dengue case presentation slideshare

• My presentations

Auth with social network:

Download presentation

We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!

Presentation is loading. Please wait.

To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video

Epidemiology, Prevention & Control of Dengue Fever / DHF

Published by Merryl Garrison Modified over 8 years ago

Similar presentations

Presentation on theme: "Epidemiology, Prevention & Control of Dengue Fever / DHF"— Presentation transcript:

DENGUE HEMORRHAGIC FEVER

Flight Surgeon RSV Day I n t e g r i t y - S e r v i c e - E x c e l l e n c e ANGRC Joint Base Andrews UNCLASSIFIED.

2 Module 1 Pathophysiology Clinical course WHO classification & limitation Other manifestations Dr Suresh Kumar Infectious Diseases Unit Hospital Sungai.

III. Clinical Manifestations of Dengue and Dengue Hemorrhagic Fever CENTERS FOR DISEASE CONTROL AND PREVENTION.

(Pronounced as Dhen Gey)

Tropical Diseases Tropical diseases encompass all diseases that occur solely, or principally, in the tropics. In practice, the term is often taken to refer.

Controlling the risk of Chikungunya

Dengue Divya Bappanad Karapitya Hospital Galle, Sri Lanka.

Arthropod-borne Viruses

Management of Dengue Fever Dr David Tran 16/09/09.

Diseases are of various types.Presently the whole world is facing many new viral diseases such as Aids,Hepatitis,dengue etc. The global prevalence of dengue.

Dengue Hemorrhagic Fever Ms. Belton October 2014.

Judith Pinkham (Ph.D. Student) Walden University PUBH 8165 Instructor: Dr. Fredric Grant Summer 2013.

Arthropod-borne Viruses Arthropod-borne viruses (arboviruses) are viruses that can be transmitted to man by arthropod vectors. Arboviruses belong to three.

DENGUE: EPIDEMIOLOGY PART 1

Virus, Vector and Epidemiology

Common Viral Haemorrhagic Fevers include:  R R R Rift valley fever, Dengue fever, Lassa fever,.  E E E Ebola and marburg viral disease.  B B

1. Outline Introduction Epidemiology transmission Clinical manifestation Treatment Prevention 2.

VIRAL HEAMORRHAGIC FEVERS Ahmed Mandil Prof of Epidemiology Dept of Family & Community Medicine College of Medicine, King Saud University.

Dengue Virus Causes dengue and dengue hemorrhagic fever

About project

© 2024 SlidePlayer.com Inc. All rights reserved.

Got any suggestions?

We want to hear from you! Send us a message and help improve Slidesgo

Top searches

Trending searches

6 templates

indigenous canada

9 templates

121 templates

education technology

232 templates

39 templates

29 templates

Dengue Fever Case Report

It seems that you like this template, dengue fever case report presentation, premium google slides theme, powerpoint template, and canva presentation template.

This template is specifically crafted to assist medical professionals in presenting their dengue fever case studies with precision and clarity. With its customizability and visually appealing slides, you can effectively highlight the key aspects of the case, including symptoms, diagnosis, treatment, and outcomes. Impress your colleagues and stakeholders with informative charts, diagrams, and customizable sections. Save time and present your dengue fever case study with confidence using this expertly designed Google Slides and PowerPoint template!

Features of this template

• 100% editable and easy to modify
• 21 different slides to impress your audience
• Contains easy-to-edit graphics such as graphs, maps, tables, timelines and mockups
• Includes 500+ icons and Flaticon’s extension for customizing your slides
• Designed to be used in Google Slides, Canva, and Microsoft PowerPoint
• 16:9 widescreen format suitable for all types of screens
• Includes information about fonts, colors, and credits of the resources used

What are the benefits of having a Premium account?

What Premium plans do you have?

What can I do to have unlimited downloads?

Don’t want to attribute Slidesgo?

Gain access to over 27300 templates & presentations with premium from 1.67€/month.

Are you already Premium? Log in

Related posts on our blog

How to Add, Duplicate, Move, Delete or Hide Slides in Google Slides

How to Change Layouts in PowerPoint

How to Change the Slide Size in Google Slides

Related presentations.

Premium template

Unlock this template and gain unlimited access

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.14(1); 2022 Jan

Dengue Encephalitis: A Case Series on a Rare Presentation of Dengue Fever

Samiksha gupta.

1 Internal Medicine, Government Medical College and Hospital, Chandigarh, Chandigarh, IND

Gautam Jesrani

Yuvraj s cheema, vivek kumar.

Neurological manifestations like encephalitis, especially hemorrhagic encephalitis, are rarely described in dengue fever (DF), and the gamut may affect any part of the central or peripheral nervous system. Herein, we report two cases from Northern India, presenting with fever and altered sensorium, subsequently diagnosed with DF. Imaging studies revealed hemorrhagic encephalitis in both of them but one of them had a grave outcome, unfolding the fatal nature of the disease. The report enlightens DF as an unusual etiology of encephalitis and the importance of considering the infirmity as a differential in patients with neurological manifestations.

Introduction

Dengue virus (serotypes DEN-1, 2, 3, 4) is a Flavivirus, which is transmitted through the bite of an infected Aedes agypti mosquito, and as per the census of the World Health Organization (WHO), the number of dengue cases has increased to eight times in the last two decades [ 1 ]. DEN-2 and DEN-3 are the serotypes traditionally involved in neurological complications [ 2 ]. The virus can affect any part of the nervous system, including the peripheral nervous system (PNS) and ophthalmic structures, due to its neurotropic nature. The major identifiable risk factors contributing to neurological involvement are high-grade fever, thrombocytopenia, elevated hematocrit, and hepatic dysfunction [ 3 ].

Case presentation

A 37-year-old female homemaker, with no comorbidities, presented to the emergency department with altered mentation. There was a history of moderate grade, intermittent fever, and associated chills and rigor of five days’ duration, along with a diffuse, dull, aching, continuous headache of three days’ duration and three to four episodes of non-bilious vomiting prior to the presentation. There was no pain in the abdomen, diarrhea, or seizures. On examination, she was febrile (102°F) but had a regular pulse rate of 102 beats/min, blood pressure 100/80 mmHg, Glasgow coma scale (GCS) 8/15 (eye-opening: 2/4, verbal response: 3/5, motor response: 3/6) and bilaterally reactive pupils. Meningeal signs were absent with bilateral flexor plantar response and no focal deficit. The rest of the systemic examination was normal.

She was then subjected to non-contrast computed tomography (NCCT) of the brain, which suggested diffuse cerebral edema (Figure ​ (Figure1 1 ).

On investigations, the patient had thrombocytopenia and transaminitis (Table ​ (Table1). 1 ). Cerebrospinal fluid (CSF) analysis had normal protein and glucose levels, no pleocytosis, and an absence of oligoclonal bands. On Gram staining and culture of the CSF, no organism was isolated and herpes simplex virus polymerase chain reaction (HSV PCR) was reported negative. She was managed on the lines of a presumptive diagnosis of infective encephalitis and started on intravenous ceftriaxone 2 gm and dexamethasone 8 mg 12 hourly.

ALP, alkaline phosphatase; serum glutamic oxaloacetic transaminase, SGOT; serum glutamic pyruvic transaminase, SGPT; immunoglobulin, Ig

In view of thrombocytopenia and the ongoing endemic of tropical illnesses, the patient was investigated for malaria, dengue fever, scrub typhus, enteric fever, and leptospirosis. Later, contrast-enhanced magnetic resonance imaging (CEMRI) of the brain revealed hyperintensities in bilateral cerebral (frontal and temporal lobes) and cerebellar hemispheres, midbrain, and thalami (Figure ​ (Figure2). 2 ). Susceptibility-weighted imaging suggested thalamic bleed (Figure ​ (Figure2) 2 ) and all these features were suggestive of acute hemorrhagic necrotizing encephalitis. Angiography of the cerebral vessels was normal. Surprisingly, the patient came out to be Dengue NS-1 antigen positive by enzyme-linked immunoassay sorbent assay (ELISA), and from Day 3 onwards, she became afebrile with an improvement in GCS 13/15 (Eye-opening: 4/4, verbal response: 4/5, motor response: 5/6) and platelet count. Her antibiotic was stopped after three days and steroids were tapered but, unfortunately, she developed bilateral horizontal gaze palsy, dysarthria, and truncal ataxia. However, repeat NCCT head had no worsening or any new lesions. On the seventh day, the patient was discharged with a GCS of 15/15 and resolving transaminitis. Follow-up at one month demonstrated minimal improvement in her residual symptoms.

A 27-year-old male, with no history of addictions or co-morbidities, presented in poor sensorium, after three episodes of generalized tonic-clonic seizures in six hours’ duration. There was a history of high-grade fever and associated chills and rigor for four days and persistent non-bilious vomiting for two days. No prior history of concurrent headache, motor weakness, or similar past episodes was documented. On presentation, he was febrile (103°F) and had a pulse rate of 115 beats/min, blood pressure 98/70 mmHg, GCS 10/15 (Eye-opening: 4/4, verbal response: 2/5, motor response: 4/6), bilaterally reactive pupils, and absent meningeal signs. The other system examinations were unremarkable. So, he was started on anti-epileptics and an intravenous antibiotic (ceftriaxone 2 gm twice a day) initially.

His first NCCT brain indicated ill-defined hypodensity in bilateral thalami, bilateral cerebellar hemisphere, and medulla (Figure ​ (Figure3). 3 ). Also, investigations suggested thrombocytopenia and deranged hepatic enzymes (Table ​ (Table2 2 ).

ALP, alkaline phosphatase; serum glutamic oxaloacetic transaminase, SGOT; serum glutamic pyruvic transaminase, SGPT; immunoglobulin, Ig

CSF analysis was deferred due to thrombocytopenia, and single donor platelets were transfused for the same. The patient had no seizure thereafter and platelet count improved to 56,000 × 10 9 /L on the next day, so a lumbar puncture was performed. CSF analysis revealed normal protein and glucose levels, no pleocytosis, and an absence of oligoclonal bands. HSV PCR was reported negative, and serology for toxoplasma was inconclusive in CSF. Since there was no improvement in sensorium, CEMRI brain was planned, but his GCS deteriorated to 4/15 with bilaterally dilated pupils on the next day. The patient was intubated immediately and shifted to the intensive care unit. Repeat NCCT brain was done, which revealed diffuse cerebral and cerebellar edema, with compression of the fourth ventricle causing hydrocephalus and diffuse hypodensity in bilateral thalami and cerebellar hemisphere, with intrathalamic hemorrhage (Figure ​ (Figure3). 3 ). Anti-edema measures were started [head end elevation, intravenous mannitol (0.5 mg/kg, 8 hourly), and dexamethasone (4 mg 8 hourly)]. However, the patient eventually succumbed to the illness four hours after the intubation. Post-obituary reports demonstrated positive Dengue NS-1 antigen by ELISA, negative serology for hepatitis A, E, B, and C, malaria, scrub typhus, typhoid fever, and leptospirosis. CSF culture did not reveal the growth of any organism and Indian ink preparation for cryptococcus was negative.

As per the WHO 2009 classification, dengue encephalitis is categorized as severe dengue. Central nervous system (CNS) involvement (ischemic/hemorrhagic stroke, encephalitis, acute disseminated encephalomyelitis, and transverse myelitis), PNS manifestations (long thoracic nerve palsy, abducens nerve palsy, facial palsy, brachial neuritis, myositis, hypokalaemic paralysis, and Guillain-Barre syndrome), and ophthalmic complications (maculopathy, optic neuropathy, and subconjunctival and vitreous hemorrhage) have been described in the context of DF [ 4 - 9 ].

Encephalitis is inflammation of the brain parenchyma, often due to viral infection. Dengue virus was earlier considered non-neurotropic, but recent observations have proven this wrong. Direct viral invasion in the CNS, possibly as a result of the blood brain barrier disruption, is the proposed pathogenesis for neural involvement. Additionally, autoimmune reactions and metabolic variations have also been established, which further worsen neurological infirmity [ 10 - 11 ].

