Remember DENGUE is a VIRUS...Symptoms of DENGUE DENGUE Awareness & Prevention FOR MISSION TRIPS What is DENGUE Dengue (pronounced as ‘Den-gay’), is a communicable disease caused

Church Volunteers

Medical Mission Teams

Student Volunteers

Humanitarian Aid Workers

Health Care Workers

Resources for Mission TravelERSCDC Travelers’ Health Websitewww.cdc.gov/travel

Health Information for International TravelCDC “Yellow Book”

International Society of Travel Medicinewww.istm.org

International Travel and HealthWHO “Green Book”

State Department - www.travel.state.gov

World Health Organization - www.who.int/int

Global WebsitesEurosurveillance - www.eurosurveillance.org

Travax EnCompass - www.travax.com

GIDEON - www.gideononline.com

International SOS - www.internationalsos.com

Medical Advisory Service for Travelers Abroad (MASTA) - www.masta.org

Armed Forces Medical Intelligence Centerwww.afmic.detrick.army.mil

Central Intelligence Agencywww.cia.gov/cia/publications/factbook

AUTHORGettie Audain, DHSc, MPH, BSN, [email protected]

DESIGNKristen Dorn - www.CameleonDesigns.com

ReferencesGubler, D. J. (2011). Dengue, urbanization and globalization: The unholy trinity of the 21st century [4 Suppl]. Tropical Medicine and Health, 39(4), 3-11.

Were, F. (2012). The dengue situation in Africa. Pediatrics and International Child Health, 32(S1), 18-20.

DENGUE Awareness & Prevention FOR MISSION TRIPS

RememberDENGUE is a VIRUS• Infected mosquitoes spread dengue from

person to person.

• Children and the elderly are at high risk.

• There are 4 types called dengue virus 1, 2, 3, & 4 .

• Only one virus can make you sick at a time.

• Multiple dengue infections can kill you with a severe bleeding disease.

• People carry a dengue virus for life.

• Symptom supportive care.

• Dengue infections should receive nursing support care for fatigue, fever, dehydration, headache, body aches, and rest.

• Dengue infection should be confirmed with a specific lab test.

• Skilled nursing care is critical for Dengue Hemorrhagic Fever.

• Dengue Shock Syndrome requires hospitalization.

Don’t Take It HomeDid you know....Dengue is under-reported since flu-like symptoms mimic West Nile virus, Yellow Fever, and Malaria. When you travel, you can be a human carrying dengue back home. How? If you were both infected in a Dengue prone areas (see map) and infectious, a dengue free mosquito can bite you at home and you can start the dengue transmission cycle!

• Dengue is often under-reported since its flu-like symptoms often look like West Nile Virus, Yellow Fever and Malaria.

• The vaccine for Yellow Fever is not treatment for dengue.

• The drugs to prevent Malaria are not for dengue.

• There are no drugs or vaccines for dengue, only prevention!

• Dengue Hemorrhagic Fever has high rates of illness and death.

• Affordable blood lab tests don’t specify virus types or if the infection is primary or secondary.

• Primary infections should receive support care for fever, dehydration, headache, body aches, and rest.

• Primary infection should be confirmed with a specific lab test.

• DHF may require skilled nursing care.

• DSS requires hospitalization.

Personal protection is the Key!Repellents & Insecticides

• Clothing & Skin: Use materials containing DEET (N-diethyl-m-toluamide), Picaridin.Patio Insecticides (Pesticide and Repellent): Permethrin.

Barriers• Bed Nets (DEET impregnated), long

sleeve shirts and pants.

• Seal buildings and repair screens.

Don’t TAKE IT HOME….Think Prevention! 1. Use repellents, insecticides, & barriers. 2. When: Protect your skin from bites morning, noon, and night, use a repellent often.

3. Skin: Lather your exposed skin with repellent lotion like DEET. 4. Clothing: Cover all exposed skin with repellent treated clothing.5. Night time: Use repellent treated nets to cover the bed completely. 6. Barriers: Buildings should be tightly screened and sealed to prevent mosquitoes from entering. 7. Police the area: All water breeding sources should be treated or drained. 8. Police the area: Contain your garbage, drain your cans. 9. Police the area: Cover all rain barrels with screens or lids. 10. Police the area: Look for beverage cans and bottles as trash outside & help to clean up!

