DENGUE CONTROL PROGRAM
Definition:
Dengue fever is a mosquito-borne tropical disease caused by the dengue virus.
This may include a high fever, headache, vomiting, muscle and joint pains, and a
characteristic skin rash.
Recovery generally takes two to seven days. In a small proportion of cases, the
disease develops into the life-threatening dengue haemorrhagic fever, resulting in
bleeding, low levels of blood platelets and blood plasma leakage, or into dengue
shock syndrome, where dangerously low blood pressure occurs.
INTRODUCTION
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.
ETIOLOGIC AGENT
The causative agent of Dengue Haemorrhagic Fever (DHF) is dengue virus, of
which there are 4 serotypes.
When a person is infected with dengue virus for the first time, clinical signs and
symptoms are usually mild. However, if he/she is reinfected with a different type
of dengue virus, severe conditions such as bleeding or shock will occur and can
be fatal. This disease is usually found in children less than 15 years of age.
MODE OF TRANSMISSION
Aedes aegypti is the main mosquito vector that transmits the dengue virus from
person to person. When a female Aedes aegypti feeds on a dengue virus infected
person, the viruses multiply in the insect body and remain there for the whole life
span of the mosquito, approximately 1-2 months. Viruses are then transferred to
another person being bitten by an infected mosquito.
Aedes aegypti can be found both inside and outside houses. They prefer to feed
during the day. Their breeding places are containers with clear water, for
example, jars, vases, ant traps, dishes, cans, pots, flower pots, tires, etc.
Aedes aegypti
VECTOR
The dengue virus is carried and spread by mosquitoes in the genus Aedes, which
includes a number of mosquito species. Of these species, the primary vector of the
dengue virus is the species Aedes aegypti. It is the principal dengue vector
responsible for dengue transmission and dengue epidemics.
INCUBATION PERIOD
Symptoms usually last for 2–7 days, after an incubation period of 4–10 days after
the bite from an infected mosquito. Severe dengue is a potentially deadly
complication due to plasma leaking, fluid accumulation, respiratory distress,
severe bleeding, or organ impairment.
CLINICAL MANIFESTATIONS
Pathognomonic sign
o According to severity: Grade I to IV
Grade 1
Fever and nonspecific constitutional symptoms
Positive tourniquet test is only haemorrhagic manifestation
Grade 2
Grade 1 manifestations + spontaneous bleeding
Grade 3
Signs of circulatory failure (rapid/weak pulse, narrow pulse pressure,
hypotension, cold/clammy skin)
Grade 4
Profound shock (undetectable pulse and BP)
According to sequelae:
Dengue fever
is an acute viral illness characterized by:
1. Fever, often with sudden onset;
2. Severe headache, often described as retro-ocular;
3. Myalgia's and arthralgia's that can be very severe;
4. Nausea and vomiting;
5. A rash that may present at different stages of the illness, and whose appearance can be
variable—it may be maculopapular, petechial, or erythematous.
6. Haemorrhagic manifestations.
Dengue Haemorrhagic fever
1. Skin haemorrhage's: petechiae, purpura, ecchymoses
2. Gingival bleeding
3. Nasal bleeding
4. Gastrointestinal bleeding: hematemesis, melena, hematochezia
5. Hematuria
6. Increased menstrual flow
Dengue Shock Syndrome
1. 4 criteria for DHF
2. Frank shock is direct evidence of circulatory failure
3. Evidence of circulatory failure manifested indirectly by all of the following:
Rapid and weak pulse
Narrow pulse pressure (< 20 mm Hg) OR
hypotension for age
Cold, clammy skin and altered mental status
PHASES OF ILLNESS
Initial febrile phase lasting from 2-3 days
• High Fever (39-40֯C) with headache
• Convulsions may appear
• Flushing of the palms and sole
• Anorexia, Vomiting, myalgia
• Abdominal Pain
• Hemorrhagic manifestation such as purpura, epistaxis and gum bleeding
• haemorrhagic manifestations may be present – petechiae, mucosal bleeding etc
• liver may be enlarged and tender
• full blood count may indicate a progressive decrease in white cell count which is one of
the earliest signs and should alert the physician to a high probability of dengue
• patients should be monitored for warning signs and other clinical parameters for the
development of the critical phase
Critical Phase
during the transition from febrile to afebrile phase. patient enters a period of highest risk
for developing the severe manifestations of plasma leak and haemorrhage
usually starts around the time of defervescence (between day 3-8 of the illness)
the following warning signs usually precede the manifestations of shock (may occur at or
after defervescence)
abdominal pain or tenderness
persistent vomiting
accumulation of clinical fluid (e.g. - ascites, pleural effusion)
spontaneous mucosal bleeding
lethargy or restlessness
liver enlargement >2 cm
increase in haematocrit with rapid decrease in platelet count
DIAGNOSTIC TESTS
Complete Blood Count (CBC)
The complete blood count (CBC) is often used as a broad screening test to determine
an individual's general health status. It can be used to:
1. Screen for a wide range of conditions and diseases
2. Help diagnose various conditions, such as anemia, infection, inflammation, bleeding
disorder or leukemia.