Three to seven days is the usual interval between the onset of neurological symptoms and systemic features of DF. Headache, fever, altered sensorium, seizures, and focal neurological deficit, in the absence of any metabolic abnormalities, are the typical features of encephalitis. Thrombocytopenia is depicted in the hemogram, and CSF analysis reveals pleocytosis with viral growth on culture. Still, CSF with normal cellularity can be seen in 75% of cases of dengue encephalitis [ 12 ].

The majority of the patients with dengue encephalitis have normal findings on neuroimaging [ 13 ]. MRI is preferred over CT head, although the findings are often non-specific [ 13 ]. The commonly affected sites of CNS are the thalamus and basal ganglia, followed by the cerebral cortex and cerebellar hemispheres. Findings such as focal hemorrhage, patchy areas of diffusion restriction, and post-contrast enhancement have also been defined.

Adequate hydration with intravenous fluids, antipyretics for fever, seizures control with anti-epileptic drugs, and transfusion of blood products (if required) forms the fundamental treatment in DF. Raised intracranial pressure can be treated with head elevation, mannitol, and steroids, with regular scrutinization of consciousness level. Our patients were managed similarly; nevertheless, the patient in Case 2 succumbed to his illness. The prognosis in dengue encephalitis is good, although mortality can range up to 3.7% [ 14 ].

Conclusions

Dengue encephalitis should be kept as a differential in patients with a short history of fever and altered sensorium in countries where the DF is endemic, especially in the post-monsoon season. Thrombocytopenia is generally a clue for tropical illnesses like dengue, malaria, and scrub typhus and can be used as a basis for the evaluation of these infirmities. Also, physicians should have a high index of clinical suspicion since the prognosis is good if managed on time.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained or waived by all participants in this study

DENGUE & DENGUE HEMORRHAGIC FEVER

Apr 20, 2012

480 likes | 1.62k Views

DENGUE & DENGUE HEMORRHAGIC FEVER. DR.I.SELVARAJ, IRMS Sr.D.M.O (Selction Grade), INDIAN RAILWAYS B.SC.,M.B.B.S.,(M.D Community Medicine)., D.P.H., D.I.H., PGCH&FW (NIHFW, New Delhi). Epidemiology. In India first outbreak of dengue was recorded in 1812

Share Presentation

• local lymph nodes
• domestic environment
• danger signs
• cleanup campaigns
• double peak hemorrhagic fever

Presentation Transcript

DENGUE & DENGUE HEMORRHAGIC FEVER DR.I.SELVARAJ, IRMS Sr.D.M.O (Selction Grade), INDIAN RAILWAYS B.SC.,M.B.B.S.,(M.D Community Medicine)., D.P.H., D.I.H., PGCH&FW (NIHFW, New Delhi)

Epidemiology • In India first outbreak of dengue was recorded in 1812 • A double peak hemorrhagic fever epidemic occurred in India for the first time in Calcutta between July 1963 & March 1964 • In New Delhi, outbreaks of dengue fever reported in 1967,1970,1982, &1996

BURDEN OF DISEASE IN S.E.ASIA • CATEGORY-A (INDONESIA,MYANMAR,AND THAILAND) • CATEGORY-B (INDIA,BANGALADESH,MALDIVES,AND SRILANKA) • CATEGORY-C (BHUTAN, NEPAL) • CTEGORY-D (DPR KOREA)

Dengue Virus • Causes dengue and dengue hemorrhagic fever • It is an arbovirus • Transmitted by mosquitoes • Composed of single-stranded RNA • Has 4 serotypes (DEN-1, 2, 3, 4)

Dengue Virus • Each serotype provides specific lifetime immunity, and short-term cross-immunity • All serotypes can cause severe and fatal disease • Genetic variation within serotypes • Some genetic variants within each serotype appear to be more virulent or have greater epidemic potential

The most common epidemic vector of dengue in the world is theAedes aegyptimosquito. It can be identified by the white bands or scale patternson its legs and thorax.

Aedes aegypti • Dengue transmitted by infected female mosquito • Primarily a daytime feeder • Lives around human habitation • Lays eggs and produces larvae preferentially in artificial containers

Clinical Characteristics of Dengue Fever • Fever • Headache • Muscle and joint pain • Nausea/vomiting • Rash • Hemorrhagic manifestations Patients may also report other symptoms, such asitching and aberrationsin the sense of taste, particularly a metallic taste.In addition, there have been reports ofsevere depressionafter the acute phase of the illness.

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.

The transmission cycle of dengue virus by the mosquito Aedes aegypti begins with a dengue-infected person. This person will have virus circulating in the blood—a viremia that lasts for about five days. During the viremic period, an uninfected female Aedes aegypti mosquito bites the person and ingests blood that contains dengue virus. Although there is some evidence of transovarial transmission of dengue virus in Aedes aegypti, usually mosquitoes are only infected by biting a viremic person. Then, within the mosquito, the virus replicates during an extrinsic incubation period of eight to twelve days. The mosquito then bites a susceptible person and transmits the virus to him or her, as well as to every other susceptible person the mosquito bites for the rest of its lifetime. The virus then replicates in the second person and produces symptoms. The symptoms begin to appear an average of four to seven days after the mosquito bite—this is the intrinsicincubation period, within humans. While the intrinsic incubation period averages from four to seven days, it can range from three to 14 days. The viremia begins slightly before the onset of symptoms. Symptoms caused by dengue infection may last three to 10 days, with an average of five days, after the onset of symptoms—so the illness persists several days after the viremia has ended.

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

Clinical Case Definition for Dengue Fever • Classical Dengue fever or Break bone fever is an acute febrile viral disease frequently presenting with headaches, bone or joint pain, muscular pains,rash,and leucopenia • Clinical Case Definition for Dengue Hemorrhagic Fever • 4 Necessary Criteria: • Fever, or recent history of acute fever • Hemorrhagic manifestations • Low platelet count (100,000/mm3 or less) • Objective evidence of “leaky capillaries:” • elevated hematocrit (20% or more over baseline) • low albumin • pleural or other effusions

Clinical Case Definition for Dengue Shock Syndrome • 4 criteria for DHF • + • Evidence of circulatory failure manifested indirectly by all of the following: • Rapid and weak pulse • Narrow pulse pressure (< 20 mm Hg) ORhypotension for age • Cold, clammy skin and altered mental status • Frank shock is direct evidence of circulatory failure

Hemorrhagic Manifestations of Dengue • Skin hemorrhages:petechiae, purpura, ecchymoses • Gingival bleeding • Nasal bleeding • Gastrointestinal bleeding:Hematemesis, melena, hematochezia • Hematuria • Increased menstrual flow

Signs and Symptoms of Encephalitis/Encephalopathy Associated with Acute Dengue Infection • Decreased level of consciousness: lethargy, confusion, coma • Seizures • Nuchal rigidity • Paresis

Four Grades of DHF • Grade 1 • Fever and nonspecific constitutional symptoms • Positive tourniquet test is only hemorrhagic manifestation • Grade 2 • Grade 1 manifestations + spontaneous bleeding • Grade 3 • Signs of circulatory failure (rapid/weak pulse, narrow pulse pressure, hypotension, cold/clammy skin) • Grade 4 • Profound shock (undetectable pulse and BP)

Danger Signs in Dengue Hemorrhagic Fever • Abdominal pain - intense and sustained • Persistent vomiting • Abrupt change from fever to hypothermia, with sweating and prostration • Restlessness or somnolence *All of these are signs of impending shock and should alert clinicians that the patient needs close observation and fluids.

This thermometer illustrates the developments in the illness that are progressive warning signs that DSS may occur. The initial evaluation is made by determining how many days have passed since the onset of symptoms. Most patients who develop DSS do so 3-6 days after onset of symptoms. Therefore, if a patient is seven days into the illness, it is likely that the worst is over. If the fever goes between three and six days after the symptoms began, this is a warning signal that the patient must be closely observed, as shock often occurs at or around the disappearance of fever. Other early warning signs to be alert for include a drop in platelets, an increase in hematocrit, or other signs of plasma leakage. If you document hemoconcentration and thrombocytopenia and other signs of DHF and the patient meets the criteria for DHF, the prognosis and the patient's risk category have changed. Though dengue fever does not often cause fatalities, a greater proportion of DHF cases are fatal. The next concern would be observation of the danger signs—severe abdominal pain, change in mental status, vomiting and abrupt change from fever to hypothermia. These often herald the onset of DSS. The goal of treatment is to prevent shock. The plasma leakage syndrome is self-limited. If you can support the patient through the plasma leakage phase and provide sufficient fluids to prevent shock, the illness will resolve itself.

Purpose of Control • Reduce female vector density to a level below which epidemic vector transmission will not occur • Based on the assumption that eliminating or reducing the number of larval habitats in the domestic environment will control the vector • The minimum vector density to prevent epidemic transmission

LABORATORY CRITERIA • ISOLATION OF DENQUE VIRUS • INCREASED IgM OR IgM ANTIBODIES TITRES • DENQUE ANTIGEN DETECTION BY IMMUNOHISTOCHEMISTRY,IMMUNOFLUROSCENCE,ELISA • PCR • LEUCOPENIA,THROMPOCYTOPENIA

Vector Control Methods: • Biological and Environmental Control • Biological control • Largely experimental • Option: place fish in containers to eat larvae • Environmental control • Elimination of larval habitats • Most likely method to be effective in the long term

Vector Control Methods: • Chemical Control: • Larvicides may be used to kill immature aquatic stages • Ultra-low volume fumigation against adult mosquitoes • Mosquitoes may have resistance to commercial aerosol sprays

BIOLOGICAL CONTROLmethods are not widely used and are primarily experimental. One option in which biological control is often used, however, is the placement of small fish that eat mosquito larvae in certain containers, such as decorative fountains or 55-gallon drums. Recently, a few countries have also reported success in controlling larvae with copepods, small invertebrate crustaceans that feed on first- and second-stage mosquito larvae. ENVIRONMENTAL CONTROLinvolves eliminating or controlling the larval habitats where the mosquito lays her eggs and the immature mosquitoes develop. This includes emptying water from containers or covering containers that are being used, cleanup campaigns to dispose of containers that are not being used, and improving water supplies so that there is less need to store water in containers. Since chemical control is generally restricted to containers that cannot otherwise be eliminated or managed, and biological control is still largely experimental, environmental methods are likely to be the most effective for long-term control of Aedes aegypti.

Larvicidinginvolves placing chemicals into containers that cannot easily be eliminated to kill the mosquito larvae. Ultra-low volume, or ULVspraying of insecticides is widely practiced to kill adult mosquitoes. ULV spraying uses machines that produce very small particles of insecticide, which are carried by wind currents. Typically, ULV machines are either mounted on trucks or are portable machines that can be carried by field workers. The insecticide particles must come in contact with the mosquito to kill it. Unfortunately, theAedes aegyptimosquito tends to reside inside houses, often resting in secluded locations such as closets that are not easily penetrable by the insecticide spray. Thus, ULV spraying from vehicles is generally ineffective, killing very fewAedes aegyptimosquitoes. The method is, therefore,expensive and ineffective. Commercial aerosol sprays to kill the mosquitoes found indoors are useful, but"knockdown resistance"may occur in some locations. Individual householders may note that spray insecticide has only atemporary effect,knocking down or paralyzing mosquitoes that later recover and fly away. In such cases, the sprayed mosquitoes must also be squashed to prevent their recovery.

Although the goal of disease control is to prevent epidemic transmission, if an epidemic does occur, ways to minimize its impact include: • Teaching the medical community how to diagnose and manage dengue and dengue hemorrhagic fever (DHF), so they are better prepared to effectively manage and treat large numbers of cases. Mortality from DHF will thus be minimized. • Implementing an emergency contingency plan to anticipate the logistical issues of hospitalizing large numbers of patients and to outline measures for community-wide vector control activities. Such plans should be prepared with the participation of all parties and agencies involved, and should be ready for implementation prior to the emergence of an epidemic. • Educating the general public to encourage and enable them to carry out vector control in their homes and neighborhoods.

