DENGUE FEVER

DENGUE HEMORRHAGIC FEVER

Epidemiology
Dengue fever is can be caused by one of four different serotypes
Having one type of Dengue does not protect you from having another
type in the future
More than one infection can cause a greater risk of developing dengue
hemorrhagic fever and dengue shock syndrome

Vector
Dengue fever is transmitted between people by mosquitos
It is spread by the bite of female mosquitoes mainly of the
species Aedes aegypti and, to a lesser extent, Ae. albopictus., which is
found in tropic and subtropic regions.

Incubation period
Symptoms usually begin 4-7 days after being bitten
Symptoms then last 3-10 days
For transmission to occur the mosquito must feed on a person during
a 5- day period when large amounts of virus are in the blood; this
period usually begins a little before the person become symptomatic

Signs and symptoms

Undifferentiated fever (usually 2-7 days)
A flat, red rash may appear over most of the body 2 to 5 days after the
fever starts. A second rash, which looks like the measles, appears later
in the disease. Infected people may have increased skin sensitivity and
are very uncomfortable.
Other symptoms include:
Fatigue
Headache (especially behind the eyes)
Joint aches (often severe)
Muscle aches (often severe)
Nausea and vomiting
Swollen lymph nodes
Cough
Sore throat
Nasal stuffiness
Dengue Hemorrhagic fever
Dengue fever can become DHF quickly, which is life threatening.

Signs and symptoms:

An acute febrile infection of sudden onset with a clinical manifestation of 3

stages:
First 4 days - febrile or invasive stage starts abruptly as high fever,
abdominal pain and headache; later flushing which may be
accompanied by vomiting, conjunctival infection and epistaxis.
4th 7th days - Toxic or hemorrhagic stage- lowering temperature,
severe abdominal pain, vomiting and frequent bleeding from G.I.T in
the form of hematemesis or melena. Unstable BP, narrow pulse
pressue and shock. Death may occur. Tourniquet test which may be
positive on 3rd day may become negative due to low or vasomotor
collapse.
7th to 10th day - convalescent or recovery stage generalized flushing
withinterventing areas of blanching appetite regained and blood
pressure already stable.

Classification
Severe, frank type- with flushing, sudden high fever, severe
hemorrhage, followed by sudden drop of temperature, shock and
terminating in recovery or death
Moderate- with high fever, but less hemorrhage, no shock
Mild- with slight fever, with or without petechial hemorrhage but
epidemiologically related to typical cases usually discovered in the
course of investigation of typical cases.

Danger Signs in Dengue Hemorrhagic Fever

Abdominal pain - intense and sustained
Persistent vomiting
Abrupt change from fever to hypothermia, with sweating and
prostration
Restlessness or somnolence

*All of these are signs of impending shock and should alert clinicians that the
patient needs close observation and fluids.

Diagnostic tests
Tourniquet Test (Rumpel Leads Test)
Inflate the bp cuff on the upper arm to point midway between the
systolic and diastolic pressure for 5 minutes.
 Release cuff and make an imaginary 2.5 cm square or 1 inch square
just below the cuff, at the antecubutal foss.
Count the number of the petechiae inside the box
A test is (+) when 20 or more petechiae per 2.5 cm square or 1
inch square are observed
Antibody titer for dengue virus types
Complete blood count (CBC)
Polymerase chain reaction (PCR) test for dengue virus types
Liver function tests

Management
Supportive and symptomatic treatment should be provided

For fever, give Paracetamol for muscle pains

For headache, give Analgesic. DONT give ASPIRIN.
Rapid replacement of body fluids is the most important treatment
Includes intensive monitoring and follow- up
Give ORESOL to replace fluid as in moderate dehydration 75 ml/ kg
in 4-6 hours or up to 2- 3 L in adults. Continue ORS intake until patients
condition improves.

Vaccine

DENGVAXIA

-The Sanofi Pasteur dengue vaccine is a live attenuated tetravalent

vaccine. The
attenuation in this innovative 4-in-1 vaccine is achieved using recombinant
DNA technology.
- The immunogenic properties of each of the four dengue serotypes are
combined with the wellcharacterized, attenuated profile of the YF-17D
vaccine strain (used for the yellow fever vaccine).
- The four recombinant dengue viruses are designed to induce an
immune response against each dengue serotype, but not to cause disease.
The immune response results in antibodies capable of fighting dengue
infections.
-The vaccines overall efficacy is based on its documented clinical
efficacy against all four serotypes which were circulating during the PIII
studies

Available for public and/or private immunization in a given country

following that countrys approval of the vaccine.

The vaccine is currently approved in:

-Mexico
 - Philippines
- Brazil
- El Salvador.

Methods of prevention and control

DENGUE PREVENTION AND CONTROL PROGRAM
The National Dengue Prevention and Control Program was first initiated by
the Department of Health (DOH) in 1993. Region VII and the National Capital
Region served as the pilot sites. It was not until 1998 when the program was
implemented nationwide. The target populations of the program are the
general population, the local government units, and the local health workers.

