Arbovirus Reference Laboratory

Centre for Emerging Zoonotic and Parasitic Diseases

1 Modderfontein Road, Sandringham
Johannesburg, 2131

DENGUE VIRUS
The disease Symptoms
 Dengue is a viral disease that is transmitted to people by  Dengue fever may occur in various forms
mosquitoes  Leukopenia and thrombocytopenia are common
 Caused by any one of four closely related dengue viruses  Dengue fever (majority of cases):
(DENV 1, DENV 2, DENV 3 or DENV 4) o Acute high fever, severe headache, pain behind eyes, body
 Areas affected extend to most tropical and subtropical aches and joint pains, nausea/vomiting, characteristic rash
countries of Oceania, Asia, the Caribbean, the Americas and (looks like sun burn – example below)
parts of Africa
 Countries and territories where dengue fever cases have
been reported (as of January, 2020)

 Most cases in South Africa were detected in travellers  Dengue haemorrhagic fever (DHF):
returning from tropical and sub-tropical countries where the o Symptoms similar to dengue fever PLUS
disease is endemic. One outbreak occurred in SA in 1926-27.  Severe and continuous pain in abdomen
 Bleeding from the nose, mouth, gums or skin bruising
 Frequent vomiting with or without blood
The mosquitoes  Black stools
 Aedes species mosquitoes transmit dengue virus  Excessive thirst (dry mouth)
 Pale, cold skin
 These same mosquitoes transmit chikungunya and Zika virus
 Restlessness, or sleepiness
 These mosquitoes bite mostly during the daytime
 Dengue shock syndrome (DSS)
o Dengue haemorrhagic fever PLUS
Laboratory investigation  Weak rapid pulse
 The laboratory diagnosis of dengue is based primarily on the  Narrow pulse pressure (less than 20mm Hg)
detection of antibodies by haemagglutination inhibition  Cold, clammy skin and restless
assay or ELISA in serum
 The detection of IgM antibodies or IgG seroconversion
between paired samples which have been taken two weeks
apart, indicates recent infection
 IgM antibodies are detectable ~ 1 week after infection and Illness course and outcomes
are highest at 2-4 weeks after onset of illness. They remain  Incubation period of 4-10 days
detectable for ~3 months  Most patients feel better within one week (range 2-7 days)
 If serum is collected within 8 days of illness onset, the  5% of patients will develop severe dengue which can result in
absence of detectable virus-specific IgM does not rule out a death
diagnosis, and the test may need to be repeated on a later  If you had dengue in the past, you are more likely to develop
sample severe dengue
 IgG antibody levels take longer to develop, but remain  DHF and DSS can occur 3-5 days after fever onset
detectable for years  Although fever may have subsided, this is the riskiest phase that
 Reverse transcription polymerase chain reaction (RT-PCR) requires high vigilance from care-givers
and virus isolation from a serum collected early in the
course of illness are additional tests that may be useful
 All samples submitted to the laboratory should include a
completed case investigation form
 Arbovirus Reference Laboratory
Centre for Emerging Zoonotic and Parasitic Diseases
1 Modderfontein Road, Sandringham
Johannesburg, 2131

Prevention Treatment and vaccines

 There is no antiviral medicine to treat dengue fever
USE INSECT REPELLANT  Currently there are one dengue vaccine, Dengvaxia® by
- Use DEET-containing insect repellents as directed by the Sanofi Pasteur, licenced in 2015, targeted for persons living
manufacturer in endemic areas, ranging from 9-45 years, who have had at
- Reapply during the day as needed least 1 documented dengue virus infection previously
WEAR LONG-SLEEVED SHIRTS AND PANTS  Many cases require no treatment
- Consider wearing long-sleeved, loose fitting shirts and  Symptomatic support such as pain and fever relief is often
pants when outdoors and likely to encounter mosquitoes prescribed
- When camping or similar activities consider using
permethrin treated gear and clothing
KEEP YOUR SURROUNDS MOSQUITO-FREE
More information on arboviral disease:
- Screen windows and doors
www.nicd.ac.za under the ‘Diseases A-Z’ tab
- Reduce mosquito breeding grounds. Mosquitoes lay eggs
www.cdc.gov/dengue/index.html
in and around water. Minimize the amount of standing
www.who.int/news-room/fact-sheets/detail/dengue-and-
water in and around the house – for example pots and
severe-dengue
other containers that contain stagnant water

Who should be tested for Dengue? Procedures to follow when submitting specimens for dengue
Persons presenting with rash (petechiae), fever, headache, ocular testing to the NICD
pain, nausea/vomiting or arthralgia/myalgia  Collect blood in a red (clotted blood) or yellow top (serum)
AND tube
Who recently (<14 days) travelled to an area with active dengue  Complete arbovirus case investigation form available on
virus transmission www.nicd.ac.za/diseases-a-z-index/arbovirus/
OR  Submit the specimen to the Arbovirus Reference Laboratory,
Persons with past dengue virus infection presenting with warning Centre for Emerging Zoonotic and Parasitic Diseases, National
signs for DHF and DSS as described under “Symptoms” Institute for Communicable Diseases for testing
 Samples should be kept cold (on ice packs or cold packs)
during transport
Laboratory testing offered by NICD  Dengue testing will be done during office hours, for additional
 RT-PCR testing and virus culture (clotted blood/serum) are information contact the laboratory at 011 386 6424 / 082 903
useful during the transient viraemic stage of infection (<7 days 9131 or [email protected]
post symptom onset). A negative RT-PCR / viral culture does  Arrange urgent testing with the NICD Hotline 082 883 9920
not exclude recent infection.  Submission of convalescent specimens is highly
 Paired serological testing (clotted blood/serum taken up to 14 recommended to facilitate interpretation of serological
days apart). A haemagglutination test (HAI) and dengue assays
specific IgM or IgG ELISA is available. Serology is limited by
cross-reactivity with other flaviviruses therefor paired
serological testing is essential. Specimens submitted for
dengue will also be tested for other arboviruses because of
overlapping clinical presentations
 Serology for dengue virus may not provide conclusive results
 Dengue virus is a category 3 notifiable medical condition
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Notifiable-Medical-Conditions_-notification-
procedures_v2Jan2018final-Copy.pdf)