Programs to Minimize the Impact of Epidemics • Education of the medical community • Implementation of emergency contingency plan • Education of the general population

THANK YOU • Reference: • http://www.who.int/ctd/docs/dengue.pdf • http://www.cdc.gov/ • http://www.cdc.gov/ncidod/index.htm • SUPERCOURSE

• More by User

Carlos Castillo-Chavez Joaquin Bustoz Jr. Professor Arizona State University

Tutorials 4: Epidemiological Mathematical Modeling, The Cases of Tuberculosis and Dengue. Mathematical Modeling of Infectious Diseases: Dynamics and Control (15 Aug - 9 Oct 2005)

1.28k views • 84 slides

Rift Valley Fever

Rift Valley Fever. Jeffrey Musser, DVM, PhD Professor J.A.W. Coetzer Suzanne Burnham, DVM Texas A&amp;M University University of Pretoria College of Veterinary Medicine Department of

1.87k views • 96 slides

Malignant Catarrhal Fever

Malignant Catarrhal Fever . Jeffrey Musser, DVM, PhD Professor Moritz van Vuuren Suzanne Burnham, DVM Texas A&amp;M University University of Pretoria

1.67k views • 92 slides

Hot Spots (Or Red Rashes With Fever)

Hot Spots (Or Red Rashes With Fever). Yasmin Tyler-Hill, M.D. Clinical Assistant Professor Department of Pediatrics Morehouse School of Medicine. Objectives. Recognize rashes that are included in the differential diagnosis of Rheumatologic diseases

1.37k views • 53 slides

African Swine Fever

African Swine Fever . Texas A&amp;M University College of Veterinary Medicine Jeffrey Musser, DVM, PhD, DABVP Suzanne Burnham, DVM. Special thanks to:. M. van Vuuren, Dept. of Veterinary Tropical Diseases, Faculty of Veterinary Science University of Pretoria

2.73k views • 84 slides

Petechiae and Hemorrhagic Rashes

Petechiae and Hemorrhagic Rashes. Dr. Harley Eisman Pediatric Emergency Medicine MUHC-Montreal Children’s Hospital. Outline. Objectives Cases Definition Background Evidence Consensus Global Evaluation of Purpura Selected Disease Entities Wrap-Up. Objectives.

2.18k views • 41 slides

LASSA Fever Lassa hemorrhagic fever (LHF)

LASSA Fever Lassa hemorrhagic fever (LHF). Basic Information. Intro. A cute viral illness that occurs in west Africa. The virus is named after the town in Nigeria where the first cases occurred. A single-stranded RNA virus and is zoonotic, or animal-borne. . Transmission.

1.84k views • 13 slides

Case Presentation

Case Presentation. 22 yo U.S. Army Active Duty male deployed to Afghanistan west of Kandahar presents with fever (102.5 o F), headache, fatigue, chills, abdominal pain with non-bloody diarrhea (SEP 8) Symptoms progressing over the previous 4 days

2.06k views • 120 slides

Diagnosis and Management of acute ischemic stroke

Diagnosis and Management of acute ischemic stroke. Stroke-Definition. Acute loss of vascular perfusion to a region of the brain resulting in ischemia and loss of neurologic function and/or tissue destruction Can be hemorrhagic or ischemic in etiology. Stroke definition continued.

1.76k views • 43 slides

Emergency Department Evaluation of Fever in the Returning Traveler

Emergency Department Evaluation of Fever in the Returning Traveler. Dr. Aric Storck October 31, 2002. Objectives. Approach to the febrile traveler History Travel history Vaccinations Chemoprophylaxis Laboratory studies Treatment overview of common imported diseases. Background.

1.18k views • 100 slides

An Approach to a Patient with Fever

An Approach to a Patient with Fever. MPPRC- IIB Group 1. General Objective. Integrate and apply knowledge acquired in the subjects of Medicine I, Pathology, Pharmacology and Radiology in the management of a patient with fever. Specific Objectives.

4.5k views • 86 slides

Fever and Rash

Fever and Rash. DR.Rezai MS Pediatrics infectious disease sub specialist. ماکول. ( اکیموز ). بثورات ماکولوپاپولر. پاپول. بثورات ماکولوپاپولر با توزیع محیطی. بثورات ماکولوپاپولر با توزیع مرکزی. وزیکول. پوستول. بول (طاول). ندول. (اریتم ندولار). اولسر نکروتیک. گانگرن (پدیده ی رینود).

1.78k views • 128 slides

PYREXIA OF UNKNOWN ORIGIN

PYREXIA OF UNKNOWN ORIGIN. Dr. Alaa Jumaa. PUO is A Common disease presenting ATYPICALLY. Terminology . Old Definition : Petersdorf and Beeson (1961) Fever higher than 38.3 o C on several occasions. Duration of fever – 3 weeks

1.55k views • 30 slides

Dealing with dengue

Officials in Brazil are dealing with a large rise in dengue fever.

1.43k views • 17 slides

Dengue Clinical Presentation

• Author: Darvin Scott Smith, MD, MSc, DTM&H, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
• Sections Dengue
• Practice Essentials
• Pathophysiology
• Epidemiology
• Patient Education
• Physical Examination
• Approach Considerations
• Complete Blood Cell Count
• Metabolic Panel and Liver Enzymes
• Coagulation Studies
• Serum Studies
• Ultrasonography
• Case Definitions
• Suspected Dengue
• Severe Dengue
• Diet and Activity
• Vaccine Development
• Consultations
• Medication Summary
• Volume Expanders
• Vaccines, Live, Viral
• Questions & Answers
• Media Gallery

Patients with dengue will have a history of living in, or recent travel to, a region where the disease is endemic. The incubation period is 3-14 days (average, 4-7 days); symptoms that begin more than 2 weeks after a person departs from an endemic area probably are not due to dengue.

Many patients experience a prodrome of chills, erythematous mottling of the skin, and facial flushing (a sensitive and specific indicator of dengue fever). The prodrome may last for 2-3 days. Children younger than 15 years usually have a nonspecific febrile syndrome, which may be accompanied by a maculopapular rash. Classic dengue fever begins with sudden onset of fever, chills, and severe (termed breakbone) aching of the head, back, and extremities, as well as other symptoms. The fever lasts 2-7 days and may reach 41°C. Fever that lasts longer than 10 days probably is not due to dengue.

Pain and other accompanying symptoms may include any of the following:

• Retro-orbital pain
• General body pain (arthralgias, myalgias)
• Nausea and vomiting (however, diarrhea is rare)
• Altered taste sensation
• Sore throat
• Mild hemorrhagic manifestations (eg, petechiae, bleeding gums, epistaxis, menorrhagia, hematuria)
• Lymphadenopathy

Rash in dengue fever is a maculopapular or macular confluent rash over the face, thorax, and flexor surfaces, with islands of skin sparing. The rash typically begins on Day 3 and persists 2-3 days.

Fever typically abates with the cessation of viremia. Occasionally, and more commonly in children, the fever abates for a day and then returns, a pattern that has been called saddleback fever. A second rash may occur within 1-2 days of defervescence, lasting 1-5 days; it is morbilliform, is maculopapular, spares the palms and soles, and occasionally desquamates.

Recovery is complete but slow, with fatigue and exhaustion often persisting after the fever has subsided. The convalescent phase may last for 2 weeks.

Patients are at risk for development of dengue hemorrhagic fever or dengue shock syndrome at approximately the time of defervescence. Abdominal pain in conjunction with restlessness, change in mental status, hypothermia, and a drop in the platelet count presages the development of dengue hemorrhagic fever.

Of patients with dengue hemorrhagic fever, 90% are younger than 15 years. The initial phase of dengue hemorrhagic fever is similar to that of dengue fever and other febrile viral illnesses. Shortly after the fever breaks (or sometimes within 24 hours before), signs of plasma leakage appear, along with the development of hemorrhagic symptoms such as bleeding from sites of trauma, gastrointestinal bleeding, and hematuria. Patients may also present with abdominal pain, vomiting, febrile seizures (in children), and a decreased level of consciousness.

If left untreated, dengue hemorrhagic fever most likely progresses to dengue shock syndrome. Common symptoms in impending shock include abdominal pain, vomiting, and restlessness. Patients also may have symptoms related to circulatory failure.

Dengue fever presents in a nonspecific manner and may not be distinguishable from other viral or bacterial illness. According to the Pan American Health Organization (PAHO), the clinical description of dengue fever is an acute febrile illness of 2-7 days duration associated with 2 or more of the following:

• Severe and generalized headache
• Severe myalgias, especially of the lower back, arms, and legs
• Arthralgias, usually of the knees and shoulders
• Characteristic rash
• Hemorrhagic manifestations

Additional findings may include the following:

• Injected conjunctivae
• Facial flushing, a sensitive and specific predictor of dengue infection
• Inflamed pharynx
• Nausea and vomiting
• Nonproductive cough
• Tachycardia, bradycardia, and conduction defects

Up to half of patients with dengue fever develop a characteristic rash. The rash is variable and may be maculopapular or macular. Petechiae and purpura may develop as hemorrhagic manifestations. Hemorrhagic manifestations most commonly include petechiae and bleeding at venipuncture sites.

A tourniquet test often is positive. This test is performed by inflating a blood pressure cuff on the upper arm to midway between diastolic and systolic blood pressures for 5 minutes. The results are considered to be positive if more than 20 petechiae per square inch are observed on the skin in the area that was under pressure. Other hemorrhagic manifestations include nasal or gingival bleeding, melena, hematemesis, and menorrhagia.

Neurologic manifestations such as seizures and encephalitis/encephalopathy have been reported in rare cases of dengue infection. Some of these cases did not display other typical features of dengue infection. Other neurologic complications associated with dengue infection include neuropathies, Guillain-Barré syndrome, and transverse myelitis.

Dengue hemorrhagic fever

Findings for dengue hemorrhagic fever are similar to those for dengue fever and include the following:

Biphasic fever curve

Hemorrhagic findings more pronounced than in dengue fever

Signs of peritoneal effusion, pleural effusion, or both

Minimal criteria for the diagnosis of dengue hemorrhagic fever, according to the World Health Organization (WHO), are as follows [ 65 ] :

Hemorrhagic manifestations (eg, hemoconcentration, thrombocytopenia, positive tourniquet test)

Circulatory failure, such as signs of vascular permeability (eg, hypoproteinemia, effusions)

Hepatomegaly

In addition, conjunctival injection develops in approximately one third of patients with dengue hemorrhagic fever. Optic neuropathy has been reported and occasionally results in permanent and significant visual impairment. [ 66 ] Pharyngeal injection develops in almost 97% of patients with dengue hemorrhagic fever. Generalized lymphadenopathy is observed.

Hepatomegaly is present more often in dengue shock syndrome than in milder cases. Hepatic transaminase levels may be mildly to moderately elevated. Encephalopathy is a rare complication that may result from a combination of cerebral edema, intracranial hemorrhage, anoxia, hyponatremia, and hepatic injury.

Dengue shock syndrome

Findings of dengue shock syndrome include the following:

Hypotension

Bradycardia (paradoxical) or tachycardia associated with hypovolemic shock

Hypothermia

Narrow pulse pressure (< 20 mm Hg)

Signs of decreased peripheral perfusion

Santos LLM, de Aquino EC, Fernandes SM, Ternes YMF, Feres VCR. Dengue, chikungunya, and Zika virus infections in Latin America and the Caribbean: a systematic review. Rev Panam Salud Publica . 2023. 47:e34. [QxMD MEDLINE Link] .

Schaefer TJ, Panda PK, Wolford RW. Dengue Fever. StatPearls . 2023 Jan. [QxMD MEDLINE Link] . [Full Text] .

Tayal A, Kabra SK, Lodha R. Management of Dengue: An Updated Review. Indian J Pediatr . 2023 Feb. 90 (2):168-177. [QxMD MEDLINE Link] .

Kok BH, Lim HT, Lim CP, Lai NS, Leow CY, Leow CH. Dengue virus infection - a review of pathogenesis, vaccines, diagnosis and therapy. Virus Res . 2023 Jan 15. 324:199018. [QxMD MEDLINE Link] .

World Health Organization. Dengue and severe dengue fact sheet. WHO. Available at http://www.who.int/mediacentre/factsheets/fs117/en/ . April 2017; Accessed: April 11, 2023.

Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. The global distribution and burden of dengue. Nature . 2013 Apr 25. 496 (7446):504-7. [QxMD MEDLINE Link] .

Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG, et al. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis . 2012. 6 (8):e1760. [QxMD MEDLINE Link] .

