This document provides information about dengue fever, including its causes, symptoms, treatment and prevention. It is caused by the dengue virus transmitted by Aedes mosquitoes. Symptoms range from mild fever to severe dengue hemorrhagic fever. There is no vaccine yet available, so prevention focuses on controlling the mosquito vector and avoiding bites. Globally, dengue affects millions annually and is widespread in tropical and subtropical regions.

1. DENGUE
By:
Waqar Younus
Group J
Fourth Year MBBS
Bolan Medical College,Quetta

2. OBJECTIVE
• To educate the people about Dengue
• To aware the people how to prevent and
control Dengue

3. SEQUENCE
• What is Dengue Fever?
• Distribution of Dengue Fever
• Outbreak in Pakistan
• Mosquito-characteristics and life cycle
• Symptoms of Dengue Fever
• Treatment of Dengue Fever
• Prevention of Dengue Fever

4. WHAT IS DENGUE FEVER
• Dengue fever also known as “BREAK BONE
FEVER” is a mosquito borne viral infection
caused by the dengue virus (flavi virus),
transmitted by the mosquito Aedes Aegypti
rarely Aedes Albopictus.

5. INCIDENCE
• 50-100 million dengue fever infections per
year globally
• 0.5 million cases of severe dengue, dengue
hemorrhagic fever or dengue shock syndrome
• 100-200 cases annually in U.S.
• Average case fatality 5%

6. DISTRIBUTION
• Endemic in more than 100 tropical and
subtropical countries.
• Pandemic began in Southeast Asia after World
War II with subsequent global spread.
• Several epidemics since 1980s.
• Distribution is comparable to malaria.

7. MOST COMMON VICTIMS OF
MOSQUITO BITE
People of Humid Areas

8. GLOBAL STATUS
• New infections annually: 50 million
• Deaths: 24,000 annually
• People at risk: 2.5-3 billion
• Hospitalized cases: 500 000/year
(90% of those affected are children)
• Disease burden: 465,000 Disability Adjusted
Life Years (DALY)
• Half of the world lives in HOT ZONE

9. DENGUE OUT BREAK IN SOUTH EAST
ASIA 2005

10. OUTBREAK IN PAKISTAN
• The first case of Dengue Fever
was detected in Pakistan in
the year 1994 in Karachi
• The first outbreak of Dengue
Fever was in the year 2006
• Since then dengue cases
detected per year are on the
rise

11. DENGUE OUT BREAK IN PAKISTAN 2006

12. OUTBREAK IN PAKISTAN 2011
• Over 4000 cases have been reported all over
Pakistan
• NIH shows 2143 confirmed and 2708
suspected cases of Dengue Fever
• Maximum cases have been seen in Punjab
Province where up to 10 deaths have been
confirmed
• In GB Province no case have been confirmed

13. OUTBREAK IN PAKISTAN 2011

14. DENGUE CASES REPORTED IN 2014

15. Out of 286 cases in Sindh,278 were
reported in Karachi.
No case reported in Quetta District

16. CHARACTERISTICS OF MOSQUITO
• Aedes Mosquito
• One distinct physical
feature – black and white
stripes on its body and
legs
• Bites during the dawn and
dusk
• Lays its eggs in clean,
stagnant water

17. CHARACTERISTICS OF MOSQUITO
• Only the female Aedes
mosquito feeds on blood
because they need the
protein found in blood to
produce eggs
• Male mosquitoes feed only
on plant nectar
• On average, a female
Aedes mosquito can lay
about 300 eggs during her
life span of 14 to 21 days

18. CHARACTERISTICS OF MOSQUITO
Anopheles Mosquito Aedes Mosquito

19. LIFE CYCLE OF AEDES MOSQUITO

21. VIROLOGY
• Flavivirus family
• Small enveloped
viruses containing
single stranded RNA
• Four distinct viral
serotypes (Den-1,
Den-2, Den-3, Den-4)

22. PATHOPHYSIOLOGY
• Transmitted by the bite
of Aedes mosquito
(Aedes aegypti)
• Incubation period: 3-14
days
• Acute illness and
viremia 3-7 days
• Recovery or progression
to leakage phase

23. MANIFESTATIONS OF DENGUE VIRUS
INFECTION

24. UNDIFFERENTIATED FEVER
• May be the most common manifestation of
dengue
• Prospective study found that 87% of students
infected were either asymptomatic or only
mildly symptomatic
• Other prospective studies including all age-
groups also demonstrate silent transmission
• DS Burke, et al. A prospective study of dengue infections in Bangkok. Am J Trop
Med Hyg 1988; 38:172-80.