Who is at Risk forDENGUEEveryone, since mosquitoes are all around. Urban mosquitoes are aggressive and bite multiple people. Non-natives have less natural resistance.

Children First-time infections can be disabling or fatal.

Elderly Secondary infections are often fatal.

Travelers Usually diagnosed by lab tests upon returning home.

types of DENGUE

Den-1Den-2Den-3Den-4

Den-1Den-2Den-3Den-4

Den-1Den-2Den-3Den-4

Den-1Den-2Den-3Den-4

Den-1Den-2Den-3Den-4

Den-1Den-2Den-3Den-4

Den-1Den-2Den-3Den-4

Yellow: MildOrange: ModerateRed: Severe

Yellow: MildOrange: ModerateRed: Severe

There are four genetically different serotypes; DENV 1, 2, 3, & 4. Each virus type can cause severe disease. Dengue hemorrhagic fever is a complication of the disease that can be fatal. Dengue shock syndrome follows as the most severe type if experienced without supportive care. In Africa, the Aedes species are A. aegypti, A. albopictus, A. africanus, and A. luteocephalus Each type of mosquito has different geographic, feeding, and survival habits. Once infected, mosquitos remain infected for their entire life, passing the virus to eggs.

Aedes Aegypti Vector Originated from West Africa. Worldwide primary dengue vector. A carrier for the West Nile virus, yellow fever, and chikungunya virus. Prefers standing water near people to lay eggs. Sneaky daytime biters. Female prefers to feed on humans for a blood meal to produce infected eggs. Bites inside homes and outside in crowded areas.

Aedes albopictus vectorKnown as the Asian tiger mosquito. First travel to United States via ship of trade to Texas in 1985. Infected eggs spread from Asia to Africa, the Americas, Europe and Texas, USA by the international trade of tires. A very adaptable vector for dengue, yellow fever, west Nile, and chikungunya. Larvae eggs adapted to a little bit of water and shares A. aegypti larvae. Mostly an outside garden mosquito. Aggressive biter. Prefers water-filled containers around outside of households.

Symptoms of DENGUE

DENGUE Awareness & Prevention FOR MISSION TRIPS

What is DENGUE Dengue (pronounced as ‘Den-gay’), is a communicable disease caused by a virus carried by a mosquito. The virus is not contagious it must be transported to humans by the bite of an infected mosquito. Dengue fever symptoms can vary from being unnoticed with no signs, to a fever with fatal bleeding conditions.

The dengue virus is part of the virus family of Flaviviridae and genus flavivirus. Flaviviridae related febrile viruses include West Nile and yellow fever. Infected vectors transmit the virus by biting humans for a blood meal.

The two main carriers are female mosquitos Aedes Aegypti and Aedes Albopictus. The mosquitos grow the virus in their gut. Each mosquito has different geographic, feeding, and survival habits. Once infected, adult mosquitos have a lifespan of 2 to 4 weeks and lay virus carrying eggs.

The human host of DENGUEInfected humans spread the virus to non-infected mosquitos. A first-time infection with any one of four virus types gives lifelong protection. A second infection with any of the other 3 virus types can make you experience severe bleeding. The very young and elderly are more likely to be very sick. People with African ancestry show more resistance to severe dengue, yet lately, dengue infections are increasing in this population.

Febrile Critical Recovery

Days of Illness

Temperature

Potential Clinical Issues

Laboratory Changes

Serology and Virology

Phases of Illness

40° C

Dehydration

Hematocrit

ShockBleedingOrganImpairment

ReabsorptionFluid Overload

Viraemia IgG / IgM

Platelets

1 2 3 4 5 6 7 8 9 10

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- Sudden-onset Fever- Headache- Mouth and Nose Bleeding- Muscle and Joint Pains- Vomiting- Rash

- Diarrhea

- Low Blood Pressure- Excess Lung Fluid- Excess Abdominal Fluid- Gastrointestinal

Bleeding

- Stable Vital Signs- Bleeding Stops- Improved Appetite- Sense of Well Being

criticalPhase

RecoveryPhase

FebrilePhase

How do i TREAT / PREVENTDENGUE

What Do I Need To Know?

Mosquito photos courtesy of Centers for Disease Control and Prevention, Atlanta, Georgia.