Dengue virus infection: Prevention and treatment
- 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 Aedes aegypti or Aedes albopictus mosquitoes during a blood meal. There are four dengue virus (DENV) 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 are infected a second time by a different DENV 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 DENV provides long-term protection against disease caused by reinfection with that particular type, supporting the feasibility of developing an effective vaccine. However, infection provides only short-lived cross-protection to the other three DENV types.
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 DENV infections.
Measures to prevent DENV infection and supportive treatment following infection and the development of disease will be reviewed here. The epidemiology, clinical manifestations, and diagnosis of infection are discussed separately. (See "Dengue virus infection: Epidemiology" and "Dengue virus infection: Clinical manifestations and diagnosis".)
Dengue virus (DENV) transmission occurs when susceptible hosts, DENVs, 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, DENV 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
- - Personal protective measures
- - 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
- ADDITIONAL APPROACHES TO MANAGEMENT
- FUTURE DIRECTIONS
- INFORMATION FOR PATIENTS