Dengue Fever

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Basics

Description

  • Dengue fever or “breakbone fever” is caused by an arbovirus—dengue virus (DENV)—a Flavivirus, from the Flaviviridae family.
  • Single-stranded positive RNA virus with four antigenically distinct serotypes (DENV1, DENV2, DENV3, DENV4)
  • Endemic in tropical and subtropical regions of Africa, Asia, and America

ALERT
Dengue fever is reportable to the CDC.

Epidemiology

Incidence
Estimated 390 million dengue infections per year—96 million have clinical manifestations (1)

Prevalence
  • 3.9 billion people, in 128 countries, are at risk for dengue infection.
  • The virus is common in tropical and subtropical climates, mostly in urban and residential areas.
  • There have been multiple dengue fever outbreaks in the continental United States over the past decade.

Etiology and Pathophysiology

  • Dengue is transmitted by the bite from an infected female Aedes mosquito.
  • Symptoms appear after a 4- to 7-day incubation period.
  • The virus spreads via the reticuloendothelial system.
  • The disease has three phases: febrile, critical (plasma leak), and spontaneous recovery (convalescent).
  • Dengue hemorrhagic fever (DHF) is a complication of dengue fever thought to be due to antibody-dependent response related to prior exposure to a different serotype with subsequent endothelial dysfunction and vascular instability; can progress to dengue shock syndrome (DSS)

Risk Factors

  • Residing in or traveling to endemic areas
  • Risk factors for the development of DHF include (2):
    • Young age; female gender
    • High body mass index
    • Sequential infection by different DENV serotypes

General Prevention

  • CYD-TDV (Dengvaxia) is a prophylactic, tetravalent, live attenuated viral vaccine licensed in several countries in Latin America and Southeast Asia in 2015; vaccination recommended for individuals with history of previous DENV infection or laboratory evidence of prior infection (seropositive individuals), as long as minimalization of risk can be assured (3)[A]
  • Avoid mosquito exposure (4)[C].
  • Vector control can be achieved through chemical, biologic, and environmental means (e.g., removal of breeding sites—standing water) (5)[C].
  • The Aedes mosquito is most active during the day and prefers to bite indoors. Wear protective clothing and use insect repellent to decrease bite exposures.

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