENGUE 1.Febrile Phase

2.​Critical Phase
AWARENESS
3.Recovery Phase
 What are the phases of DENGUE infection?

DENGUE 1.Febrile Phase

• Usually last 2-7 days
AWARENESS
• Mild haemorrhagic manifestations like
petechiae and mucosal membrane bleeding (e.g
nose and gums) may be seen.
•Monitoring of warning signs is crucial to
recognize its progression to critical phase.
 What are the phases of DENGUE infection?

DENGUE 2. ​Critical Phase

•Phase when patient can either improve or deteriorate.
AWARENESS
•Defervescence occurs between 3 to 7 days of illness. Defervescence is
known as the period in which the body temperature (fever) drops to
almost normal (between 37.5 to 38°C).
•Those who will improve after defervescence will be categorized
as Dengue without Warning Signs, while those who will deteriorate will
manifest warning signs and will be categorized as Dengue with Warning
Signs or some may progress to Severe Dengue.
•When warning signs occurs, severe dengue may follow near the time
of defervescence which usually happens between 24 to 48 hours.
 What are the phases of DENGUE infection?

DENGUE 3. Recovery Phase

•Happens in the next 48 to 72 hours in which the
AWARENESS
body fluids go back to normal.
•Patients’ general well-being improves.
•Some patients may have classical rash of “isles
of white in the sea of red”.
•The White Blood Cell (WBC) usually starts to
rise soon after defervescence but the
normalization of platelet counts typically
happens later than that of WBC. 
 What are the diagnostic tests for DENGUE?

DENGUE
AWARENESS
 What are the diagnostic tests for DENGUE?

DENGUE Dengue virus testing is not recommended for:

•Asymptomatic patients
AWARENESS
•Preconception screening

Patients with symptoms consistent with dengue

can be tested with both molecular and serologic
diagnostic tests during the first 7 days of illness.
After the first 7 days of illness, test only with
serologic diagnostic tests.
 What are the diagnostic tests for DENGUE?

DENGUE ≤7 Days After >7 Days Post

Diagnostic Test Specimen Types
AWARENESS Symptom Onset Symptom Onset
Serum, plasma,
Molecular Tests ✓ — whole blood,
cerebrospinal fluid*
Dengue Virus Antige ✓ — Serum
n Detection
 (NS1)
Serologic Tests ✓ ✓ Serum,
cerebrospinal fluid*
Tissue Tests ✓ ✓ Fixed tissue
 Test Description

• Requested between 1-5 days of illness

• Use to detect dengue virus antigen during early phase of
1.      Dengue NS1 RDT acute dengue infection
• Test is for
What are the diagnostic free
tests forinDENGUE?
all health centers and selected public
hospitals nationwide

DENGUE •Demonstration ofRequested

a fourfoldbeyond
or greater
fivechange
days of illness
•
in reciprocal immunoglobulin
• Use to detectGdengue
(IgG) orantibodies
IgM during acute late stage
AWARENESS
antibody titers to of
1 or more infection
dengue dengue virus
(IgM) and to determine previous
2.      Dengue IgM/IgGantigens in pairedinfection (IgG)
serum samples
• May give false positive result due to antibodies induced
by dengue vaccine
• DOH augmentation is limited to selected government
hospitals only

3.      Other tests: • Routinely used in hospitals as standard dengue

-Total While Blood Cell (WBC) count diagnostic tests
-Platelet • Look for trend of decreasing WBC, decreasing platelet
-Hematocrit and increasing hematocrit
 Test Description

• One of the gold standard laboratory tests to confirm

dengue virus.
4.      Polymerase Chain Reaction
What (PCR)
are the • Molecular
diagnostic based
tests for test confirmatory test
DENGUE?
• Available only in dengue sub-national and national
• reference laboratories
DENGUE Demonstration of a fourfold or greater change
AWARENESS in reciprocal immunoglobulin G (IgG) or IgM confirmatory test used to
• A novel molecular-based
antibody titers to 1 detect
or more dengue
dengue virus
virus.
5.      Nucleic Acid Amplification Test- Work just like PCR but cheaper and simpler in nature.
antigens in paired•serum
Loop Mediated Isothermal samples
Amplification Assay (NAAT-LAMP) • In the pipeline to be introduced under the National
Dengue Prevention and Control Program in district and
provincial hospitals

• Gold standard to characterize and quantify circulating

6.      Plaque Reduction Neutralization level of anti-DENV neutralizing antibody (NAb)
Test (PRNT) • Available only at the dengue national reference
laboratory
 What are the diagnostic tests for DENGUE?

