dengue
DENGUE
Treatment Guideline Chart

Dengue infection is caused by the dengue virus that belongs to the family Flaviviridae. It is generally self-limiting and rarely fatal.
There are 4 serotypes (DEN-1, DEN-2, DEN-3, DEN-4). Infection with dengue serotype confers lifetime protective immunity to that specific serotype; cross-protection for other serotypes is only short-term.
It is transmitted to humans through the bites of infected Aedes mosquitoes. It is primarily transmitted by female Aedes aegypti, a tropical and subtropical species. Humans and monkeys are the amplifying hosts after the mosquito bite.
After 4-10 days of incubation period, illness begins immediately.
The acute phase of illness lasts for 3-7 days, but the convalescent phase may be prolonged for a week and may be associated with weakness and depression especially in adults.

Dengue Management

Prevention

  • Preventing or reducing the transmission of dengue virus is dependent on controlling mosquito vectors or disturbing human-vector contact
  • Vaccination against dengue viruses are currently being developed, with promising results

Methods of Vector Control

  • Methods to control transmission should target habitats of immature and adult stages of A aegypti, one of the most efficient vectors for arboviruses, in the household and places where human-vector contact occurs
    • These mosquitoes mostly stay within 100 meters from where they emerged, and feeds mainly during daylight hours

Environmental Management

  • Controlling mosquito vectors are achieved mainly by eradicating container habitats that are favorable oviposition sites and development of aquatic stages through prevention of access to containers or emptying and cleaning them regularly and by using insecticides or biological control agents to kill developing stages of adult vectors
  • Mosquito screens on windows or doors, mosquito nets, and clothing that covers the arms and legs may be used while sleeping during daytime to decrease human-vector contact

Chemical Control

  • Larvicides should be done as complementary to environmental management 
  • Adulticides are used to target adult vectors which is applied either as surface treatments or as space treatments
  • Individual and household protection are advised to minimize exposure of skin and be protected from bites of dengue vectors during their active hours
    • Repellents that contain DEET (N, N-diethyl-3-methylbenzamide), IR3535 (3-[N-acetyl-N-butyl]-aminopropionic acid ethyl ester), or Icaridin (1-piperidinecarboxylic acid-2-(2-hydroxyethyl)-1-methylpropylester) may be applied to skin or to clothes; Citronella-based repellents may also be considered
    • Mosquito nets that are insecticide-treated, insecticide aerosol products, or mosquito coils may also help

Vaccination

  • Due to the immunopathological component in dengue pathogenesis, development of a dengue vaccine focuses on the creation of a tetravalent vaccine that will provide long-term protection against all virus serotypes
  • The first dengue vaccine developed, CYD-TDV, is recommended by the United States (US) Advisory Committee on Immunization Practices (ACIP) to prevent dengue in children aged 9 to 16 years, with laboratory-confirmed previous dengue virus infection and living in areas where dengue is endemic
    • CYD-TDV is a live recombinant tetravalent dengue vaccine that will be used in individuals aged 9-45 years residing in endemic areas
    • Data from the 2 pivotal phase III clinical studies showed that CYD-TDV given on a 3-dose series on a 0/6/12 month schedule has a good safety profile with secondary analysis demonstrating efficacy against the four dengue serotypes and protection from severe disease and hospitalization
    • In May 2019, CYD-TDV was approved by the US Food and Drug Administration (FDA) for use in children aged 9 to 16 years with laboratory-confirmed previous dengue virus infection and living in an area with endemic dengue
    • As of June 2019, dengue vaccine has been approved in 20 countries (ie Mexico, Brazil, Philippines), including the US and Europe for prevention of dengue
  • Other vaccines under clinical trial evaluation include subunit, deoxyribonucleic acid (DNA) and purified inactivated as well as other live-attenuated vaccines
    • Additional vaccines under preclinical study evaluation are the virus-vectored and VLP-based vaccines
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