COMMUNICABLE DISEASE: DENGUE FEVER Community Health Nursing NUR
4404 Michelle Boswell Spring 2011
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PURPOSE This presentation will discuss various aspects of
Dengue fever: o Signs and symptoms o Vectors o Areas of prevalence
o At risk population o Stages of infection o Spectrum of disease
occurrence o Control of the disease o Treatment
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EPIDEMIOLOGY Dengue fever is can be caused by one of four
different serotypes Having one type of Dengue does not protect you
from having another type in the future More than one infection can
cause a greater risk of developing dengue hemorrhagic fever and
dengue shock syndrome (Dengue fever, 2010)
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VECTOR Nies and McEwen tell us that vectors can be animals or
arthropods, and they can transmit through biological and mechanical
routes (p. 500, 2007). Dengue fever is transmitted between people
by mosquitos In rare cases, dengue fever can be transmitted from
organ transplants or from mother to fetus (Dengue fever, 2010)
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INCUBATION PERIOD Symptoms usually begin 4-7 days after being
bitten Symptoms then last 3-10 days For transmission to occur the
mosquito must feed on a person during a 5- day period when large
amounts of virus are in the blood; this period usually begins a
little before the person become symptomatic Some people never have
significant symptoms but can still infect mosquitoes. After
entering the mosquito, the virus will need 8-12 days incubation
before it can then be transmitted to another human. The mosquito is
infected for the rest of its life. (Dengue fever, 2010)
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EMERGING DISEASE Dengue occurs in some parts of the tropics and
subtropics as an endemic, which means every year during rainy
season The four types of Dengue emerged from monkeys The virus
independently jumped to humans in Africa and Southeast Asia between
100 and 800 years ago (Dengue fever, 2010)
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INCIDENCE Prior to 1981, there were no known cases of Dengue in
south or central America The first documented cases were not until
the 1950s in the Philippines and Thailand (Dengue fever, 2010) The
World Health Organization (WHO) estimates that 50 to 100 million
infections occur yearly, including 500,000 DHF (Dengue hemorrhagic
fever) cases and 22,000 deaths, mostly among children.
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AREAS OF PREVALENCE
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DENGUE IN THE U.S. Nearly all cases in the United States have
been from travelers or immigrants The last continental outbreak was
in south Texas in 2005 There was a small outbreak in Hawaii in 2001
26 states have a law that mandates reporting of Dengue fever cases
Starting in 2009, all cases in the United States must be reported
to the CDC (Dengue fever, 2010)
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SIGNS AND SYMPTOMS Undifferentiated fever (usually 2-7 days)
Severe headache, retro-orbital eye pain, myalgias, arthralgias, a
diffuse erythematous maculo-papular rash, and mild hemorrhagic
manifestation. Subtle, minor epithelial hemorrhage, in the form of
petechiae, are often found on the lower extremities (but may occur
on buccal mucosa, hard and soft palates and or subconjunctivae as
well), easy bruising on the skin, or the patient may have a
positive tourniquet test. Leukopenia is frequently found and may be
accompanied by varying degrees of thrombocytopenia. Children may
also present with nausea and vomiting. Serological testing for
anti-dengue IgM antibodies or molecular testing for dengue viral
RNA or viral isolation can confirm the diagnosis, but these tests
often provide only retrospective confirmation. (Dengue fever,
2010)
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SIGNS AND SYMPTOMS
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VIRUS FLOW CHART
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DENGUE HEMORRHAGIC FEVER Dengue fever can become DHF quickly,
which is life threatening.
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DENGUE SHOCK SYNDROME Dengue fever can quickly become DHF or
DSS (Dengue shock syndrome) if not treated quickly Signs and
symptoms of the disease process are noted below: Abdominal pain or
tenderness Persistent vomiting Clinical fluid accumulation (i.e.,
pleural effusion or ascites) Mucosal bleeding Lethargy or
restlessness Liver enlargement (2cm) Increases in hematocrit
concurrent with rapid decrease in platelet count
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CLINICAL MANIFESTATIONS
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TREATMENT Dengue feverDHF or DSS Fluid replacement to maintain
perfusion and urine output, decrease tachycardia, and improve blood
pressure Methods to keep fever down, except aspirin Timely and
judicious use of supportive care Administration of isotonic
intravenous fluids or colloids Close monitoring of vital signs and
hemodynamic status, fluid balance, and hematologic parameters
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PREVENTION There is no vaccine for dengue fever Travelers must
be aware of risks in the areas they are visiting. There is a Travel
Notices page within the CDC website that allows travelers to see
current outbreaks in different countries
http://wwwnc.cdc.gov/travel/notices.aspx
http://wwwnc.cdc.gov/travel/notices.aspx Stay away from
mosquito-infested areas Wear bug repellant, cover extremities, and
sleep under a mosquito net if necessary
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LOCAL ACTIONS Local government health departments put out
fliers reminding citizens to protect themselves against mosquitos,
including not leaving containers of water around, because these are
breeding grounds for mosquitos Using mosquito nets and bug
repellent are other ways to prevent the virus, but many citizens
may not have access to these items Some countries efforts are
listed on the following slides
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PUERTO RICO Dengue is a major health burden in Puerto Rico.
