The document aims to educate about dengue, a viral disease transmitted by Aedes mosquitoes, emphasizing prevention and control measures. It outlines the disease's symptoms, treatment, and historical outbreaks, particularly in Pakistan, where cases have been on the rise since the first reported outbreak in 2006. Global statistics indicate significant annual infections and deaths, underscoring the importance of community awareness and vector control to mitigate dengue spread.

4. OBJECTIVE
• To educate the people about Dengue
• To aware the people how to prevent and control
Dengue
• Dengue is an endemic in 110 countries,
including Pakistan.

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

6. WHAT IS DENGUE ?
•Dengue is a viral disease
•It is transmitted by the infective bite of
female Aedes Aegypti mosquito
•Man develops disease after 5-6 days of
being bitten by an infective mosquito

7. 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

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

9. Distribution of Dengue Fever
•It occurs in two forms:
1. Dengue Fever
2. Dengue Haemorrhagic Fever(DHF)
•Dengue Fever is a severe, flu-like illness (Influenza)
•Dengue Haemorrhagic Fever (DHF) is a more
severe form of disease, which may cause death
•Person suspected of having dengue fever or DHF
must see a doctor at once

10. 1. WHAT IS DENGUE FEVER
Dengue Fever also known as the ‘Break Bone
Fever’ is a mosquito borne viral infection caused
by the dengue virus (Flavi Virus) transmitted
by the mosquito Aedes Aegypti rarely Aedes
Albonictus

11. WHAT IS DENGUE FEVER
Flavi Virus

12. 2. DENGUE HEMORRHAGIC FEVER
DHF is more severe form of disease, which may cause death.
Thrombocytopenia (platelet count <100,000)
Fever 2-7 days
Hemoconcentration or evidence of plasma leakage
Mortality is 10-20% if untreated, but decreases to <1% if adequately
treated
Plasma leakage may progress to dengue shock syndrome

13. SIGNS & SYMPTOMS OF DENGUE
HAEMORRHAGIC FEVER AND SHOCK
SYNDROM
•Symptoms similar to dengue fever
•Severe continuous stomach pains
•Skin becomes pale, cold or clammy
•Bleeding from nose, mouth & gums and skin rashes
•Frequent vomiting with or without blood
•Sleepiness and restlessness
•Patient feels thirsty and mouth becomes dry
•Rapid weak pulse
•Difficulty in breathing

14. HISTORY DENGUE
• This disease was first described 1780, and the virus
was isolated by Sabin 1944. Dengue virus infection is
the most common arthropod-borne disease worldwide
with an increasing incidence in the tropical regions of
Asia, Africa, and Central and South America. There are
four serotypes of the virus. All are transmitted by
mosquitoes, which are not affected by the disease,
although an infected mosquito may infect others (not
via man).

15. GLOBAL STATUS
• New infections annually: 50-100 million peoples
• Deaths: 25,000 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.

16. CURRENT TRENDS
• In the 1980s, DHF began a second expansion into Asia
when Sri Lanka, India, and the Maldives Islands had
their first major DHF epidemics; Pakistan first reported
an epidemic of dengue fever in 1994. The epidemics in
Sri Lanka and India were associated with multiple
dengue virus serotypes, but DEN-3 was predominant
and was genetically distinct from DEN-3 viruses
previously isolated from infected persons in those
countries.

17. DENGUE INFECTION AND
IMPLICATIONS
• Dengue virus (DENV) infects 50 million (WHO) to 100 million
(NIH) people annually. Forty percent of the world’s population,
predominately in the tropics and sub-tropics, is at risk for
contracting dengue virus. DENV infection can cause dengue
fever, dengue hemorrhagic fever, dengue shock syndrome, and
death.
• Dengue cases are being reported from over 100 countries
across the globe, During 2015, most of the cases were reported
from August to October.

18. 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

19. Year Suspected
cases
Cases
laboratory-
confirmed
Deaths
2006 4961 1931 41
2007 2304 1226 18
2008 2792 2469 17
2009 1940 1085 13
2010 15 901 11 024 40
2011 20000 17 057 219
2012 Less than
1000
--- Not confirmed
2013 20710 --- 104
2014 1991 ---- 18
2015 9899 cases
registered
--- 7
2016 Less than
1000
--- 6 deaths
Denge fever cases reported from Pakistan,
2006–2016
22 jan 2016 report
27 March 2016
report

20. Denge fever cases reported from
province of Pakistan, 2010–2016
Year PUnjab Sind KPK Baluchistan
2016 92 780..19 lst weak 130…6 die
2015 4348 2703…2639
katrachi
2265
2014 1440 1286…1250
katrachi
307 no death 06
2013 2641 5970 11600 37 deaths
2012 258 734 ----
2011 21292 1079 32 03
2010 5400 4072 ---

21. There are actually four dengue clinical syndromes:
1. Undifferentiated fever;
2. Classic dengue fever;
3. Dengue hemorrhagic fever, or DHF; and
4. Dengue shock syndrome, or DSS.
Dengue shock syndrome is actually a severe form of
DHF.
Dengue clinical syndrome

22. 1. The virus is inoculated into humans with the mosquito
saliva.
2. The virus localizes and replicates in various target organs,
for example, local lymph nodes and the liver.
3. The virus is then released from these tissues and spreads
through the blood to infect white blood cells and other
lymphatic tissues.
4. The virus is then released from these tissues and circulates
in the blood.
5. The mosquito ingests blood containing the virus.
6. The virus replicates in the mosquito midgut, the ovaries,
nerve tissue and fat body. It then escapes into the body cavity,
and later infects the salivary glands.
7. The virus replicates in the salivary glands and when the
mosquito bites another human, the cycle continues.
TRANSMISSION CYCLE OF DENGUE