Wilson ME, Chen LH. Dengue: update on epidemiology. Curr Infect Dis Rep . 2015 Jan. 17 (1):457. [QxMD MEDLINE Link] .

WHO. Ten threats to global health in 2019. World Health Organization. Available at https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 . 2019; Accessed: April 11, 2023.

Kyle JL, Harris E. Global spread and persistence of dengue. Annu Rev Microbiol . 2008. 62:71-92. [QxMD MEDLINE Link] .

Statler J, Mammen M, Lyons A, Sun W. Sonographic findings of healthy volunteers infected with dengue virus. J Clin Ultrasound . 2008 Sep. 36(7):413-7. [QxMD MEDLINE Link] .

Gubler DJ. Cities spawn epidemic dengue viruses. Nat Med . 2004 Feb. 10(2):129-30. [QxMD MEDLINE Link] .

Wilder-Smith A, Gubler DJ. Geographic expansion of dengue: the impact of international travel. Med Clin North Am . 2008 Nov. 92(6):1377-90, x. [QxMD MEDLINE Link] .

Messina JP, Brady OJ, Scott TW, Zou C, Pigott DM, Duda KA, et al. Global spread of dengue virus types: mapping the 70 year history. Trends Microbiol . 2014 Mar. 22 (3):138-46. [QxMD MEDLINE Link] . [Full Text] .

Halstead SB. Dengue. Lancet . 2007 Nov 10. 370(9599):1644-52. [QxMD MEDLINE Link] .

Chowell G, Torre CA, Munayco-Escate C, Suárez-Ognio L, López-Cruz R, Hyman JM. Spatial and temporal dynamics of dengue fever in Peru: 1994-2006. Epidemiol Infect . 2008 Dec. 136(12):1667-77. [QxMD MEDLINE Link] .

Osterweil N. Dengue 'Under-recognized' as Source of Febrile Illness in US. Medscape Medical News. Jan 23 2014. Available at http://www.medscape.com/viewarticle/819656 . Accessed: April 11, 2023.

Sharp TM, Gaul L, Muehlenbachs A, Hunsperger E, Bhatnagar J, Lueptow R, et al. Fatal hemophagocytic lymphohistiocytosis associated with locally acquired dengue virus infection - new Mexico and Texas, 2012. MMWR Morb Mortal Wkly Rep . 2014 Jan 24. 63(3):49-54. [QxMD MEDLINE Link] .

Freedman DO, Weld LH, Kozarsky PE, Fisk T, Robins R, von Sonnenburg F. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med . 2006 Jan 12. 354(2):119-30. [QxMD MEDLINE Link] .

Liu-Helmersson J, Quam M, Wilder-Smith A, Stenlund H, Ebi K, Massad E, et al. Climate Change and Aedes Vectors: 21st Century Projections for Dengue Transmission in Europe. EBioMedicine . 2016 May. 7:267-77. [QxMD MEDLINE Link] .

CDC. Imported dengue--United States, 1997 and 1998. MMWR Morb Mortal Wkly Rep . 2000 Mar 31. 49(12):248-53. [QxMD MEDLINE Link] . [Full Text] .

Engelthaler DM, Fink TM, Levy CE, Leslie MJ. The reemergence of Aedes aegypti in Arizona. Emerg Infect Dis . 1997 Apr-Jun. 3(2):241-2. [QxMD MEDLINE Link] . [Full Text] .

Chye JK, Lim CT, Ng KB, et al. Vertical transmission of dengue. Clin Infect Dis . 1997 Dec. 25(6):1374-7. [QxMD MEDLINE Link] .

Wagner D, de With K, Huzly D, Hufert F, Weidmann M, Breisinger S, et al. Nosocomial acquisition of dengue. Emerg Infect Dis . 2004 Oct. 10(10):1872-3. [QxMD MEDLINE Link] .

Arragain L, Dupont-Rouzeyrol M, O'Connor O, Sigur N, Grangeon JP, Huguon E, et al. Vertical Transmission of Dengue Virus in the Peripartum Period and Viral Kinetics in Newborns and Breast Milk: New Data. J Pediatric Infect Dis Soc . 2017 Nov 24. 6 (4):324-331. [QxMD MEDLINE Link] .

Lalle E, Colavita F, Iannetta M, Gebremeskel Teklè S, Carletti F, Scorzolini L, et al. Prolonged detection of dengue virus RNA in the semen of a man returning from Thailand to Italy, January 2018. Euro Surveill . 2018 May. 23 (18): [QxMD MEDLINE Link] .

Liew CH. The first case of sexual transmission of dengue in Spain. J Travel Med . 2020 Feb 3. 27 (1): [QxMD MEDLINE Link] .

Dejnirattisai W, Duangchinda T, Lin CL, Vasanawathana S, Jones M, Jacobs M, et al. A complex interplay among virus, dendritic cells, T cells, and cytokines in dengue virus infections. J Immunol . 2008 Nov 1. 181(9):5865-74. [QxMD MEDLINE Link] .

Halstead SB, Heinz FX, Barrett AD, Roehrig JT. Dengue virus: molecular basis of cell entry and pathogenesis, 25-27 June 2003, Vienna, Austria. Vaccine . 2005 Jan 4. 23(7):849-56. [QxMD MEDLINE Link] .

Limjindaporn T, Wongwiwat W, Noisakran S, Srisawat C, Netsawang J, Puttikhunt C, et al. Interaction of dengue virus envelope protein with endoplasmic reticulum-resident chaperones facilitates dengue virus production. Biochem Biophys Res Commun . 2009 Feb 6. 379(2):196-200. [QxMD MEDLINE Link] .

Zhang JL, Wang JL, Gao N, Chen ZT, Tian YP, An J. Up-regulated expression of beta3 integrin induced by dengue virus serotype 2 infection associated with virus entry into human dermal microvascular endothelial cells. Biochem Biophys Res Commun . 2007 May 11. 356(3):763-8. [QxMD MEDLINE Link] .

Rothman AL, Ennis FA. Immunopathogenesis of Dengue hemorrhagic fever. Virology . 1999 Apr 25. 257(1):1-6. [QxMD MEDLINE Link] .

Chen LC, Lei HY, Liu CC, Shiesh SC, Chen SH, Liu HS. Correlation of serum levels of macrophage migration inhibitory factor with disease severity and clinical outcome in dengue patients. Am J Trop Med Hyg . 2006 Jan. 74(1):142-7. [QxMD MEDLINE Link] .

Green S, Rothman A. Immunopathological mechanisms in dengue and dengue hemorrhagic fever. Curr Opin Infect Dis . 2006 Oct. 19(5):429-36. [QxMD MEDLINE Link] .

Guzman MG, Alvarez M, Rodriguez-Roche R, Bernardo L, Montes T, Vazquez S. Neutralizing antibodies after infection with dengue 1 virus. Emerg Infect Dis . 2007 Feb. 13(2):282-6. [QxMD MEDLINE Link] .

Restrepo BN, Ramirez RE, Arboleda M, Alvarez G, Ospina M, Diaz FJ. Serum levels of cytokines in two ethnic groups with dengue virus infection. Am J Trop Med Hyg . 2008 Nov. 79(5):673-7. [QxMD MEDLINE Link] .

Rothman AL. Dengue: defining protective versus pathologic immunity. J Clin Invest . 2004 Apr. 113(7):946-51. [QxMD MEDLINE Link] .

de Macedo FC, Nicol AF, Cooper LD, Yearsley M, Pires AR, Nuovo GJ. Histologic, viral, and molecular correlates of dengue fever infection of the liver using highly sensitive immunohistochemistry. Diagn Mol Pathol . 2006 Dec. 15(4):223-8. [QxMD MEDLINE Link] .

Shah I. Dengue and liver disease. Scand J Infect Dis . 2008. 40(11-12):993-4. [QxMD MEDLINE Link] .

Dejnirattisai W, Jumnainsong A, Onsirisakul N, et al. Cross-reacting antibodies enhance dengue virus infection in humans. Science . 2010 May 7. 328(5979):745-8. [QxMD MEDLINE Link] .

Schmidt AC. Response to dengue fever--the good, the bad, and the ugly?. N Engl J Med . 2010 Jul 29. 363(5):484-7. [QxMD MEDLINE Link] .

Kurane I, Innis BL, Nimmannitya S, Nisalak A, Meager A, Ennis FA. High levels of interferon alpha in the sera of children with dengue virus infection. Am J Trop Med Hyg . 1993 Feb. 48(2):222-9. [QxMD MEDLINE Link] .

Ojha A, Nandi D, Batra H, Singhal R, Annarapu GK, Bhattacharyya S, et al. Platelet activation determines the severity of thrombocytopenia in dengue infection. Sci Rep . 2017 Jan 31. 7:41697. [QxMD MEDLINE Link] .

Hottz ED, Oliveira MF, Nunes PC, Nogueira RM, Valls-de-Souza R, Da Poian AT, et al. Dengue induces platelet activation, mitochondrial dysfunction and cell death through mechanisms that involve DC-SIGN and caspases. J Thromb Haemost . 2013 May. 11 (5):951-62. [QxMD MEDLINE Link] .

Wang E, Ni H, Xu R, Barrett AD, Watowich SJ, Gubler DJ. Evolutionary relationships of endemic/epidemic and sylvatic dengue viruses. J Virol . 2000 Apr. 74(7):3227-34. [QxMD MEDLINE Link] .

Centers for Disease Control and Prevention Web site. CDC traveler's health page. Dengue. CDC. Available at http://www.cdc.gov/Dengue/travelOutbreaks/ . Accessed: April 11, 2023.

Chen WS, Wong CH, Cillekens L. Dengue antibodies in a suburban community in Malaysia. Med J Malaysia . 2003 Mar. 58(1):142-3. [QxMD MEDLINE Link] .

Istúriz RE, Gubler DJ, Brea del Castillo J. Dengue and dengue hemorrhagic fever in Latin America and the Caribbean. Infect Dis Clin North Am . 2000 Mar. 14(1):121-40, ix. [QxMD MEDLINE Link] .

Hotez PJ, Bottazzi ME, Franco-Paredes C, Ault SK, Periago MR. The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination. PLoS Negl Trop Dis . 2008 Sep 24. 2(9):e300. [QxMD MEDLINE Link] . [Full Text] .

Centers for Disease Control and Prevention (CDC). Travel-associated Dengue surveillance - United States, 2006-2008. MMWR Morb Mortal Wkly Rep . 2010 Jun 18. 59(23):715-9. [QxMD MEDLINE Link] . [Full Text] .

Centers for Disease Control and Prevention (CDC). Locally acquired Dengue--Key West, Florida, 2009-2010. MMWR Morb Mortal Wkly Rep . 2010 May 21. 59(19):577-81. [QxMD MEDLINE Link] .

Rey JR. Dengue in Florida (USA). Insects . 2014 Dec 16. 5 (4):991-1000. [QxMD MEDLINE Link] .

Malavige GN, Fernando S, Fernando DJ, Seneviratne SL. Dengue viral infections. Postgrad Med J . 2004 Oct. 80(948):588-601. [QxMD MEDLINE Link] . [Full Text] .

Stephenson JR. Understanding dengue pathogenesis: implications for vaccine design. Bull World Health Organ . 2005 Apr. 83(4):308-14. [QxMD MEDLINE Link] . [Full Text] .

World Health Organization. Dengue and Severe Dengue. WHO. Available at https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue . March 17, 2023; Accessed: April 11. 2023.

Lin CC, Huang YH, Shu PY, et al. Characteristic of dengue disease in Taiwan: 2002-2007. Am J Trop Med Hyg . 2010 Apr. 82(4):731-9. [QxMD MEDLINE Link] . [Full Text] .

Anderson KB, Chunsuttiwat S, Nisalak A, Mammen MP, Libraty DH, Rothman AL. Burden of symptomatic dengue infection in children at primary school in Thailand: a prospective study. Lancet . 2007 Apr 28. 369(9571):1452-9. [QxMD MEDLINE Link] .

Anker M, Arima Y. Male-female differences in the number of reported incident dengue fever cases in six Asian countries. Western Pac Surveill Response J . 2011 Apr. 2 (2):17-23. [QxMD MEDLINE Link] .

Lahiri M, Fisher D, Tambyah PA. Dengue mortality: reassessing the risks in transition countries. Trans R Soc Trop Med Hyg . 2008 Oct. 102(10):1011-6. [QxMD MEDLINE Link] .

