Dengue Hemorrhagic Fever

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  • 1. DENGUE
  • 2. Key point: Early recognition and timely intervention Airamsherlyn P. Natinga, M.D.
  • 3. DISCUSSION
  • 4. Epidemiology  estimated 50 million dengue infections occur annually  approximately 2.5 billion people live in dengue endemic countries
  • 5. Epidemiology  From 1993 to 2007, a total of 307,850 cases of dengue with 3,406 deaths were reported in the Philippines.  Most of the cases occur in children between 1 to 10 years old with a case fatality rate of 1.7%.
  • 6. “Dengue is one disease entity with different clinical presentations and often with unpredictable clinical evolution and outcome.” Expert consensus groups
  • 7. Case Classification Expert group (Geneva, Switzerland, 2008)
  • 8. Criteria for Dengue ± Warning Signs
  • 9. Herman’s Rash
  • 10. Dengue with warning signs Severe dengue
  • 11. Transmission
  • 12. Dengue virus (DEN)  small single-stranded RNA virus comprising four distinct serotypes (DEN-1 to -4)  genus Flavivirus, family Flaviviridae  Asian genotypes of DEN-2 and DEN-3 are frequently associated with severe disease accompanying secondary dengue infections Dengue virus (DEN)
  • 13. Vector: Aedes aegypti
  • 14.  immature stages are found in water-filled habitats, mostly in artificial containers closely associated with human dwellings and often indoors.
  • 15. Host  After an incubation period of 4-10 days, infection by any of the four virus serotypes can produce a wide spectrum of illness, although most infections are asymptomatic or subclinical
  • 16. Individual Risk factors  Age  Ethnicity  Chronic illnesses
  • 17. Blood meal viremia Immune response Genetic Virus Severe dengue Plasma leakage Transient and reversible imbalance of inflammatory mediators, cytokines and chemokines Endothelial cell dysfunction Derangement of hemocoagulation system Shock Bleeding
  • 18. Course of dengue illness
  • 19. Clinical problems
  • 20. Management
  • 21. Group A  able to tolerate adequate volumes of oral fluids and pass urine at least once every six hours, and do not have any of the warning signs, particularly when fever subsides.  Sent home
  • 22. Group B  Referred for in-hospital management
  • 23. Group C  Emergency treatment and urgent referral
  • 24. Prevention
  • 25.  Vector control - controlling larval habitats and combatting adult mosquitos by screening widows and doors and using household insecticide space sprays.
  • 26.  Provision of reliable potable water.  Sanitation  Solid waste management  Health education  COMMUNITY PARTICIPATION
  • 27. New Avenues  Tetravalent dengue vaccines are under development.