23. TRANSMISSION OF DENGUE FEVER

24. Few common and favoured
breeding places/sites of Ae.
aegypti

25. LABORATORY DIAGNOSIS OF DENGUE
1. Haemagglutination inhibition (HI) test
2. Compliment Fixation Test (CFT)
3. Neutralization test (NT)
4. IgM-capture Enzyme-Linked Immunosorbent Assay
(MAC-ELISA) ndvbcp recommended
5. IgG-ELISA
6. Rapid Diagnostic tests (NS 1)

26. CLASSIS DENGUE
Acute febrile illness with headache, retro-orbital pain,
myalgia, arthralgia
“Break-bone fever”
High fever 5-7 days
Second fever for 1-2 days in 5% patients
Followed by marked fatigue days to weeks
Classic dengue 15-60% of infections
Nausea, vomiting, diarrhea (30%)
Macular or maculopapular rash (50%)
Respiratory symptoms: cough, sore throat (30%)

27. SIGNS & SYMPTOMS OF DENGUE FEVER
•Abrupt onset of high fever
•Severe frontal headache
•Pain behind the eyes which worsens with eye movement
•Muscle and joint pains
•Loss of sense of taste and appetite
•Measles-like rash over chest and upper limbs
•Nausea and vomiting

28. 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
• 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

29. CHARACTERISTICS OF MOSQUITO
ANOPHELES MOSQUITO AEDES
MOSQUITO

30. TIMINGS OF THE MOSQUITO BITE
Dawn Dusk

31. LIFE CYCLE OF AEDES MOSQUITO

32. SYMPTOMS OF DENGUE FEVER
Manifestation of Dengue Fever
 Dengue Fever (DF)
 Dengue Hemorrhagic Fever (DHF)
 Dengue Shock Syndrome (DSS)

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

34. SYMPTOMS OF DENGUE FEVER
Dengue Shock Syndrome (DSS)
• Rapid pulse
• Clammy cold skin
• Drop in blood pressure
• Abdominal pain
• 1% of patients
• Need ICU care

35. TREATMENT OF DENGUE FEVER
Treatment is purely concerned with relief of the
symptoms:
• Rest
• Fluid intake for adequate hydration
• Aspirin
• NSAID (nonsteroidal anti-inflammatory drugs)
• Acetoaminophen
• Codeine

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

37. Management of Dengue Fever (DF)
•No specific therapy, management of Dengue fever is symptomatic and supportive
i. Bed rest is advisable during the acute phase.
ii. Use cold sponging to keep temperature below 39o C.
iii. Antipyretics may be used to lower the body temperature. Aspirin/NSAID like Ibuprofen etc
should be avoided since it may cause gastritis, vomiting, acidosis and platelet disfunction.
Paracetamol is preferable in the doses as follows:
1-2 years: 60 -120 mg/doses 3-6 years: 120 mg/dose 7-12 years: 240 mg/dose
Adult : 500mg/dose
In children the dose is calculated as per 10mg/KG Body Weight per dose
which can be repeated at the interval of 6hrs
iv. Oral fluid and electrolyte therapy are recommended for patients with excessive sweating or
vomiting.
v. Patients should be monitored in DHF endemic area until they become afebrile for one day
without the use of antipyretics and after platelet and haematocrit determinations are stable,
platelet count is >50,000/ cumm.

38. VACCINATION
 No current dengue vaccine
 Estimated availability in 5-10 years
 Vaccine development is problematic as the vaccine
must provide immunity to all 4 serotypes
 Lack of dengue animal model
 Live attenuated tetravalent vaccines under phase 2
trials
 New approaches include infectious clone DNA and
naked DNA vaccines

39. PREVENTION OF DENGUE FEVER
Focus on vector control
• Use mosquito nets, spray and
repellent oil
• Drain stagnant water sites
• Use mosquito nets
• Wear full clothes at dusk and
dawn
• Fumigation

40. PREVENTION
Personal:
 clothing to reduce exposed skin
 insect repellent especially in early morning, late afternoon. Bed netting
important
 mosquito repellants(pyrethroid based)
 coils, sanitation measures
Environmental:
 reduced vector breeding sites
 solid waste management
 public education
 empty water containers and cut weed/tall grass

41. PREVENTION
Biological:
 Target larval stage of Aedes in large water storage
containers
 Larvivorous fish (Gambusia), endotoxin producing
bacteria (Bacillus), copepod crustaceans (mesocyclops)
Chemical:
Thermal fogging-malathion,pyrethrum
 Insecticide treatment of water containers
 Space spraying (thermal fogs)
 Indoor space spraying(2% pyrethrum),
organophosphorus compounds

42. PUBLIC AWARENESS

43. FACTS ABOUT DENGUE FEVER
• It is caused by a Virus
• No specific medicine or antibiotic to treat it
• Treatment is purely concerned with relief of the symptoms
• Illness with fever and myalgias lasts about one to two weeks
• DHF is a specific syndrome that tends to affect children under
10 years of age
• Prevention of dengue fever req control or eradication of the
mosquitoes carrying the virus

47. PLEASE CLAP FOR THAT
AMAZING PRESENTATION