Dengue Fever



  • 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
Dengue fever is reportable to the CDC.


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


  • 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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