Vision: Dengue Risk-Free Philippines

Mission: To improve the quality of health of Filipinos by adopting an

integrated dengue control approach in the prevention and control of dengue
infection.

Goal: Reduce morbidity and mortality from dengue infection by

preventing the transmission of the virus from the mosquito vector human.

Objectives:

The objectives of the program are categorized into three: health status
objectives; risk reduction objectives; and services & protection objectives.

Health Status Objectives:

Reduce incidence from 32 cases/100,000 population to 20 cases/100,000

population;
Reduce case fatality rate by <1%; and
Detect and contain all epidemics.

Risk Reduction Objectives:

Reduce the risk of human exposure to aedes bite by House index of <5 and
Breteau index of 20;
Increase % of HH practicing removal of mosquito breeding places to 80%;
and
Increase awareness on DF/DHF to 100%.

Services & Protection Objectives:

Establish a Dengue Reference Laboratory capable of performing IgM capture

ELISA for Dengue Surveillance;
Increase the % of 1 and 2 government hospitals with laboratory capable of
platelet count and hematocrit; and
Ensure surveillance and investigation of all epidemics.

Partner Organizations/Agencies:

The following organizations/agencies take part in the achievement of the

programs objectives:

World Health Organization (WHO)

United Nations childrens Fund (UNICEF)
Department of Interior and Local Government (DILG)
Department of Education (DepEd)
United States Agency for International Development (USAID)
Asian Development Bank (ADB)
Philippine Health Insurance Corporation (PhilHealth)

ABKD (AKSYON BARANGAY KONTRA

DENGUE)
Bilang tugon sa patuloy na pagtaas ng kaso ng dengue sa bansa, inilabas ng
Department of Health ang ilang mga hakbang para maiwasan ang pagdami
ng lamok na maaaring may dalang dengue sa mga barangay. Ang ABKD
(Aksyon Barangay Kontra Dengue) ay kampanya ng DOH para malinis ang
mga lugar na maaring pamugaran ng lamok na may dengue.

Ang mga sumusunod na hakbang ay makatutulong na labanan ang pagdami

ng lamok
1. Butasan, biyakin o kaya ay lagyan ng lupa ang mga gulong upang hindi
maipunan ng tubig at pangitlugan ng lamok.
2. Takpan ang mga drum, timba at iba pang ipunan ng tubig upang hindi
pamahayan ng kiti-kiti at linisin ito minsan isang linggo.
3. Palitan ang tubig ng plorera o flower vase minsan isang linggo.
4. Linisin at alisin ang tubig sa paminggalan o lalagyan ng mga plato.
5. Itapon ang iba pang bagay na maaring pag-ipunan ng tubig at pangitlugan
ng lamok tulad ng lata, bote at tansan.
6. Linisin ang alulod ng bahay upang hindi maipunan ng tubig at pamahayan
ng kiti-kiti.

Nursing care

1. For hemorrhage keep patient at rest during bleeding episodes.

 - For nose bleeding, maintain an elevated position of trunk and
promote vasoconstriction in nasal mucosa membrane through an
ice bag over the forehead
- For melena, ice bag over the abdomen. Avoid unecessary movement
2. For shock- prevention is the best treatment. Dorsal recumbent position
facilitates circulation.
3. Diet- low fat, low fiber, non irritating, non- carbonated. Noodle soup may
be given

ABKD (Aksyon Barangay Kontra Dengue)

The Department of Health (DOH) led by Secretary Janette Loreto Garin along with
the Department of Education (DepEd) and the Department of the Interior and Local
Government (DILG) intensified the prevention and control of dengue through the
Aksyon Barangay Kontra Dengue (ABKD) program held at North Fairview Elementary
School on October 9, 2015.

DOH is implementing the ABKD to encourage everyone to do the 4S habit: Search

and destroy, use Self protection measures, Seek early consultation, and Say no to
indiscriminate fogging. This was an anti-dengue advocacy activity participated by
different barangay associations and schools officials and pupils to involve them in
the DOHs aim to lessen the cases of dengue. Also present and showed their
support in the event were Assistant Secretary Dr. Gerardo Bayugo of DOH, Regional
Director Ariel Valencia of DOH- National Capital Regional Office, Assistant Schools
Division Superintendent Betty Cabo, Zaldy Masangkay Division Chief of Bureau of
Local Government, City Health Officer Dr. Verdades Linga, Barangay officials and
staff led by Barangay Chairman Manuel Chua, and North Fairview teachers and
pupils led by Principal Susana de Jesus. As what Secretary Garin said, the
involvement of the community and other government agencies are essential on this
matter.

Sa ating sama-samang aksyon, mapapababa natin ang bilang ng kaso dengue at

dahil po sa inyo magiging successful po ang programang ito. Uulutin lang po namin,
the Department of Health is doing everything that it could, ang Aquino Health
Agenda, si Pangulong Aquino po ay walang pong ibang tugon kundi sugpuin talaga
ang dengue but the government alone cannot do this, we need you and we need
you to help us help you more. Sec. Garin stated.

