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

10. Herman’s Rash

11. Dengue with
warning signs
Severe dengue

12. Transmission

14. 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)

15. Vector: Aedes aegypti

16.  immature stages are found in water-filled
habitats, mostly in artificial containers
closely associated with human dwellings
and often indoors.

17. 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

18. Individual Risk factors
 Age
 Ethnicity
 Chronic illnesses

20. 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

21. Course of dengue
illness

23. Clinical problems

24. Management

26. 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

28. Group B
 Referred for in-hospital management

29. Group C
 Emergency treatment and urgent referral

30. Prevention

31.  Vector control
- controlling larval habitats and
combatting adult mosquitos by
screening widows and doors and using
household insecticide space sprays.

32.  Provision of reliable potable water.
 Sanitation
 Solid waste management
 Health education
 COMMUNITY PARTICIPATION

33. New Avenues
 Tetravalent dengue vaccines are under
development.