DENGUE Commonly used nowadays:

AWARENESS
NS1
IgM
IgG

Rapid Combo Tests (NS1, IgM, IgG)

 What are the diagnostic tests for DENGUE?

DENGUE There are a lot of self-test kits in the markets

(cheaper) but need to be done with guidance
AWARENESS
from physicians.
 What are the diagnostic tests for DENGUE?

DENGUE There are a lot of self-test kits in the markets

(cheaper) but need to be done with guidance
AWARENESS
from physicians.
 What is the treatment for DENGUE?

DENGUE
AWARENESS
 What is the treatment for DENGUE?

DENGUE There is NO specific medicine for DENGUE /

SEVERE DENGUE.
AWARENESS
Symptoms of dengue can be mild or severe.

Mild symptoms can be treated at home.

Severe symptoms should be hospitalized.

 What is the treatment for DENGUE?

DENGUE If you get dengue, it’s important to:

•rest
AWARENESS
•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.

•NO to antibiotics
 DENGUE
AWARENESS
 DENGUE
AWARENESS
 DENGUE
AWARENESS
 Is there immunity from DENGUE? Vaccines
against DENGUE?
There is a vaccine
DENGUE called Dengvaxia
Recovery from infection by one dengue virus
AWARENESS for people who
provides lifelong immunity against that
particular virus serotype. However, this have had dengue at
immunity confers only partial and transient least once and live
protection against subsequent infection by the in places where the
other three serotypes of the virus. disease is common.
 What are ROJoson’s Patient Empowerment advice on the DENGUE?

DENGUE • Beware of DENGUE infection. Majority are mild. Some may be fatal.
• Avoid mosquito bites.
AWARENESS
• Remove breeding places of mosquitoes in your home / in the
backyard.
• The moment there are symptoms suspected of DENGUE, REST and
HYDRATE right away.
• May need diagnostic tests (consult a physician).
• Monitor oneself. If with progression and warning signs, consult a
physician right away.
 Contents
• When and what is National DENGUE Awareness Month in the
Philippines?
DENGUE • What is the current disease burden of DENGUE in the Philippines?
AWARENESS • What is a DENGUE?
• How is DENGUE virus transmitted? Summary
• How to avoid / control DENGUE infection? Take Away
• What are the usual symptoms of DENGUE?
• What are the clinical categories of DENGUE?
• What is the DENGUE CASE CLASSIFICATION AND LEVEL OF
SEVERITY?
• What are the phases of DENGUE infection?
• What are the diagnostic tests for DENGUE?
• What are the treatment for DENGUE?
• Is there immunity from DENGUE? Vaccine against DENGUE?
• What are ROJoson’s Patient Empowerment advice on the DENGUE?
 Be always in touch with reliable medical Take Away in
information on DENGUE. relation to
DENGUE Patient
AWARENESS Empowerment
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions /
make better decisions on DENGUE issues
in your health management.
 us

Empowerment
objective - for
DENGUE laypeople to have an
AWARENESS essential
understanding of
DENGUE in their
health management.
Reminder after the PEP
Talk:

Take the Online Learning

cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.

Link is in Chat Box.

Reminder:
50 OLETE Certificates = 1
Voucher for ROJoson
Telemedical Consultation
 ROJOSON’S REQUEST:

Empowerment FEEDBACK TO THIS

objective - for PEP TALK!
DENGUE laypeople to have an
Pls. type in your
AWARENESS essential feedback in the chat
understanding of box during the open
DENGUE in their forum and before we
health management. adjourn!

Thank you!
 LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
Empowerment START Q&A AND
objective - for INTERACTIONS!
DENGUE laypeople to have an
AWARENESS essential Pls. turn on your
video!
understanding of
Show your face!
DENGUE in their
health management.