25. SYMPTOMS OF DENGUE FEVER
Dengue Fever
• Headaches
• High grade fever
• Swollen glands
• Vomiting
• Muscle joints pain
• Positive tourniquet test
• Basic symptoms in 90% of
patients
• Settles in two weeks

26. SYMPTOMS OF DENGUE
HEMORRHAGIC FEVER
• All previous symptoms of Dengue Fever
• Skin hemorrhages:
petechiae, purpura, ecchymoses
• Gingival bleeding
• Nasal bleeding
• Gastro-intestinal bleeding:
hematemesis, melena, hematochezia
• Hematuria
• Increased menstrual flow

27. Positive tourniquet test

28. GRADES OF DHF

29. CLINCAL CASE DEFINITION FOR
DENGUE HEMORRHAGIC FEVER
• Fever, or recent history of acute fever
• Hemorrhagic manifestations
• Low platelet count (100,000/mm3 or less)
• Objective evidence of “leaky capillaries:”
• elevated hematocrit (20% or more over
baseline)
• low albumin
• pleural or other effusions

30. DANGER SIGNS IN
DENGUE HEMORRHAGIC FEVER
• Abdominal pain - intense and sustained
• Persistent vomiting
• Abrupt change from fever to hypothermia,
with sweating and prostration
• Restlessness or somnolence

31. TREATMENT FOR DENGUE FEVER &
DHF I & II
• Fluids
• Rest
• Antipyretics (avoid aspirin and non-steroidal
anti-inflammatory drugs)
• Monitor blood pressure, hematocrit, platelet
count, level of consciousness

32. TRAETMENT FOR DHF III & IV
• All above treatment plus
• In case of severe bleeding, give fresh whole
blood 20 ml/kg as a bolus
• Give platelet rich plasma transfusion
exceptionally when platelet counts are below
5,000–10,000/ mm3 .
• After blood transfusion, continue fluid therapy at
10 ml/kg/h and reduce it stepwise to bring it
down to 3 ml/kg/h and maintain it for 24-48 hrs

33. NATURAL DENGUE TREATMENT
• Papaya Juice vs. Dengue ?
• Raw papaya leaves, 2 pcs just cleaned and pound
and squeeze with filter cloth. You will only get
one tablespoon per leaf. So two tablespoon per
serving once a day.
• Do not boil or cook or rinse with hot water, it will
loose its strength. Only the leafy part and no
stem or sap.
• It is very bitter and you have to swallow it like
Wong Low Kat. But it works.
• Source: from Indonesia March 2005

34. DO YOU KNOW
• Dengue fever and dengue hemorrhagic fever
are the most common mosquito-borne viral
disease in the world.
• Only the female mosquito feeds on blood. This
is because they need the protein found in
blood to produce eggs. Male mosquitoes feed
only on plant nectar.

35. DO YOU KNOW
• The mosquito is attracted by the body odors,
carbon dioxide and heat emitted from the
animal or humans.
• The female Aedes mosquito searches for
suitable places to lay their eggs.
• Aedes are day-biters, most active during
dawn and dusk.

36. VACCINE
Chemeri Vax Dengue
• A tetravalent vaccine
• Uses Yellow Fever vaccine
as base
• 20% sero conversion
• Still under research

37. PREVENTION
• Focus on vector control
• Use mosquito nets, spray and repellent oil
• Drain stagnant water sites
• Turn over all water storage containers
• Wear full clothes at dusk and dawn
• Fumigation

38. PREVENTION
• Biological:
• Target larval stage of Aedes in large water storage
containers
• Larvivorous fish (Gambusia), endotoxin producing
bacteria (Bacillus), copepod crustaceans
(mesocyclops)
• Chemical:
• Insecticide treatment of water containers
• Space spraying (thermal fogs)

39. COMMON SITES OF AEDES
GROWTH

43. LEVELS OF DENGUE CONTROL

45. THANK YOU