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Dengue Lectureadasdasdadasdad, Lecture notes of Public Health

Cagayan State University (CSU)Public Health

About Dengue DOH Program adasdasdadasd

Typology: Lecture notes

2018/2019

Uploaded on 02/17/2019

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DENGUE
Dengue is the fastest spreading vector-borne disease in the world endemic in 100 countries·
•Dengue virus has four serotypes (DENV1, DENV2, DENV3 and DENV4)
•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.
•Dengue has no treatment but the disease can be early managed.
• The five year average cases of dengue is 185,008; five year average deaths is 732; and five year
average Case Fatality Rate is 0.39 (2012-2016 data).
TRANSMISSION
Dengue virus is transmitted by day biting Aedes aegypti and Aedes albopictus mosquitoes.
DENGUE CASE CLASSIFICATION AND LEVEL OF SEVERITY
•Dengue illness is categorized according to level of severity as dengue without warning signs, dengue with
warning signs and severe dengue.
•Dengue without warning warnings can be further classified according to signs and symptoms and
laboratory tests as suspect dengue, probable dengue and confirmed dengue.
a. dengue without warning signs
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)
a.2 probable dengue
- a suspect dengue case plus laboratory test: Dengue NS1 antigen test and atleast CBC
(leukopenia with or without thrombocytopenia) or dengue IgM antibody test (optional)
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)
b. dengue with warning signs
• a previously well person with acute febrile illness of 1-7 days plus any of the following: abdominial pain
or tenderness, persistent vomiting, clinical signs of fluid accumulation (ascites), mucosal bleeding,
lethargy or restlessness, liver enlargement, increase in haematocrit and/or decreasing platelet count
c. severe dengue
severe plasma leakage leading to
pf3
pf4
pf5

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DENGUE

Dengue is the fastest spreading vector-borne disease in the world endemic in 100 countries·

  • Dengue virus has four serotypes (DENV1, DENV2, DENV3 and DENV4)
  • 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.
  • Dengue has no treatment but the disease can be early managed.
  • The five year average cases of dengue is 185,008; five year average deaths is 732; and five year average Case Fatality Rate is 0.39 (2012-2016 data).

TRANSMISSION

Dengue virus is transmitted by day biting Aedes aegypti and Aedes albopictus mosquitoes.

DENGUE CASE CLASSIFICATION AND LEVEL OF SEVERITY

  • Dengue illness is categorized according to level of severity as dengue without warning signs, dengue with warning signs and severe dengue.
  • Dengue without warning warnings can be further classified according to signs and symptoms and laboratory tests as suspect dengue, probable dengue and confirmed dengue.

a. dengue without warning signs

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)

a.2 probable dengue

  • a suspect dengue case plus laboratory test: Dengue NS1 antigen test and atleast CBC (leukopenia with or without thrombocytopenia) or dengue IgM antibody test (optional)

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)

b. dengue with warning signs

  • a previously well person with acute febrile illness of 1-7 days plus any of the following: abdominial pain or tenderness, persistent vomiting, clinical signs of fluid accumulation (ascites), mucosal bleeding, lethargy or restlessness, liver enlargement, increase in haematocrit and/or decreasing platelet count

c. severe dengue

severe plasma leakage leading to

  • shock (DSS)
  • fluid accumulation with respiratory distress

severe 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)

PHASES OF DENGUE INFECTION

a. Febrile Phase

  • (^) Usually last 2-7 days
  • 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.

b. Critical Phase

  • Phase when patient can either improve or deteriorate.
  • 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.

c. Recovery Phase

  • Happens in the next 48 to 72 hours in which the 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.

LABORATORY TESTS

Test Description

1. Dengue NS1 RDT • Requested between 1-5 days of illness

  • Use to detect dengue virus antigen during early phase of acute dengue infection
  • Test is for free in all health centers and selected public hospitals nationwide

2. Dengue IgM/IgG • Requested beyond five days of illness

  • Use to detect dengue antibodies during acute late stage of dengue infection (IgM) and to determine previous infection (IgG)
  • May give false positive result due to antibodies induced by dengue vaccine
  • May cross react with other arboviral diseases such as Chikungunya and Zika
  • DOH augmentation is limited to selected government hospitals only

3. Polymerase Chain Reaction (PCR) • One of the gold standard laboratory tests to confirm dengue virus.

  • Molecular based test confirmatory test
  • Available only in dengue sub-national and national reference laboratories
  1. Nucleic Acid Amplification Test- Loop Mediated Isothermal Amplification Assay (NAAT-LAMP)
  • A novel molecular-based confirmatory test used to detect dengue virus.
  • Work just like PCR but cheaper and simpler in nature.
  • In the pipeline to be introduced under the National Dengue Prevention and Control Program in district and provincial hospitals

5. Plaque Reduction Neutralization Test (PRNT) • Gold standard to characterize and quantify circulating level of anti-

DENV neutralizing antibody (NAb)

  • Available only at the dengue national reference laboratory
  1. Other tests: -Total While Blood Cell (WBC) count -Platelet -Hematocrit
  • Routinely used in hospitals as standard dengue diagnostic tests
  • Look for trend of decreasing WBC, decreasing platelet and increasing hematocrit

NATIONAL DENGUE PREVENTION AND CONTROL PROGRAM

Vision A dengue free Philippines

Mission Ensure healthy lives and promote well-being for all at all ages

Goal To reduce the burden of dengue disease

Objectives/ 1.) To reduce dengue morbidity by atleast 25% by 2022

Indicators Morbidity rate = No. of suspect, probable & confirmed cases x100,

total population

(baseline: 198.1 per 100,000 population)

(2015 data: 200,145/100,981,437 x 100,000)

2.) To reduce dengue mortality by atleaset 50% by 2022

Mortality rate = No of dengue (probable & confirmed) deaths x 100,

total population

(baseline: 0.59 per 100,000 population)

(2015 data: 598/100,981.437 x 100,100)

3.) To maintain Case Fatality Rate (CFR) to < 1% every year.

CFR = no. of dengue (probable & confirmed) deaths x 100

no. of probable & confirmed cases