Dengue Fever

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KEY POINTS

• Dengue fever is an infection caused by a virus that you can get from a mosquito bite. Usually dengue fever is a relatively mild illness. Dengue hemorrhagic fever and dengue shock syndrome are more serious forms of dengue fever and can be deadly.
• There is no medicine that treats dengue fever. Most children get better with supportive care within a couple weeks after they started having symptoms. If your child has dengue hemorrhagic fever, your child may need to stay at the hospital where IV fluids and blood transfusions can be given if needed.
• Follow your healthcare provider's instructions. Ask your provider how long it will take your child to recover and how to take care of your child at home.

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What is dengue fever?

Dengue fever is an infection caused by a virus that you can get from a mosquito bite. It is also known as breakbone fever because of the severe joint and muscle aches it causes.

Usually dengue fever is a relatively mild illness. Dengue hemorrhagic fever and dengue shock syndrome are more serious forms of dengue fever and can be deadly.

What is the cause?

The virus is carried from one person to another by mosquitoes. Mosquitoes get infected when they bite an infected person. The infected mosquito can then pass the virus to you when it bites you. The infection does not spread directly from person to person.

Dengue is found mostly in tropical and subtropical areas such as the Caribbean, South America, and southern parts of Asia. Most dengue cases in US citizens happen in Puerto Rico, the US Virgin Islands, Samoa, and Guam. There have also been outbreaks in Florida, Hawaii, and Texas.

What are the symptoms?

Symptoms usually start 4 to 7 days after your child is bitten by an infected mosquito. Sometimes it may be as long as 2 weeks before your child starts having symptoms. Symptoms of dengue fever may include:

• Sudden high fever
• Severe headache
• Severe joint and muscle pain
• Rash
• Nausea and vomiting
• Pain behind the eyes

Dengue hemorrhagic fever, which is a more serious form, may also cause:

• Unusual bleeding such as bleeding gums or nosebleeds
• Easy bruising

Dengue shock syndrome can have any of the symptoms listed above plus:

• Severe swelling
• Severe bleeding
• Severe muscle spasms in the arms, legs, stomach, and back
• Shock (very low blood pressure). Symptoms of shock include:
  • Lightheadedness or fainting
  • Restlessness or confusion
  • Cool, moist skin, with possibly sweating
  • Convulsions
  • Fast, shallow breathing
  • Change in awareness or consciousness

Dengue shock syndrome may cause the heart, lungs, or kidneys to stop working.

How is it diagnosed?

Your healthcare provider will ask about your child's symptoms and recent travels and examine your child. Your child may have blood tests.

How is it treated?

There is no medicine that treats dengue fever. Most children get better with supportive care within a couple weeks after they started having symptoms.

You need to make sure that your child:

• Drinks plenty of liquids.
• Gets plenty of rest.

You may give your child acetaminophen to control fever and pain if necessary. Do not give more than the package recommends based on your child’s age and weight. Do not give aspirin or nonsteroidal anti-inflammatory medicines (NSAIDs). These medicines can make it harder for the blood to clot. If your child has dengue hemorrhagic fever, they can cause more bleeding. Also, children and teens who take aspirin during a viral illness are at risk for a serious illness called Reye syndrome.

If your child has dengue hemorrhagic fever, your child may need to stay at the hospital, where IV fluids and blood transfusions can be given if needed.

How can I help take care of my child?

Follow your child’s healthcare provider's instructions. Ask your provider:

• How and when you will get your child’s test results
• How long it will take for your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup.

How can I help prevent dengue fever?

A vaccine to prevent dengue is offered in some countries for people ages 9 to 45 years old. It is not available in the US. The vaccine should only be given to a person who had a confirmed dengue virus infection in the past. A person who receives the vaccine who has not already had the dengue virus may be at risk of having severe dengue.

Take these precautions to avoid mosquito bites:

• Schedule travel to tropical areas during seasons when mosquitoes are less active.
• Stay in places that are clean, insect free, and have air conditioning or well-screened windows.
• Avoid wearing perfume or other scented products. They may attract mosquitoes.
• Stay indoors at dawn and in the early evening when mosquitoes are most likely to be around.
• Wear long pants and long-sleeved shirts, especially from dusk to dawn. This is the time when you are most likely to get bitten.
• Make sure your child always uses an insect repellent when outdoors. Don't use more repellent than recommended in the package directions. Don’t let children handle or spray the product. Don't put repellent on open wounds or rashes. Don’t put it on the eyes or mouth. When using sprays for the skin, don’t spray the repellent directly on the face. Spray the repellent on the adult’s hands first and then put it on the child’s face. Then wash the spray off the hands.
  • Children older than 2 months can use repellents with no more than 30% DEET. DEET should be applied just once a day. Wash it off your child’s body with soap and water when your child goes back indoors.
  • Picaridin may irritate the skin less than DEET and appears to be just as effective.
  • In some studies, oil of lemon eucalyptus, a plant-based repellent, provided as much protection as repellents with low concentrations of DEET, but it hasn't been as well tested as DEET. Oil of lemon eucalyptus should not be used on children under age 3.
  • Spray clothes with repellents because insects may crawl from clothing to the skin or bite through thin clothing. Products containing permethrin are recommended for use on clothing, shoes, bed nets, and camping gear. Permethrin-treated clothing repels and kills ticks, mosquitoes, and other insects and can keep working after laundering. Permethrin should be reapplied to clothing according to the instructions on the product label. Some commercial products are available pretreated with permethrin. Permethrin does not work as a repellent when it is put on the skin.
• Use a spray that kills flying insects in the room where you sleep. Sleep under a mosquito net if you are sleeping in an area with open and unscreened windows or doors.
• Mosquitoes lay eggs in water. To reduce mosquito breeding, drain standing water from flowerpots, buckets, barrels, cans, and other items that collect water. Avoid swimming in places where mosquitoes breed, like small ponds or lagoons.

The risk of dengue infection for international travelers appears to be small unless there is an epidemic in the area you are visiting.

For more information, contact:

• World Health Organization
  https://www.who.int/en/
• Centers for Disease Control and Prevention
  1-888-232-3228
  https://www.cdc.gov/