Beatty ME, Beutels P, Meltzer MI, et al. Health economics of dengue: a systematic literature review and expert panel's assessment. Am J Trop Med Hyg . 2011 Mar. 84(3):473-88. [QxMD MEDLINE Link] . [Full Text] .

Shepard DS, Coudeville L, Halasa YA, Zambrano B, Dayan GH. Economic impact of dengue illness in the Americas. Am J Trop Med Hyg . 2011 Feb. 84(2):200-7. [QxMD MEDLINE Link] . [Full Text] .

Suaya JA, Shepard DS, Siqueira JB, et al. Cost of dengue cases in eight countries in the Americas and Asia: a prospective study. Am J Trop Med Hyg . 2009 May. 80(5):846-55. [QxMD MEDLINE Link] .

WHO. Dengue and Severe Dengue. World Health Organization. Available at https://www.who.int/health-topics/dengue-and-severe-dengue . Accessed: April 11, 2023.

Sanjay S, Wagle AM, Au Eong KG. Dengue optic neuropathy. Ophthalmology . 2009 Jan. 116(1):170; author reply 170. [QxMD MEDLINE Link] .

Teves Maria A. Wrong treatment most common cause of dengue fatality. ABS/CBN News. Available at http://www.abs-cbnnews.com/nation/09/03/09/wrong-treatment-most-common-cause-dengue-fatality . Accessed: April 11, 2023.

Bottieau E, Clerinx J, Van den Enden E, Van Esbroeck M, Colebunders R, Van Gompel A. Fever after a stay in the tropics: diagnostic predictors of the leading tropical conditions. Medicine (Baltimore) . 2007 Jan. 86(1):18-25. [QxMD MEDLINE Link] .

Malhotra N, Chanana C, Kumar S. Dengue infection in pregnancy. Int J Gynaecol Obstet . 2006 Aug. 94(2):131-2. [QxMD MEDLINE Link] .

Singh N, Sharma KA, Dadhwal V, Mittal S, Selvi AS. A successful management of dengue fever in pregnancy: report of two cases. Indian J Med Microbiol . 2008 Oct-Dec. 26(4):377-80. [QxMD MEDLINE Link] .

Warrilow D, Northill JA, Pyke A, Smith GA. Single rapid TaqMan fluorogenic probe based PCR assay that detects all four dengue serotypes. J Med Virol . 2002 Apr. 66(4):524-8. [QxMD MEDLINE Link] .

Kong YY, Thay CH, Tin TC, Devi S. Rapid detection, serotyping and quantitation of dengue viruses by TaqMan real-time one-step RT-PCR. J Virol Methods . 2006 Dec. 138(1-2):123-30. [QxMD MEDLINE Link] .

Trung DT, Thao le TT, Hien TT, et al. Liver involvement associated with dengue infection in adults in Vietnam. Am J Trop Med Hyg . 2010 Oct. 83(4):774-80. [QxMD MEDLINE Link] . [Full Text] .

Potts JA, Rothman AL. Clinical and laboratory features that distinguish dengue from other febrile illnesses in endemic populations. Trop Med Int Health . 2008 Nov. 13(11):1328-40. [QxMD MEDLINE Link] . [Full Text] .

Lima EQ, Nogueira ML. Viral hemorrhagic fever-induced acute kidney injury. Semin Nephrol . 2008 Jul. 28(4):409-15. [QxMD MEDLINE Link] .

Lombardi R, Yu L, Younes-Ibrahim M, Schor N, Burdmann EA. Epidemiology of acute kidney injury in Latin America. Semin Nephrol . 2008 Jul. 28(4):320-9. [QxMD MEDLINE Link] .

Chaterji S, Allen JC Jr, Chow A, Leo YS, Ooi EE. Evaluation of the NS1 rapid test and the WHO dengue classification schemes for use as bedside diagnosis of acute dengue fever in adults. Am J Trop Med Hyg . 2011 Feb. 84(2):224-8. [QxMD MEDLINE Link] . [Full Text] .

Wichmann O, Stark K, Shu PY, Niedrig M, Frank C, Huang JH. Clinical features and pitfalls in the laboratory diagnosis of dengue in travellers. BMC Infect Dis . 2006. 6:120. [QxMD MEDLINE Link] .

Domingo C, de Ory F, Sanz JC, Reyes N, Gascón J, Wichmann O, et al. Molecular and serologic markers of acute dengue infection in naive and flavivirus-vaccinated travelers. Diagn Microbiol Infect Dis . 2009 Sep. 65(1):42-8. [QxMD MEDLINE Link] .

Srikiatkhachorn A, Krautrachue A, Ratanaprakarn W, Wongtapradit L, Nithipanya N, Kalayanarooj S. Natural history of plasma leakage in dengue hemorrhagic fever: a serial ultrasonographic study. Pediatr Infect Dis J . 2007 Apr. 26(4):283-90; discussion 291-2. [QxMD MEDLINE Link] .

Santhosh VR, Patil PG, Srinath MG, Kumar A, Jain A, Archana M. Sonography in the diagnosis and assessment of dengue Fever. J Clin Imaging Sci . 2014. 4:14. [QxMD MEDLINE Link] . [Full Text] .

Srikiatkhachorn A, Gibbons RV, Green S, et al. Dengue hemorrhagic fever: the sensitivity and specificity of the world health organization definition for identification of severe cases of dengue in Thailand, 1994-2005. Clin Infect Dis . 2010 Apr 15. 50(8):1135-43. [QxMD MEDLINE Link] . [Full Text] .

Setiati TE, Mairuhu AT, Koraka P, Supriatna M, Mac Gillavry MR, Brandjes DP, et al. Dengue disease severity in Indonesian children: an evaluation of the World Health Organization classification system. BMC Infect Dis . 2007 Mar 26. 7:22. [QxMD MEDLINE Link] . [Full Text] .

Tassniyom S, Vasanawathana S, Chirawatkul A, Rojanasuphot S. Failure of high-dose methylprednisolone in established dengue shock syndrome: a placebo-controlled, double-blind study. Pediatrics . 1993 Jul. 92(1):111-5. [QxMD MEDLINE Link] .

Wills BA, Nguyen MD, Ha TL, Dong TH, Tran TN, Le TT, et al. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. N Engl J Med . 2005 Sep 1. 353(9):877-89. [QxMD MEDLINE Link] .

Yadav SP, Sachdeva A, Gupta D, Sharma SD, Kharya G. Control of massive bleeding in dengue hemorrhagic fever with severe thrombocytopenia by use of intravenous anti-D globulin. Pediatr Blood Cancer . 2008 Dec. 51(6):812-3. [QxMD MEDLINE Link] .

Waduge R, Malavige GN, Pradeepan M, Wijeyaratne CN, Fernando S, Seneviratne SL. Dengue infections during pregnancy: a case series from Sri Lanka and review of the literature. J Clin Virol . 2006 Sep. 37(1):27-33. [QxMD MEDLINE Link] .

Ismail NA, Kampan N, Mahdy ZA, Jamil MA, Razi ZR. Dengue in pregnancy. Southeast Asian J Trop Med Public Health . 2006 Jul. 37(4):681-3. [QxMD MEDLINE Link] .

Billingsley PF, Foy B, Rasgon JL. Mosquitocidal vaccines: a neglected addition to malaria and dengue control strategies. Trends Parasitol . 2008 Sep. 24(9):396-400. [QxMD MEDLINE Link] .

Erlanger TE, Keiser J, Utzinger J. Effect of dengue vector control interventions on entomological parameters in developing countries: a systematic review and meta-analysis. Med Vet Entomol . 2008 Sep. 22(3):203-21. [QxMD MEDLINE Link] .

Kay B, Vu SN. New strategy against Aedes aegypti in Vietnam. Lancet . 2005 Feb 12-18. 365(9459):613-7. [QxMD MEDLINE Link] .

Hanh TT, Hill PS, Kay BH, Quy TM. Development of a framework for evaluating the sustainability of community-based dengue control projects. Am J Trop Med Hyg . 2009 Feb. 80(2):312-8. [QxMD MEDLINE Link] .

Hoffmann AA, Montgomery BL, Popovici J, Iturbe-Ormaetxe I, Johnson PH, Muzzi F, et al. Successful establishment of Wolbachia in Aedes populations to suppress dengue transmission. Nature . 2011 Aug 24. 476 (7361):454-7. [QxMD MEDLINE Link] .

Lang J. Recent progress on sanofi pasteur's dengue vaccine candidate. J Clin Virol . 2009 Oct. 46 Suppl 2:S20-4. [QxMD MEDLINE Link] .

World Health Organization. Dengue vaccine: WHO position paper – July 2016. Wkly Epidemiol Rec . 2016 Jul 29. 91 (30):349-64. [QxMD MEDLINE Link] .

Aguiar M, Stollenwerk N, Halstead SB. The risks behind Dengvaxia recommendation. Lancet Infect Dis . 2016 Aug. 16 (8):882-3. [QxMD MEDLINE Link] . [Full Text] .

Dengvaxia. European Medicines Agency. Available at https://www.ema.europa.eu/en/medicines/human/EPAR/dengvaxia . 2018 Dec 18; Accessed: April 11, 2023.

Adams LE, Waterman S, Paz-Bailey G. Vaccination for Dengue Prevention. JAMA . 2022 Mar 1. 327 (9):817-818. [QxMD MEDLINE Link] .

Dengvaxia (dengue vaccine) [package insert]. Swiftwater, PA: Sanofi Pasteur, Inc. May 2019. Available at [Full Text] .

Monath TP. Dengue and yellow fever--challenges for the development and use of vaccines. N Engl J Med . 2007 Nov 29. 357(22):2222-5. [QxMD MEDLINE Link] .

Questions and Answers on Dengue Vaccines. World Health Organization. Available at https://www.who.int/immunization/research/development/dengue_q_and_a/en/ . 2018 April 20; Accessed: April 11, 2023.

McArthur JH, Durbin AP, Marron JA, Wanionek KA, Thumar B, Pierro DJ, et al. Phase I clinical evaluation of rDEN4Delta30-200,201: a live attenuated dengue 4 vaccine candidate designed for decreased hepatotoxicity. Am J Trop Med Hyg . 2008 Nov. 79(5):678-84. [QxMD MEDLINE Link] . [Full Text] .

O'Brien J. 12th Annual Conference on Vaccine Research. Expert Rev Vaccines . 2009 Sep. 8(9):1139-42. [QxMD MEDLINE Link] .

Edelman R. Dengue vaccines approach the finish line. Clin Infect Dis . 2007 Jul 15. 45 Suppl 1:S56-60. [QxMD MEDLINE Link] .

Blaney JE Jr, Durbin AP, Murphy BR, Whitehead SS. Development of a live attenuated dengue virus vaccine using reverse genetics. Viral Immunol . 2006 Spring. 19(1):10-32. [QxMD MEDLINE Link] .

Larsen CP, Whitehead SS, Durbin AP. Dengue human infection models to advance dengue vaccine development. Vaccine . 2015 Sep 28. [QxMD MEDLINE Link] .

• Drawing of Aedes aegypti mosquito. Courtesy of the Centers for Disease Control and Prevention (CDC).
• Aedes albopictus. Courtesy of the Centers for Disease Control and Prevention (CDC).
• Worldwide distribution of dengue in 2000. Courtesy of the Centers for Disease Control and Prevention (CDC).
• Worldwide distribution of dengue in 2003. Courtesy of the Centers for Disease Control and Prevention (CDC).
• Worldwide distribution of dengue in 2005. Courtesy of the Centers for Disease Control and Prevention (CDC).
• Increasing rates of dengue infection by regions of the world. Courtesy of the World Health Organization (WHO).
• Dengue transmission cycle. Courtesy of the Centers for Disease Control and Prevention (CDC).
• Reinfestation by Aedes aegypti in the Americas after the 1970 (left) mosquito eradication program and most recent distribution as of 2002 (right). Courtesy of the Centers for Disease Control and Prevention (CDC).
• A child with dengue hemorrhagic fever or dengue shock syndrome may present severely hypotensive with disseminated intravascular coagulation (DIC), as this severely ill pediatric ICU patient did. Crystalloid fluid resuscitation and standard DIC treatment are critical to the child's survival.
• Delayed capillary refill may be the first sign of intravascular volume depletion. Hypotension usually is a late sign in children. This child's capillary refill at 6 seconds was delayed well beyond a normal duration of 2 seconds.
• Signs of early coagulopathy may be as subtle as a guaiac test that is positive for occult blood in the stool. This test should be performed on all patients in whom dengue virus infection is suspected.
• Aedes aegypti mosquito. Courtesy of Wikimedia Commons (https://commons.wikimedia.org/wiki/File:Aedes_aegypti.jpg; author Muhammad Mahdi Karim).
• Global map of dengue risk. Frequent or continuous risk = frequent outbreaks or ongoing transmission. Sporadic or uncertain risk = variable and unpredictable risk, country-level data are unavailable. Courtesy of the Centers for Disease Control and Prevention (CDC) (https://www.cdc.gov/dengue/areaswithrisk/around-the-world.html).