Televised public service announcements and posters, elementary and
pre-school educational programs, and an exhibit at the Children's
Museum in Old San Juan were evaluated separately using knowledge
and practices surveys administered to children and their parents,
surveys of house lots for larval container habitats, focus groups,
and interviews with program organizers and participants. Exposure
to the programs was associated with increased dengue-related
knowledge, increased proportion of tires protected from rain,
decreased proportion of water storage containers positive for
mosquito larvae, and increased indoor use of aerosol insecticides.
Exposure to the elementary school program was associated with
slightly lower indices of residential mosquito infestation. The
programs have resulted in high levels of awareness, some behavior
change, and limited change in larval indices. Greater emphasis on
the skills necessary for community members to keep containers free
of mosquito larvae would increase program effectiveness. (Winch,
2002)
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DOMINICAN REPUBLIC The Ministries of Public Health and Social
Assistance announced a RD$17 million campaign for dengue prevention
and control throughout the country. Deputy Minister of Public
Health, Dr. Nelson Rodriguez Monegro said that over the next three
months the health authorities will be involved in the process
together with the municipalities, civil society bodies and
community representatives. He explained that the measures include
overall management of dengue prevention and control, which will
involve the entire Dominican population in order to reduce the
incidence of the disease in the country. He said that the
components of the program include increased surveillance for the
detection of fever, overall control by eliminating mosquitoes that
spread dengue and eliminating breeding sites, and launching a
massive educational campaign. Monegro also cited efforts for
improvement in the care of people who contract the disease and the
involvement of local groups in actions to prevent and control
dengue. (Dengue fever prevention, 2010)
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SRI LANKA The Ministry of Health is to commence its special
dengue prevention program from Colombo The Ministry plans to carry
out the dengue prevention program in two phases. In the first phase
the Ministry plans to introduce an awareness program followed by a
sanitization program in the second phase. The Health Ministry hopes
to carry out its awareness program from house to house with the
assistance of the Colombo Municipal Council (CMC) and several
nurses unions. In the second phase of this process the Ministry
will destroy all the places that promote the mosquito breeding in
the Colombo municipality. The Health Ministry expects the public
support for this program as the spreading of the dengue fever in
the country has become a national crisis. Similar dengue prevention
programs for outstations will be carried out in the coming weeks.
(Dengue prevention programs, 2009)
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PHILIPPINES The government has embarked on a nationwide
information campaign in the wake of the rising incidence of dengue
cases in the country. In a news briefing, President Benigno S.
Aquino III said the drive is focused on cleanliness particularly in
the light of a Department of Health report of a 50 percent increase
in the incidence of the killer disease this year. During our
meeting on Monday, Dr. Enrique Ona (DOH Secretary) mentioned there
was a 50 percent increase in the incidence of dengue cases. He is
now going around for an education campaign dealing with the
cleanliness drive, the President said. The President said the
educational drive involves public awareness and participation in
cleaning the common breeding grounds of the Aedes aegypti
mosquitoes such as unattended old tires, empty cans and bottles,
gutters and the like. From January to July this year alone, the DOH
reported 40,648 cases with a total of 328 deaths (Government
launches, 2010)
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METHODS OF RESEARCH Dengue fever (2010). In Centers for disease
control. Retrieved April 20, 2011, from http://www.cdc.gov/Dengue/
Dengue fever prevention program (n.d.). In
real-estate-dominican.com. Retrieved April 21, 2011, from
http://www.real-estate-
dominican.com/medical-info/153-dengue-fever-prevention-
program-2010.html Dengue prevention programs to commence from Sri
Lanka capital (2009, May 16). In Colombopage: Sri Lanka Internet
Newspaper. Retrieved April 21, 2011, from
http://www.colombopage.com/archive_091/May1242481165RA.ht ml
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METHODS OF RESEARCH Government launches nationwide dengue info
drive (2010, August 25). In Philippines, Embassy of the
Philippines. Retrieved April 21, 2011, from
http://www.philippineembassy-usa.org/news/526/300/Gov-t-
launches-nationwide-dengue-info-drive/d,phildet/ Nies, M. A., &
McEwen, M. (2007). Community/Public health nursing (4th ed., p.
500). St. Louis, MO: Saunders Elsevier. Winch, P., Leontsini, E.,
Rigau-Perez, J., Ruiz-Perez, M., Clark, G., & Gubler, D. (2002,
October). Community-based dengue prevention programs in Puerto
Rico: impact on knowledge, behavior, and residential mosquito
infestation [Electronic version]. American Journal of Tropical
Medicine and Hygiene, 67(4), 363-370.