Prevention and treatment of dengue virus infection
- Stephen J Thomas, MD
Stephen J Thomas, MD
- Professor and Chief, Division of Infectious Diseases
- State University of New York, Upstate Medical University
- Alan L Rothman, MD
Alan L Rothman, MD
- University of Rhode Island
- Anon Srikiatkhachorn, MD
Anon Srikiatkhachorn, MD
- Associate Professor
- University of Rhode Island
- Siripen Kalayanarooj, MD
Siripen Kalayanarooj, MD
- Professor of Pediatrics
- Rangsit University
- Consultant, WHO Collaborating Centre for Case Management of Dengue/DHF/DSS
- Queen Sirikit National Institute of Child Health (QSNICH)
Dengue is a febrile illness caused by a flavivirus transmitted by the bite of an Aedes aegypti mosquito. There are four dengue virus types (DENV-1, DENV-2, DENV-3, and DENV-4), all of which are capable of inducing severe disease (dengue hemorrhagic fever [DHF]/dengue shock syndrome [DSS]). Dengue is endemic in more than 100 countries in tropical and subtropical regions and causes an estimated 390 million infections annually worldwide, of which 96 million are clinically apparent .
The likelihood for development of severe dengue is highest among individuals who develop a second dengue infection caused by a different virus type from the first infection (known as secondary or heterotypic infection) . Thus, severe disease occurs primarily among individuals in areas where multiple serotypes circulate simultaneously. Infection with dengue virus provides long-term protection against the particular serotype that caused the disease, supporting the feasibility of developing an effective vaccine. However, infection provides only short-lived immunity to the other three dengue virus serotypes.
There are numerous documents providing guidance on the optimal approaches to managing dengue [3-6]. Data from well-designed randomized controlled trials are limited. The guidance in this document largely agrees with published guidelines and is also based on the contributors' clinical experience in management of complex dengue infections.
Measures to prevent dengue infection and supportive treatment for dengue virus infection will be reviewed here. The epidemiology, clinical manifestations, and diagnosis of infection are discussed separately. (See "Epidemiology of dengue virus infections" and "Clinical manifestations and diagnosis of dengue virus infection".)
Dengue virus transmission occurs when susceptible hosts, dengue viruses, and mosquitoes capable of transmission are co-located in space and time. Infection risk exists for anyone living in or traveling in a dengue-endemic region, especially in tropical Asia, Central and South America, and the Caribbean. In most of these regions, dengue virus transmission occurs year-round. However, the greatest risk of infection tends to be seasonal or during a recognized outbreak.
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- Endemic areas
- - Mosquito control
- - Vaccination
- TREATMENT APPROACH
- Phases of infection and clinical assessment
- - Outpatient management
- - Inpatient management
- Management of fever
- Management of plasma leakage
- - Treatment of shock
- Management of bleeding
- ALTERNATIVE MANAGEMENT APPROACHES
- FUTURE DIRECTIONS
- INFORMATION FOR PATIENTS