Contributor Information and Disclosures

Darvin Scott Smith, MD, MSc, DTM&H, FIDSA Chief of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, Kaiser Permanente Medical Group Darvin Scott Smith, MD, MSc, DTM&H, FIDSA is a member of the following medical societies: American Medical Association , American Society of Tropical Medicine and Hygiene , Infectious Diseases Society of America , International Society of Travel Medicine Disclosure: Nothing to disclose.

David J Mariano, BS, MS MD Candidate, University of California, San Diego, School of Medicine Disclosure: Nothing to disclose.

Micah Lynne Trautwein, BS MD Candidate, Geisel School of Medicine at Dartmouth Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha , American College of Physicians , American Medical Association , Association of Professors of Medicine , Infectious Diseases Society of America , Oklahoma State Medical Association , Southern Society for Clinical Investigation Disclosure: Nothing to disclose.

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM Professor of Emergency Medicine, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine; Medical Director, Fast Track, Department of Emergency Medicine Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha , American Academy of Emergency Medicine , American Society of Tropical Medicine and Hygiene , International Society of Travel Medicine , Society for Academic Emergency Medicine , Wilderness Medical Society Disclosure: Nothing to disclose.

Patrick B Hinfey, MD Emergency Medicine Residency Director, Department of Emergency Medicine, Newark Beth Israel Medical Center; Clinical Assistant Professor of Emergency Medicine, New York College of Osteopathic Medicine Patrick B Hinfey, MD is a member of the following medical societies: American Academy of Emergency Medicine , Wilderness Medical Society , American College of Emergency Physicians , Society for Academic Emergency Medicine Disclosure: Nothing to disclose.

William H Shoff, MD, DTM&H Former Director, PENN Travel Medicine; Former Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians , American Society of Tropical Medicine and Hygiene , International Society of Travel Medicine , Society for Academic Emergency Medicine , Wilderness Medical Society Disclosure: Nothing to disclose.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha , American Academy of Pediatrics , American Society for Microbiology , Infectious Diseases Society of America , Pediatric Infectious Diseases Society , and Phi Beta Kappa

Disclosure: Nothing to disclose.

Hagop A Isnar, MD, FACEP Department of Emergency Medicine, Crouse Hospital

Hagop A Isnar, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians , American Medical Association , and Society for Academic Emergency Medicine

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha , American College of Physicians , American Public Health Association , American Society for Microbiology , American Society of Tropical Medicine and Hygiene , Infectious Diseases Society of America , Medical Society of Virginia , and Wilderness Medical Society

Deborah Sentochnik, MD Consulting Staff, Department of Internal Medicine, Division of Infectious Disease, The Mary Imogene Bassett Hospital

Deborah Sentochnik, MD is a member of the following medical societies: American College of Physicians , Infectious Diseases Society of America , and Medical Society of the State of New York

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics , American Association of Immunologists , American Pediatric Society , American Society for Microbiology , Infectious Diseases Society of America , Louisiana State Medical Society , Pediatric Infectious Diseases Society , Society for Pediatric Research , and Southern Medical Association

Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

What would you like to print?

• Print this section
• Print the entire contents of
• Print the entire contents of article

• Tropical Myeloneuropathies
• Tropical Sprue
• Endomyocardial Fibrosis
• Pathology of Eosinophilic Pneumonia
• Cutaneous Larva Migrans
• Ainhum (Dactylolysis Spontanea)
• Is Metformin a 'Drug for All Diseases'?
• Major Gaps in Care, Management of Neurologic Diseases
• ECDC Warns of Increase In Mosquito-Borne Diseases
• COP28 Focus on Health Draws $777 Million to Fight Tropical Disease

• Drug Interaction Checker
• Pill Identifier
• Calculators

• 2001/s/viewarticle/999057News News COP28 Focus on Health Draws $777 Million to Fight Tropical Disease

• 2001/viewarticle/979171 What Caused a Series of Cases of Melioidosis?

• Fact sheets
• Facts in pictures
• Publications
• Questions and answers
• Tools and toolkits
• HIV and AIDS
• Hypertension
• Mental disorders
• Top 10 causes of death
• All countries
• Eastern Mediterranean
• South-East Asia
• Western Pacific
• Data by country
• Country presence 
• Country strengthening 
• Country cooperation strategies 
• News releases
• Feature stories
• Press conferences
• Commentaries
• Photo library
• Afghanistan
• Cholera 
• Coronavirus disease (COVID-19)
• Greater Horn of Africa
• Israel and occupied Palestinian territory

Disease Outbreak News

• Situation reports
• Weekly Epidemiological Record
• Surveillance
• Health emergency appeal
• International Health Regulations
• Independent Oversight and Advisory Committee
• Classifications
• Data collections
• Global Health Estimates
• Mortality Database
• Sustainable Development Goals
• Health Inequality Monitor
• Global Progress
• Data collection tools
• Global Health Observatory
• Insights and visualizations
• COVID excess deaths
• World Health Statistics
• Partnerships
• Committees and advisory groups
• Collaborating centres
• Technical teams
• Organizational structure
• Initiatives
• General Programme of Work
• WHO Academy
• Investment case
• WHO Foundation
• External audit
• Financial statements
• Internal audit and investigations 
• Programme Budget
• Results reports
• Governing bodies
• World Health Assembly
• Executive Board
• Member States Portal
• Disease Outbreak News /
• Dengue- Global situation

Dengue - Global situation

Description of the situation.

Global Overview 

Current situation 

The global incidence of dengue has markedly increased over the past two decades, posing a substantial public health challenge. From 2000 to 2019, the World Health Organization (WHO) documented a ten-fold surge in reported cases worldwide increasing from 500 000 to 5.2 million. The year 2019 marked an unprecedented peak, with reported instances spreading across 129 countries.  

After a slight decline of cases between the year 2020-2022 due to the COVID-19 pandemic and lower reporting rate, in 2023, an upsurge in dengue cases have been observed globally, characterized by a significant increase in the number, scale, and simultaneous occurrence of multiple outbreaks, spreading into regions previously unaffected by dengue. 

Dengue transmission is cyclic and large outbreaks every 3-4 years can be expected. During the COVID-19 pandemic we saw moderate transmission of dengue in some regions and low transmission in others leading to an accumulation of people without immunity to certain dengue virus serotypes. However, the data on the circulating dengue serotypes is limited.  

Since the beginning of 2023, ongoing transmission, combined with an unexpected spike in dengue cases have resulted in close to a historic high of over five million cases and more than 5000 dengue-related deaths reported in over 80 countries/territories and five WHO regions: Africa, Americas, South-East Asia, Western Pacific and Eastern Mediterranean Regions globally (Figure 1). Close to 80% of these cases, or 4.1 million, have been reported in the Region of the Americas. Dengue is the most widespread arbovirus and causes the highest number of arboviral disease cases in the Region of the Americas, with cyclic epidemics recurring every 3 to 5 years. In addition, clusters of autochthonous dengue have been reported in the WHO European Region. However, these numbers are likely an underestimate of the true burden as most of the primary infections are asymptomatic and dengue reporting is not mandatory in many countries.     

Several factors are associated with the increasing risk of spread of the dengue epidemic including, the changing distribution of the vectors (chiefly Aedes aegypti and Aedes albopictus ), especially in previously dengue naïve countries; the consequences of El Nino phenomena in 2023 and climate change leading to increasing temperatures and high rainfall, humidity among others; fragile health systems in the midst of COVID-19 pandemic, political and financial instabilities in countries facing complex humanitarian crises and high population movements. These factors also challenge the response to the epidemic and the risk of further spread to other countries. Weakness in the surveillance systems in many affected countries may have led to delayed reporting and response and missed identification of symptoms, contributing to increased severe dengue outcomes. 

WHO has assessed the risk to be high globally considering the increasing risk of transmission and the upsurge of cases and deaths.  

Figure 1: Countries/territories/areas reporting autochthonous dengue cases (November 2022- November 2023)  *

* Based on most recent available data (the data should be interpreted considering the differences in reporting rates and case definitions between the regions).

Regional overview 

WHO Region of Africa: 

Africa is among the top four regions most affected by arboviral diseases, including yellow fever, dengue, chikungunya, O'nyong nyong, Rift Valley fever, and Zika. In 2023, 171 991 dengue cases have been reported in countries in the region and 753 deaths. Evidence of dengue circulation has been detected in local populations and/or among travelers returning from more than 30 African countries.  

Outbreaks have been reported from 15 of the 47 countries including Benin, Burkina Faso, Cape Verde, Chad, Côte d'Ivoire, Ethiopia, Ghana, Guinea, Mali, Mauritius, Niger, Nigeria, São Tomé and Principe, Senegal and Togo. The outbreaks in most of these countries began in 2023, except in São Tomé and Príncipe, where it was a continuation of an outbreak that started in April 2022. As of 19 December 2023, outbreaks are still ongoing in 11 countries and were declared over in Chad, Guinea, Mauritius, and São Tomé and Príncipe. 

The most affected country in the region in 2023 is Burkina Faso, experiencing a significant increase in dengue cases compared with the same periods in 2021 and 2022. As of 18 December, the cumulative number of cases reported in the country for 2023 is 146 878 suspected cases, including 68 346 probable cases (positive rapid diagnostic test) and 688 deaths among suspected cases, representing a case fatality rate of 0.5%.   

The burden of dengue in Africa is not well understood due to i) similarity of common, non-specific clinical symptoms of the disease with malaria and other tropical febrile illnesses; ii) limited laboratory capacity for timely detection and confirmation of dengue, which is crucial for detecting and reporting cases and preventing its spread; and iii) inadequate surveillance and limited case reporting, especially for dengue. 

Efforts are ongoing to better understand the transmission dynamics of dengue and other arboviruses in the region.  The WHO Regional Office for Africa has endorsed the Framework for the integrated control, elimination and eradication of tropical and vector-borne diseases in the African Region 2022-2030. Equally, the Regional Office has also drafted the Framework for implementation of the Global Arbovirus Initiative by targeted Member States in the WHO African Region . 

WHO Region of the Americas:

Between 1 January 2023 and 11 December 2023, a total of 4.1 million suspected dengue cases (cumulative incidence of 419 cases per 100 000 population), including 6710 severe cases (0.16% of suspected cases) and 2049 deaths (CFR 0.05%) were reported from 42 countries and territories in the Region of the Americas, with 15 countries reporting active outbreak. Of the total number of dengue cases until 12 November 2023 (EW 48 of 2023), 1 895 122 (45%) were laboratory confirmed. 

Currently, 46 countries and territories systematically report, through the Health Information Platform for the Americas (PLISA), on a weekly basis, the total number of cases, incidence, number of severe cases, number of deaths and lethality due to dengue, as well as entomological surveillance data. As of EW 48, Brazil has reported the highest number of suspected cases in the Region (n = 2 909 404; 1359 cases per 100 000 population), followed by Peru (n= 271 279; 813 cases per 100 000 population), and Mexico (n = 235 616; 179 cases per 100 000 population). In terms of severe dengue, Colombia reported the most cases (1504; 1.35% of cases), followed by Brazil (1474; 0.05% of cases), Mexico (1272; 0.54% of cases), Peru (1065; 0.39% of cases), and Bolivia (640; 0.44% of cases).   