This years rate of dengue cases is not alarming but is higher than last year.
According to Secretary Garin it is expected to increase and they are doing more
efforts to make action. In a positive note the case of death caused by dengue is
lower compared to the previous year.

At the end of the program, Insecticide Treated Screens (ITCs) were given to the
school to be placed in classrooms to prevent pupils in getting affected by mosquito
bringing dengue. The DOH will give these ITCs to 20, 000 classrooms on selected
schools in the Philippines. The screen can last up to 5 years if well-taken care of.
According to a research, mosquito bringing dengue are active before sunrise and
after sunset. So most likely the pupils will have a higher chance of getting dengue.
As a matter of fact, 40 % of dengue cases were from children from 1-10 years old
and 35 % from 11-20 years old.

The said event also held other set of activities and games for the pupils which topics
are in line with dengue. One of activity was the Amazing Race wherein students
searched for pictures of mosquito breeding places around the campus. Other
activities were Bandillo, Search and Destroy, and Vector control initiative games.
Participants were also able to receive advisories or flyers about dengue.

After the program a press conference was done to tackle issues and other concerns.
Secretary Garin briefly presented the major points with regards to dengue and
reminded everyone not just to remember the 4S but to practice it to prevent
dengue. Representatives from DepEd, DILG, Barangay and City Health Office
guaranteed that they will contribute for the success of Aksyon Barangay Kontra
Dengue program.

Last February 2, 2016, the Department of Health (DOH) assured the public
that the Philippines is still free from the continuous widespread of the Zika virus
infection. In a press briefing, Health Secretary Janette Garin said the government
remained vigilant against the disease since the mosquito carrying the virus was
present in the country.
As the Zika virus epidemic continues to spread across the globe, the
Department of Health (DOH) never fails to announce immediate precautions to
prevent acquiring the disease. Its effort to address the public to remember and use
the "4S" against the Zika virus and other mosquito-borne diseases. The acronym
"4S" encompasses the following guidelines:
S Search and destroy mosquito breeding places
S Use self-protection measures
S Seek early consultation for fever lasting more than two days
S Say yes to fogging when there is an impending outbreak
"The first step to prevent mosquito-borne diseases is within our homes. We
should not only remember the information being delivered by DOH to the
communities. Instead, let us make it a practice and instill cleanliness in our
surroundings. It is not only your family that will benefit from this habit, but the
entire community as well." Health Secretary Janette Garin said.
This January, news regarding the Zika virus has spread worldwide. Even its
increasing cases are alarming. The Zika virus disease is caused by a virus
transmitted by Aedes mosquitos. It causes an influenza-like disease with concurrent
conjunctivitis. This is the same mosquito that transmits dengue and chikungunya.
Once bitten, the person will experience mild fever, rash, conjunctivitis, and muscle
pain that normally last for 2 to 7 days. It is highly important to take precautions
such as cleaning your surroundings to prevent places where mosquitos can breed.
One must remember that mosquitos serve as the source of the infectious Zika virus.
In addition, due to the growing reports of microcephaly cases in other
countries, health authorities internationally and locally are continually studying the
potential link of the Zika virus in pregnant women and microcephaly. Microcephaly is
the destruction of the cerebral structure of an infant that makes it significantly
smaller than the heads of other children of the same age and sex. It reduces the
infants brain development that eventually leads to seizures, developmental delay,
intellectual disability, feeding problems, hearing loss, and vision problems.
Microcephaly is not a common condition, but somehow in some parts of Latin
America, its growing reported cases raised potential links with the Zika virus
infection.
Until concrete evidences are verified, women who are pregnant or planning to
become pregnant should take extra care to protect themselves from mosquito bites.
DOH advises that pregnant women who are experiencing symptoms of Zika virus
disease should seek early consultation. [1]
The Department of Health (DOH) continues to ensure the Filipinos if the Zika
virus situation invades the country, the health authorities will definitely be prepared
and ready for it. At present, there are 1,000 kits available for testing the Zika virus
at the Research Institute for Tropical Medicine (RITM). Health Secretary Garin added
that RITM can accommodate patients who show symptoms of Zika infection. In
addition, five other public hospitals namely the Lung Center of the Philippines,
Baguio General Hospital, San Lazaro Hospital, Southern Philippine Medical Center,
and the Vicente Sotto Memorial Medical Center are set to train in using the
detection kits for the Zika virus.
The World Health Organization (WHO) still does not recommend the
imposition of any travel, trade, or screening restrictions related to Zika virus
disease. However, it is advised that travelers going to and coming from countries
with known Zika virus cases maintain a high level of vigilance and self-care. [2]
Health Secretary Garin added, "Lets go back to basics; we always say that
prevention is better than cure. Prevention should start from our home. Make 4S a
regular habit and participate in cleaning activities initiated in our community.
Kalinisan at kalusugan. Makiisa sa kalinisan ng ating komunidad, ang kalusugan ay
responisibilad ng bawat isa."