3. Monitor the condition and/or effectiveness of treatment after a diagnosis is established
4. Monitor treatment that is known to affect blood cells, such as chemotherapy or radiation
therapy
Platelet Count
A platelet count is used to detect the number of platelets in the blood. The test is included
in a complete blood count (CBC), a panel of tests often performed as part of a general
health examination.
Platelets are tiny fragments of cells that are essential for normal blood clotting. A platelet
count may be used to screen for or diagnose various diseases and conditions that can
cause problems with clot formation. It may be used as part of the workup of a bleeding
disorder, bone marrow disease, or excessive clotting disorder,
Hematocrit
The hematocrit test is often used to check for anemia, usually along with a hemoglobin test or as
part of a complete blood count (CBC). The test may be used to screen for, diagnose, or monitor a
number of conditions and diseases that affect the proportion of the blood made up of red blood
cells (RBCs). RBCs circulate in the blood and carry oxygen throughout the body.
A hematocrit may be used to:
1. Identify and evaluate the severity of anemia (low RBCs, low hemoglobin, low
hematocrit) or polycythemia (high RBCs, high hemoglobin, high hematocrit)
2. Monitor the response to treatment of anemia or polycythemia and other disorders that
affect RBC production or lifespan
3. Help make decisions about blood transfusions or other treatments if anemia is severe
4. Evaluate dehydration
Capillary refill time (CRT)
is defined as the time taken for color to return to an external capillary bed after pressure
is applied to cause blanching.It can be measured by holding a hand higher than heart-
level and pressing the soft pad of a finger or fingernail until it turns white, then taking
note of the time needed for the color to return once pressure is released.
Hemagglutination Inhibition (HI, HAI) test
a highly sensitive procedure for the measurement of soluble antigens in biologic
specimens; the amount of hemagglutination reflects the amount of free antibody present
after reaction with the specimen and thus varies inversely with amount of antigen in the
specimen.
Medical and Nursing Management
Preventive and control measures that would involve health education and strongly
advocating the implementation of 4S, recognition of disease, case finding and reporting
for cases in the community.
DENGUE STRATEGY
• Daily monitoring of patient’s status,
• Encourage intake of oral fluids like oresol, water, juice
• Note any dengue warning signs like persistent vomiting and bleeding
• Give paracetamol for fever and NOT aspirin, because aspirin induces bleeding
• Use mosquito nets
• Early consultation is adviced for any warning signs
The Four S drive implemented by the Department of Health corresponds to:
Search and destroy the mosquito dengue carrier’s breeding sites (recently
pinpointing buko shell or coconut shells, tires, and bromeliads)
Self protection against mosquito (use of loose clothing with long sleeves and long
socks, use of mosquito nets, tested mosquito repellants)
Seek early consultation (Early detection of condition means treatment could be
administered readily to prevent fatal complications of dengue)
Say NO to indiscriminate fogging (Fogging is not advised nowadays because it does not
really eliminate mosquitoes but it only scares them away. It is also not recommended
because of its respiratory consequences.)
Vaccine Development
The first dengue vaccine, Dengvaxia (CYD-TDV) by Sanofi Pasteur, was first registered In
Mexico in December, 2015.
Duration of protection Vaccine efficacy against virologically-confirmed dengue illness of
any severity has been measured in the first and second years post dose 1. Active
surveillance is currently being re-initiated, so that vaccine efficacy 5–6 years post dose 1
can be evaluated.