Although dengue is endemic in most countries of South America, Mexico and Central America, and the Caribbean countries, the second half of 2023 has witnessed an alarming increase in cases, with cumulative cases for the year surpassing all previous yearly totals and in some countries extending beyond historically affected areas of transmission. Dengue cases have increased in the Americas over the past four decades, from 1.5 million cases from 1980 to 1989 to 17.5 million in 2010-2019. Before 2023, the highest historical dengue caseload was in 2019, with over 3.18 million cases, 28 208 severe cases, and 1823 deaths (CFR 0.06).  

DENV is the most widespread arbovirus and causes the highest number of arboviral disease cases in the Region of the Americas, with cyclic epidemics recurring every 3 to 5 years. Approximately 500 million people in the region are at risk of dengue infection today. Ae. aegypti , the vector mosquito for dengue, is widely distributed in the Americas, only Canada is free from dengue and its vector. In Uruguay, where Ae. Aegypti is present, limited autochthonous transmission was last reported in 2016, and only imported cases have been reported since then. 

All four DENV serotypes (DENV-1, DENV-2, DENV-3 and DENV-4) are currently circulating in the Americas. DENV-3 and DENV-4 are being detected more frequently in 2023 after several years of predominant detection of DENV-1 and DENV-2. Nevertheless, nine countries are reporting the co-circulation of all four dengue serotypes. Simultaneous circulation of all these serotypes has been detected in Brazil, Colombia, Costa Rica, Guatemala, Honduras, Mexico, Nicaragua, Panama, and Venezuela. The Arbovirus Diagnosis Laboratory Network of the Americas (RELDA as per its acronym in Spanish) has been strengthened to face the introduction of new dengue serotypes and the re-emergence of other arboviral diseases, such as chikungunya, Zika, and West Nile virus, all of which are currently circulating in the region alongside dengue. The main objective of the network is to ensure efficient laboratory surveillance and robust installed capacity to respond to outbreaks and epidemics. 

WHO Eastern Mediterranean Region: 

Dengue and severe dengue epidemics were first reported in the Region in 1998, and since then, their frequency and geographical spread have increased, with outbreaks occurring in all nine endemic countries: Afghanistan, Djibouti, Egypt, Oman, Pakistan, Saudi Arabia, Somalia, Sudan, and Yemen.  

Among these are fragile, conflict affected and vulnerable countries such as Afghanistan, Pakistan, Sudan, Somalia and Yemen. The outbreaks are exacerbated due to disruption of health services (Sudan), fragile health systems (Afghanistan, Somalia, Sudan, Pakistan and Yemen), mass population movements, poor water and sanitation infrastructure, and recurring natural disasters such as floods affecting Somalia, Sudan, Pakistan, and Yemen, along with earthquakes in Afghanistan. Outbreaks are also reported in middle- and high-income countries such as Egypt, Oman and Saudi Arabia due to climate change leading to unusual rainfalls. Pakistan (n= 20 072), Saudi Arabia and Oman have reported the highest number of confirmed cases thus far in 2023.   

During these epidemics, all four serotypes of dengue virus were known to circulate in the Region. Ae. aegypti is the predominant and primary vector transmitting dengue in the EMR endemic countries. More recently, Bahrain, Iran, and Qatar have reported the presence of Ae. aegypti, although no local transmission of dengue has been documented. Additionally, presence of the secondary vector of dengue, Ae. albopictus, has also been reported from ten EMR countries (Afghanistan, Iran, Jordan, Lebanon, Morocco, Oman, Pakistan, Palestine, Syria and Tunisia).   

The effectiveness of response measures is hindered by several factors including i) constrained laboratory capacities ii) challenges in accessing healthcare iii) shortages of human resources iv) limited and inconsistent vector surveillance v) insecticide resistance, vi) poor community engagement and health education vii) a fragmented surveillance system. vii) The ongoing armed hostilities in many Eastern Mediterranean Region countries further compound the complexities of response efforts. 

WHO European Region:  

Dengue is not endemic in the WHO European Region and cases are mainly travel-related; however, since 2010, there have been reports of autochthonous cases in a number of countries in the region, including Croatia, France, Israel, Italy, Portugal and Spain. In 2018, the year with the most comprehensive data available, a total of 2500 cases of dengue were reported to WHO through the regional annual surveillance data collection mechanism with Germany, France, and the United Kingdom contributing the majority of cases. The vast majority of these cases were imported. However, it should be noted that data completeness remains challenging.     

Between 1 January and 5 December 2023, sporadic autochthonous cases and outbreaks have been reported in three countries: Italy (n = 82), France (n = 43) and Spain (n = 3). Routine testing for dengue in Member States of the WHO European Region is not common unless there is a travel history and clinical suspicion, hence the actual numbers of dengue cases in 2023 is likely to be underestimated. One death of an imported, travel-related case was reported in Italy; no additional deaths have been reported in European countries in 2023 to date.  

The Ae. albopictus mosquito, which is the main vector of dengue virus in Europe, is established in several Southern European countries. Ae. albopictus mosquitoes have been detected further north and west in the past ten years and it has capacity to hibernate in winter. In 2023, this mosquito species has been identified in 13 countries of the region, a notable increase from eight countries in 2013. 

While cold winters prevent year-round transmission of mosquito-borne diseases, the climatic suitability for transmission of DENV in Europe is increasing, leading to floods and stagnant water pools. These create more favorable conditions for the competent vector population.  Ae. aegypti (principal dengue vector in most countries) does not survive over winter well but has been established in Cyprus and Madeira, Portugal since 2022. 

These trends can potentially lead to an increase in the number of dengue cases and possible fatalities. 

Robust public health systems in many countries, including access to early diagnosis, case referral, and management of severe cases, contribute to reduced severe health impact and further disease spread for both imported and autochthonous cases.    

WHO South-East Asia Region:   

In the WHO Southeast Asia region, 10 out of 11 Member States are known to be endemic for dengue virus. In 2023, several countries, including Bangladesh and Thailand, have reported a notable surge in dengue cases compared to previous years. In particular, India, Indonesia, Myanmar, Sri Lanka and Thailand rank among the world's 30 most highly endemic countries.  

Compared to 2022, in 2023, Bangladesh and Thailand recorded a larger number of dengue cases . By November 2023, Bangladesh experienced a substantial rise in cases reaching 308 167 compared to 62 382 reported for the entirety of 2022. Thailand saw an increase of over 300%, with dengue cases rising from 46 678 in 2022 to 136 655 in 2023 (as of 22 November 2023). During the same period, the death toll in Bangladesh rose from 281 (CFR 0.45%) to 1598 (CFR 0.52%), while in Thailand, it increased from 34 (CFR 0.07%) to 147 (CFR 0.11%). In other countries, the CFR ranged from 0.04% in Nepal to 0.72% in Indonesia. It's important to interpret these values cautiously due to variations in the case definition used across countries, with some systems primarily focused on reporting hospitalized or severe dengue cases. 

In addition, spatial and temporal shifts in dengue patterns were observed in 2022 and continued in 2023. Nepal and Bangladesh experienced spikes in case numbers earlier than usual. Cases in Nepal shifted from the Kathmandu Valley in 2022 to the southeast Terai region and hill districts in Gandaki province in 2023. India, in 2023, experienced an increase in cases in Kerala and northeastern States bordering Bangladesh compared to the previous year. 

WHO Western Pacific Region: 

The Western Pacific Region continues to face a high burden of mosquito-borne arboviral diseases, particularly dengue. These diseases cause significant morbidity and mortality, especially among those unreached by quality primary health care (PHC) services.  

Between 1 January 2023 to 7 December 2023, over 500 000 dengue cases and 750 deaths were reported from eight countries/territories/areas in the WHO Western Pacific Region: Australia, Cambodia, China, Lao People’s Democratic Republic, Malaysia, Philippines, Singapore, and Viet Nam. The most affected countries are the Philippines, reporting 167 355 cases and 575 deaths (CFR 0.34%), and Viet Nam with 149 557 cases and 36 deaths (CFR: 0.02%). Dengue is endemic in several countries such as Cambodia, Lao People’s Democratic Republic, the Philippines, and Viet Nam.   

In Pacific Island countries/territories (n = 21), in 2023, dengue-like illness 1 was reported from nine Pacific countries/territories, resulting in a total of 13 339 cases, a 28% increase reported as of 30 November compared to 2022. Among the most affected are Fiji, which reported 8418 cases in 2022 and 11 522 cases and 2023, reflecting a 37% increase.   

Member States with endemic transmission continue to report longer seasonal dengue epidemics with increasing magnitude and geographic spread. However, disease incidence is less reliable due to the underreporting of cases, particularly in the Pacific Island Countries and territories based on their current syndromic surveillance of dengue as dengue-like illness (DLI) reporting system. Furthermore, the reported number of deaths due to severe dengue is variable. As such, country-level and sub-national case fatality rates (CFR) may appear inconsistent.   

Due to the endemicity of dengue and public health burden in the Western Pacific Region, in 2008, the Regional Committee for WPR endorsed the Dengue Strategic Plan for the Asia Pacific Region 2008-2015 ( resolution WPR/RC59.R6 ), serving as a road map. Subsequently, in 2016, considering the growing regional trends in dengue morbidity and mortality, the Western Pacific Regional Action Plan for Dengue Prevention and Control was developed. This plan recommended a switch in strategy from outbreak containment to reducing the impact of dengue on communities.  There is a window of opportunity for Pacific countries/territories to improve the adherence to the existing WHO “ Framework for National Surveillance and control plans for Aedes vectors ” in the Pacific for non-endemic countries in the Pacific Region. Given the impact of climate change on the spread and endemicities of Arboviral diseases, establishing a comprehensive Early Warning System (EWS) that integrates climate, disease, viral/ serological, and entomology surveillance is crucial. Such a system has the potential to predict future risks in vulnerable communities.  

Epidemiology

Dengue virus (DENV) is transmitted to humans through the bite of infected mosquitoes typically in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas. The primary vectors that transmit the disease are Aedes aegypti and, to a lesser extent, Aedes albopictus mosquitoes, though in some regions such as Europe and North America this latter vector is more widespread.  

DENV has four serotypes (DENV-1, DENV-2, DENV-3, DENV-4). Infection with one serotype provides long-term immunity to the same serotype and only transient immunity to the other serotypes, after which secondary infections with a different serotype increase the risk for severe dengue. Dengue cases are most commonly asymptomatic or result in mild febrile illness. However, some cases will develop severe dengue, which may involve shock, severe bleeding or severe organ impairment. This stage often starts after the fever has gone away and it is preceded by warning signs such as intense abdominal pain, persistent vomiting, bleeding gums, fluid accumulation, lethargy or restlessness, and liver enlargement.   

There is no specific treatment for dengue, but the timely diagnosis of dengue cases, identification of warning signs for severe dengue, and appropriate clinical management are key elements of care to prevent the progression to severe dengue and deaths.  

Public health response

Heterogeneity in capacity across Member States impacts the ability to detect and respond to DENV endemic and epidemic transmission. While the majority of the countries in the Americas, South-East Asian and Western-Pacific regions are endemic for the disease and have the capacity to manage cases, a few countries do not mandate reporting of dengue cases and thus under- or non-reporting of cases results in pockets of vulnerability within regions. Simultaneous outbreaks across multiple WHO regions strain the capacity for epidemic response. The overall capacity to respond to multiple, concurrent outbreaks continues to be strained due to the global lack of resources, including shortages of good quality dengue diagnostic kits for early detection, lack of trained clinical and vector control staff, and lack of resources to support risk community and community engagement interventions. Prevention and control of dengue continue to be variable due to changes in the predominant circulating serotypes and co-circulation of multiple dengue serotypes in the different regions, limited funding, competing health priorities and diverse perceptions about the effectiveness of interventions and control measures. Surveillance and response capacity is particularly limited in many countries in the African region, and as stated earlier, five of the Eastern Mediterranean Member States with DENV are dealing with conflicts and natural disasters.  

There is a pressing need to increase advocacy and resource mobilization in an integrated approach to influence policymakers in affected countries within these regions.  

The following activities are being undertaken at WHO to support Member States in the response to this event.  

