Dengue Fever

in the Philippines

VILORIA, Klarissa D.
Yamzon, Liana Alpha T.
3F-PH

What is Dengue Fever?

Mosquito: Aedes Aegypti

Also known as breakbone fever.
Common in tropical countries
like Philippines
Symptoms : mild to high grade fever,
headache, joint and muscle pain, rash
Complication: Dengue Hemorrhagic Fever
Lethal!

Dengue Serotypes

DEN-1
DEN-2
DEN-3
DEN-4

Serotypes each has different interactions with the

antibodies in human blood serum
Share approximately 65% of their genomes
The four dengue serotypes share the same geographic
and ecological niche.

1970s

2004

DEN-1 and DEN-2 were found in Central America and

Africa
all four serotypes were present in Southeast Asia
the geographical distribution of the four serotypes had
spread widely

At present

all four dengue serotypes circulate together in tropical and

subtropical regions around the world

Scientists hypothesize that the dengue viruses

evolved in nonhuman primates and jumped from
these primates to humans in Africa or Southeast Asia
between 500 and 1,000 years ago.

After recovering from an infection with one dengue

serotype, a person has immunity against that
particular serotype.
Individuals are protected from infections with the
remaining three serotypes for two to three months
after the first dengue infection.
No long-term protection
After that short period, a person can be infected with
any of the remaining three dengue serotypes.

Impact of Dengue in the Philippines

1996-2005
Dengue Incidence Manila,
Philippines 1996 -2005

Transmission of Dengue

VECTOR: Transmitted
to humans by bite of
female aedes aegypti
mosquito. Dengue
mosquitos lay eggs in
areas with water

HOST: Humans
become host of virus.
Virus incubation is 4-10
days then produce
dengue
symptoms
TRANSMISSION:

Humans get infected

from bite of infected
aedes mosquito.
Mosquitos get infected
when they bite infected
humans.

Transmission

Infected
mosquito

Healthy person
Incubation Period: 3 to 14 days
Most commonly 4 to 7 days

Infected
person

Diagnosis

Basis: reported symptoms and physical

examinations

However, early disease can be difficult to

differentiate from other viral infections.
Probable diagnosis: Fever plus two of the ff.

nausea and vomiting, rash, generalized pains, low white

blood cell count, positive tourniquet test, or any warning
sign in someone who lives in an endemic area.

Tourniquet test

particularly useful in settings where no laboratory

investigations are readily available
application of a blood pressure cuff at between the
diastolic and systolic pressure for five minutes, followed
by the counting of any petechial hemorrhages
a higher number makes a diagnosis of dengue more likely
with the cut off being more than 10 to 20 per 1 inch2
(6.25 cm2).

Diagnosis should be considered in anyone who

develops a fever within two weeks of being in the
tropics or subtropics.
Difficult to distinguish dengue fever and chikungunya
Cause similar symptoms, such as malaria,
leptospirosis, viral hemorrhagic fever, typhoid fever,
meningococcal disease, measles, and influenza

Dengue fever (WHO 1997 classification)

undifferentiated fever
dengue fever
dengue hemorrhagic fever

Dengue fever (WHO 2009 classification)

Uncomplicated
Severe

 Severe

dengue

defined as that associated with severe

bleeding, severe organ dysfunction, or
severe plasma leakage while all other
cases are uncomplicated.

Dengue hemorrhagic fever was subdivided further

into grades IIV.

Grade I is the presence only of easy bruising or a positive

tourniquet test in someone with fever
Grade II is the presence of spontaneous bleeding into the
skin and elsewhere
Grade III is the clinical evidence of shock
Grade IV is shock so severe that blood pressure and
pulse cannot be detected.
Grades III and IV are referred to as "dengue shock
syndrome".

LABORATORY TESTS
Microbiological laboratory testing

virus isolation in cell cultures

nucleic acid detection by PCR,
viral antigen detection (such as for NS1)
specific antibodies (serology)

Treatment

no specific medication for treatment for a dengue

infection
adequate hydration and pain control- will help the
person through the infection

Nonsteroidal anti-inflammatory agents (aspirin, ibuprofen)

should be avoided because of the tendency of the dengue

viruses to cause hemorrhages. The NSAIDs may add to the
hemorrhage symptoms.

Other medications such as acetaminophen, codeine, or

other agents that are not NSAIDs may be used.

For those with dengue fever (hemorrhagic and shock

syndrome) usually require additional supportive
treatments:

Hospitalization
IV hydration
blood transfusions
platelet transfusions
blood pressure support

Prevention

Environmental Management
Biological Control
Chemical Control

ENVIRONMENTAL MANAGEMENT

Modification

Manipulation

Changes in Human
Behavior

CHEMICAL CONTROL

Use of insecticides
Fogging
Use of mosquito coils
Repellents

BIOLOGICAL CONTROL

Fish (poecilia reticulata)

Predatory copepods
(copepoda cyclopoidea)

Lethal ovitraps

Epidemiology

Fatality rate

15%, and less than 1% with adequate treatment

up to 26% for those who develop significantly low blood
pressure
More common in 110 countries
infects 50 to 528 million people worldwide a year
half a million hospitalizations
approximately 25,000 deaths
12 countries in Southeast Asia were estimated to have
about 3 million infections and 6,000 deaths annually

most commonly acquired in the urban environment

increased the number of epidemics and circulating
viruses

expansion of villages, towns and cities in the areas in

which it is common, and the increased mobility of people

Rates of dengue increased 30 fold between 1960

and 2010

due to a combination of urbanization, population growth,

increased international travel, and global warming

An infection with dengue is second only to malaria

as a diagnosed cause of fever among travelers
returning from the developing world.

It is the most common viral disease transmitted by

arthropods, and has a disease burden estimated at
1,600 disability-adjusted life years per million
population.

The World Health Organization counts dengue as

one of seventeen neglected tropical diseases.

Anti-Dengue Programs in the Philippines

June 2011: Dengue

Prevention Month
Massive antidengue campaign

Anti-Dengue Programs in the Philippines

Distribution and training

on use of mosquito OL
trap (ovicidal-larvicidal
trap)

Anti-Dengue Programs in the Philippines

Multi-sectoral
mosquito search
and destroy cleanup
campaign

References
WEBSITES:
World Health Organization http://www.who.int/topics/dengue/en/
Centers for Disease Control and Prevention
http://www.cdc.gov/dengue/
WHO. Dengue Haemorrhagic fever ealy recognition diagnosis and
hospital management. An audiovisual guide for healthcrae workers
responding to
outbreaks.http://www.who.int/csr/don/archive/disease/dengue_fever/den
gue.pdf
WHO. Global Alert and response.
http://www.who.int/csr/disease/dengue/en/
World Heath Organization. Guidelines for treatment of demgue
fever/dengue hemorrhagic fever in small hospitals.
http://www.searo.who.int/LinkFiles/Dengue_Guideline-dengue.pdf
CDC, Clinicians Reference
card.http://www.cdc.gov/Dengue/resources/Dengue%20Case%20Manag
ement_card_125085_12x6_Zcard_Dengue.pdf
CDC. Information for health care practitioners.
http://www.cdc.gov/dengue/resources/Dengue&DHF%20Information%20
for%20Health%20Care%20Practitioners_2009.pdf
CDC. Basic facts on Dengue
http://www.cdc.gov/dengue/resources/CS_205910A.Dengue%20patient%20Ed%20Eng.FINAL.pdf

References
JOURNALS/ARTICLES:
Bernardo, E. C. (2008). Solid-Waste Management Practices of
Households in Manila, Philippines. Annals Of The New York
Academy Of Sciences, 1140420-424. doi:10.1196/annals.1454.016
Johansson, MA, F Dominici, & GE Glass. Local and global effects of
climate on dengue transmission in Puerto Rico. PLoS Neglected
Tropical Diseases. 3(2): e382 (2009).
Barrera R. 2009. Simplified Aedes aegyptis pupal-surveys for
entomological surveillance and dengue control. American Journal of
Tropical Medicine and Hygiene 81: 100-107.
http://www.ajtmh.org/cgi/reprint/81/1/100
Barrera R, Amador M, Daz A. Joshua Smith, Muoz-Jordn JL,
Rosario Y. 2008. Unusual productivity of Aedes aegypti in septic
tanks and its implications for dengue control. Medical and Veterinary
Entomology 22:62-69. http://www3.interscience.wiley.com/cgibin/fulltext/119401311/PDFSTART
Group on Dengue Meeting 1-5 October 2006, Special Programme for
Research and Training in Tropical Diseases UNICEF/UNDP/World
Bank and WHO.

References
World Health Education ( 2009).Dengue guidelines for diagnosis treatment prevention and
control. Retrieved from http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf
Centers for Disease Control and Prevention (2009). Dengue frequently asked questions.
Retrieved from http://www.cdc.gov/Dengue/faqFacts/index.html
World Health Organization (2006). Dengue hemorrhagic fever early recognition
diagnosis and hospital management an audiovisual guide for health care
workers responding to outbreaks. retrieved from
http://www.who.int/csr/don/archive/disease/dengue_fever/dengue.pdf
Department of Health (2011) Disease surveillance report morbidity week 36. Retrieved
from http://dev1.doh.gov.ph/sites/default/files/2011Den36WMR_draft.pdf
Sia Su, G. L. (2008). Correlation of Climatic Factors and Dengue Incidence in Metro Manila,
Philippines. AMBIO - A Journal Of The Human Environment, 37(4), 292-294. Retrieved from
http://web.ebscohost.com.ezp.waldenulibrary.org/ehost/detail?vid=5&hid=12&sid=c81b1f84903a-4856-81e3d2a7b75da458%40sessionmgr14&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl#db=a9
h&AN=33116717

References
Centers for Disease and Control Prevention ( 2010) . Transmission of dengue virus
retrieved from http://www.cdc.gov/Dengue/epidemiology/index.html#transmission
Centers for Disease and Control Prevention ( n.d.) how to prevent the spread of
mosquito that causes dengue. Retrieved from
http://www.cdc.gov/dengue/resources/Vector%20control%20sheet%20dengue.pdf
Centers for disease control and prevention (2010). Larval control and other vector
control preventions. Retrieved from
http://www.cdc.gov/malaria/malaria_worldwide/reduction/vector_control.html
Elias, M. Islam, M. Kabir, M & Rahman,M. ( 1995, August). Biological control of
mosquito larvae by guppy fish. Bangladesh medical research council bulletin.21(2):81-6.
Department of medical entomology. Institute of preventative and social medicine
Mohakhali, Dhaka.Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8815867
Department of health ( 2011). Dengue surge in Luzon. Retrieved from
http://dev1.doh.gov.ph/content/dengue-surge-luzon

References
Department of science and technology (n.d.).Mosquioto OL trap. Retrieved
from www.science.ph/oltrap/

Department of Health (2011) . National dengue prevention and control

program. Retrieved form http://www.doh.gov.ph.content/national-dengueprevention-and-control-program

World Health Organization (2012) Dengue epidemiology philippines. World

health organization Western pacific region Retrieved from
http://www.wpro.who.int/sites/mvp/epidemiology/dengue/phl_profile.htm