Coordination and leadership 

• Establishment of a Global Joint Incident Management Support Team (IMST) at WHO, involving WHO Health Emergencies Programme (Response and Preparedness departments) and technical expertise from the Neglected Tropical Disease department to support the response to outbreaks. 
• Implementation of integrated response aligned with the overarching Global Arbovirus Initiative.   The Global Arbovirus Initiative is an integrated strategic plan to tackle emerging and re-emerging arboviruses with epidemic and pandemic potential focusing on monitoring risk, pandemic prevention, preparedness, detection and response, and building a coalition of partners. The initiative is a collaborative effort between the World Health Emergencies Programme, the Department of Control of Neglected Tropical Diseases, and the Immunization, Vaccines and Biologicals Department. This integrated initiative will build a coalition of key partners to strengthen the coordination, communication, capacity-building, research, preparedness, and response necessary to mitigate the growing risk of epidemics due to these diseases. 

Preparedness and Response

• Conducting risk mapping to categorize countries  (preparedness, readiness or response) and to enable appropriate packages of interventions to be developed. 
• Developing global operational response plan and a strategic plan for preparedness and response including needs and required funds. 
• Supporting Member States through the development of guidelines on preparedness and response to dengue outbreaks (including the strengthening of epidemiological and entomological surveillance, laboratory diagnosis and genomic surveillance, clinical management, risk communication and community engagement (RCCE), vector surveillance and control, and also organization of health services).   
• Provision of technical support to all ongoing outbreaks (epidemiology, laboratory, case management, RCCE including behavioral science, and vector and environmental surveillance and control.  

3. Multisectoral collaboration 

• Support country adoption of a multisectoral One health strategy while preparing for and responding to dengue outbreaks as well as other arboviral diseases.  
• Collaboration with One Health and climate change partners to coordinate the multisectoral response to dengue outbreaks.
• Supporting the deployment of experts through GOARN and Standby Partners to countries that are experiencing high-magnitude outbreaks.     

Vector control activities 

• Supporting the implementation of effective integrated vector management (surveillance and control) by Member States (in priority countries) through publishing guidelines and the provision of epidemiological surveillance materials and technical assistance to national authorities.
• Working with Member States to support the vector control response with specialized vector control technicians to help coordinate the response.
• Support training on insecticide resistance management and vector surveillance in Member States. 
• Support the strengthening of laboratory-capacity to enable timely and accurate diagnosis and case detection in affected and at-risk countries.  
• Leveraging the capacities built during the COVID-19 pandemic to strengthen molecular diagnosis and genomic surveillance at the country level.  

6. Operations, Support and Logistics (OSL) 

• Working closely with suppliers to secure dengue kits and establishing a pipeline for bulk items.
• Supporting Member States in purchasing equipment and insecticides and provision of insecticide resistance management kits.   

Case management guidelines and capacity building 

• Sharing case management guidelines and clinical training with health care workers through webinars and refresher sessions.   
• Ongoing development of the WHO guideline for the clinical management and diagnosis of dengue, chikungunya, Zika, and yellow fever, due for completion in early 2024, which will be an important tool.  
• WHO/PAHO has produced a 20-hour self-learning, virtual course on dengue clinical management, available in Spanish and English languages, focused on identifying early predictors of severe disease (warning signs) and preventing the progression of dengue cases to severe dengue and deaths. The course has already trained over 312 000 clinicians since its launch in September 2020 (219 000 in 2023 alone).    

Epidemiological Surveillance 

• Virtual cooperation spaces (VCS) have been created for collaborative surveillance between PAHO and its Member States that allow the automated generation of different epidemiological analyses, situation rooms, and epidemiological bulletins, strengthening the epidemiological surveillance of dengue and other arboviruses.  
• In 2023, PAHO/WHO issued five updates on the dengue situation in the Region of the Americas and an epidemiological alert regarding the increase in dengue cases in Central America and the Caribbean.  
• The WHO Regional Office for Africa has developed a country risk classification tool for dengue, which is being adapted for use in other regions.  
• WHO is working globally to enhance surveillance for dengue cases, severe dengue, and dengue deaths, in order to better understand the global burden in a more timely manner.   

Risk communication and community engagement (RCCE)  

• Providing advice on risk assessment, including community centered approach. 
• Supporting the development of RCCE evidence based and tailored interventions, encouraging both Individual and community actions. 
• Reviewing existing RCCE materials and lessons learned from previous and ongoing outbreaks.  
• Finalizing the RCCE toolkit on dengue.

WHO risk assessment

Recent data from 2023 emphasize escalated dengue outbreaks in several countries, particularly Bangladesh, Brazil, Burkina Faso, Fiji, Pakistan, the Philippines, and Viet Nam. Additionally, non-endemic countries are increasingly facing dengue as a significant public health concern. The emergence and re-emergence of dengue and its unprecedented worldwide spread are linked to various factors:  i) Changing distribution and adaptation of the Aedes aegypti vector; ii) increased unplanned urbanization and human activities fostering conducive environments for vector-host interaction; iii) Climate change-induced shifts in weather patterns; iv) Fragile healthcare systems amidst political and financial instabilities; v) Co-circulation of multiple dengue serotypes; vi) Challenges in clinical diagnosis due to non-specific symptoms; vii) Inadequate laboratory and testing capacity; viii) Prolonged ongoing concurrent outbreaks, including COVID-19; ix) Lack of specific treatment for dengue; x) Limited behavioral data available on community risk perceptions, awareness and health seeking behaviors: xi) Lack of community centered approach and RCCE resources to support engagement and mobilization of local communities in vector control activities; xi) Insufficient vector surveillance and control capacities and, xii) Lack of coordination among stakeholders, chronic underfunding,  low donor interest and xii) large scale movement of people and goods.   

The expansion of DENV beyond its endemic transmission areas presents additional challenges.  A significant population that is immunologically naïve to the current virus circulating, increasing the risk of outbreaks. Moreover, people in these areas might lack awareness of dengue warning signs, leading to potential delays in seeking health care which is critical to reducing mortality from severe disease.  Accessibility challenges to medical facilities, compounded by limited geographical access, heighten the difficulty in accessing basic healthcare services.  These challenges are aggravated by stockouts of essential supplies for prevention and control, laboratory diagnostic reagents, and the need for ongoing training of healthcare workers.  

These factors, along with others, including financial crises, mass migration of internally displaced persons (IDPs) and refugees, and longstanding developmental inadequacies, have deprived large populations across all continents of adequate healthcare, consequently increasing their vulnerability to dengue. However, it is important to note that the distribution of dengue risk varies significantly across regions, countries, and within countries.   

Based on all the above WHO has assessed the risk at global level as high. Following the risk assessment and an internal grading process, WHO Regional Offices have agreed on priority interventions to implement in support of Member States. 

Dengue prevention and outbreak response involves several agencies in the public health sector. Addressing these challenges requires a multidisciplinary and multisectoral integrated approach, especially at national level to achieve its goal of reducing the impact on public health. The strain on epidemic response capacity due to simultaneous concurrent outbreaks coupled with political crises highlights the need for robust emergency response mechanisms and strengthened collaboration among stakeholders. The global lack of resources, including shortages of good quality dengue diagnostic kits for early detection, lack of trained clinical and vector control personnel, and community awareness remain a critical obstacle to an effective response. While coordination efforts with global health organizations like WHO and other partners strive to set common priorities and analyses, the need for continuous support to affected countries and enhanced collaboration is imperative.  

Effective vector control measures: 

Effective vector control is key to the prevention and control of the DENV. Vector control activities should target all areas where there is a risk of human-vector contact, such as residences, workplaces, schools, and hospitals. WHO promotes Integrated Vector Management (IVM) to control Aedes species. IVM should include removing potential breeding sites, reducing vector populations, and minimizing individual exposure. This should involve vector control strategies for larvae and adults (i.e., environmental management and source reduction), especially monitoring water storage practices, draining and cleaning household water storage containers weekly, larvicide in non-potable water using WHO-prequalified larvicides at correct dosages, distribution of insecticide-treated nets (ITNs) for fever/dengue inpatients to contain spread of the virus from health facilities. Indoor space spraying for rapidly containing dengue-infected mosquitoes may be challenging to deliver in densely populated areas.   

The Global Arbovirus Initiative promotes coordination and collaboration among multisectoral partners, an integrated vector management approach and sustained control measures at all levels. Its guiding principle is to harmonize prevention, surveillance (entomological and epidemiological) and case management with existing health systems, such that they are sustainable, cost-effective and ecologically sound.  

Personal Protective Measures:  

Personal protective measures during outdoor activities include topical repellents to exposed skin or the treatment of clothing and using long-sleeved shirts and pants. Additionally, indoor protection can include the use of household insecticide aerosol products, or mosquito coils during the day. Window and door screens can reduce the probability of mosquitoes entering the house. Insecticide-treated nets offer good protection to people against mosquito bites while sleeping during the day. Since Aedes mosquitoes are most active at dawn and dusk, personal protective measures are recommended particularly at these times of day. Personal protection measures and mosquito control should also cover workplaces and schools since the vectors are day-biting mosquitoes.  

Entomological Surveillance: 

Entomological surveillance should be undertaken to assess the breeding potential of Aedes mosquitoes in containers and monitor insecticide resistance to help select the most effective insecticide-based interventions.  

Case management: 

There is no specific treatment for dengue infection. However, early detection and access to appropriate healthcare for case management can reduce mortality, as can rapid detection of severe dengue cases and timely referrals to tertiary healthcare facilities.   

Most people with dengue have mild or no symptoms and will get better in 1–2 weeks.  

Individuals who are infected for the second time are at greater risk of severe dengue. Severe dengue symptoms often come after the fever has gone away such as: 

• severe abdominal pain 
• persistent vomiting 
• rapid breathing
• bleeding gums or nose  
• restlessness
• blood in vomit or stool
• being very thirsty
• pale and cold skin
• feeling weak.

People with these severe symptoms should get care right away. 

Enhanced case surveillance: 

Case surveillance should be enhanced in all affected countries and globally. Where feasible, resources should be allocated for the strengthening of surveillance to determine the overall dengue burden (i.e., including outpatient cases), counting severe and fatal cases, and for the confirmation and sub-typing of the dengue virus.   

Operational research and learning from successful examples: 

Countries must learn and adopt successful examples of effective case management, prevention, community engagement, and vector control of dengue and other arboviruses through heightened research projects, particularly given the recent WHO recommendations on clinical trials .  

Ministries of Health and partners should closely review local interventions to accept and recommend them for public health programmes for early adaptation to reduce the growing health impact of dengue.     

WHO does not recommend that any general travel or trade restrictions be applied to countries/territories/areas based on the available information.  

Further information

• WHO Fact sheet: Dengue and severe dengue   
• Ending the neglect to attain the Sustainable Development Goals: A road map for neglected tropical diseases 2021–2030  
• Public Health Situation Analysis: El Niño (October-December 2023)  
• Establishing syndromic surveillance and event-based surveillance systems for Zika, dengue and other arboviral diseases ;  
• Half of world population at risk of dengue virus : WHO   
• WHO warns of dengue risk as global warming pushes cases near historic highs   
• Laboratory testing for Zika virus and dengue virus infections   
• Dengue and severe dengue cases and deaths for the subregions of the Americas  
• PAHO Guidelines for clinical diagnosis and treatment of dengue, chikungunya and zika (2022) 
• Dengue situation in America  
• ECDC, increasing risk of mosquito-borne diseases in EU/EEA following spread of Aedes species   
• Vector control: the ARS confirms a first indigenous case of dengue in Île-de-France and initiates two mosquito control actions in Limeil-Brévannes (94)  
• Dengue cases in Italy: updated data
• WHO Bangladesh. Dengue Situation Report, Issue # 10, 30 Oct 2023   
• Disease Outbreak News. Dengue – Bangladesh   
• National Dengue Control Unit, Ministry of Health. Publications, 2023    
• Western Pacific regional action plan for dengue prevention and control (2016)   
• WPRO dengue situation reports  

1 DLI (Dengue Like Illness). Case definition: Fever for at least 2 days, in addition to at least two of the following:

i. Nausea or vomiting; ii. Muscle or joint pain; iii. Severe headache or pain behind the eyes; iv. Rash;v. Bleeding

Citable reference: World Health Organization (21 December 2023). Disease Outbreak News; Dengue – Global situation Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON498