Jump to content

Dengue fever

From Wikipedia, the free encyclopedia
(Redirected fromDengue)

Dengue fever
Other namesDengue, breakbone fever[1][2]
Photograph of a person's back with the skin exhibiting the characteristic rash of dengue fever
Typical rash seen in dengue fever
Pronunciation
SpecialtyInfectious disease
SymptomsFever, headache, muscle and joint pain, rash. Can be severe, mild or asymptomatic[1][2]
ComplicationsBleeding,low levels of blood platelets,dangerously low blood pressure[2]
Usual onset3–14 days after exposure[2]
Duration2–7 days[1]
CausesDengue virusbyAedesmosquitos[1]
Diagnostic methodDetectingantibodiesto the virus or itsRNA[2]
Differential diagnosisMalaria,yellow fever,viral hepatitis,leptospirosis[5]
PreventionDengue fever vaccine,decreasing mosquito exposure[1][6]
TreatmentSupportive care,intravenous fluids,blood transfusions[2]
Frequency5 million per year (2023)[7]
Deaths5,000 per year (2023)[7]

Dengue feveris amosquito-bornediseasecaused bydengue virus,prevalent intropicalandsubtropicalareas. It is frequentlyasymptomatic;if symptoms appear they typically begin 3 to 14 days after infection. These may include a highfever,headache,vomiting,muscleandjoint pains,and a characteristic skin itching andskin rash.Recovery generally takes two to seven days. In a small proportion of cases, the disease develops intosevere dengue(previously known as dengue hemorrhagic fever or dengue shock syndrome)[8]withbleeding,low levels of blood platelets,blood plasmaleakage, anddangerously low blood pressure.[1][2]

Dengue virus has four confirmedserotypes;infection with one type usually gives lifelongimmunityto that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications.[9]The symptoms of dengue resemble many other diseases includingmalaria,influenza,andZika.[10]Blood tests are available to confirm the diagnosis including detecting viralRNA,orantibodiesto the virus.[11]

There is no specific treatment for dengue fever. In mild cases, treatment is focused on treating pain symptoms. Severe cases of dengue require hospitalisation; treatment of acute dengue is supportive and includes giving fluid either by mouth orintravenously.[1][2]

Dengue is spread by several species of femalemosquitoesof theAedesgenus,principallyAedes aegypti.[1]Infection can be prevented by mosquito elimination and the prevention of bites.[12]Two types ofdengue vaccinehave been approved and are commercially available. Dengvaxia became available in 2016 but it is only recommended to prevent re-infection in individuals who have been previously infected.[13]The second vaccine, Qdenga, became available in 2022 and is suitable for adults, adolescents and children from four years of age.[14]

The earliest descriptions of a dengue outbreak date from 1779; its viral cause and spread were understood by the early 20th century.[15]Alreadyendemicin more than one hundred countries, dengue is spreading from tropical and subtropical regions to the Iberian Peninsula and the southern states of the US, partly attributed to climate change.[7][16]It is classified as aneglected tropical disease.[17]During 2023, more than 5 million infections were reported, with more than 5,000 dengue-related deaths.[7]As most cases are asymptomatic or mild, the actual numbers of dengue cases and deaths are under-reported.[7]

Signs and symptoms

[edit]
Outline of a human torso with arrows indicating the organs affected in the various stages of dengue fever
Schematic depiction of the symptoms of dengue fever
Clinical course of dengue fever

Typically, people infected with dengue virus areasymptomatic(80%) or have only mild symptoms such as an uncomplicated fever.[18][19]Others have more severe illness (5%), and in a small proportion it is life-threatening.[18][19]Theincubation period(time between exposure and onset of symptoms) ranges from 3 to 14 days, but most often it is 4 to 7 days.[20]

The characteristic symptoms of mild dengue are sudden-onset fever, headache (typically located behind the eyes), muscle and joint pains, nausea, vomiting, swollen glands and a rash.[1][12]If this progresses to severe dengue the symptoms are severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums or nose, fatigue, restlessness, blood in vomit or stool, extreme thirst, pale and cold skin, and feelings of weakness.[1]

Clinical course

[edit]

The course of infection is divided into three phases: febrile, critical, and recovery.[21]

The febrile phase involveshigh fever(40 °C/104 °F), and is associated with generalized pain and a headache; this usually lasts two to seven days.[22][1]There may also be nausea, vomiting, a rash, and pains in the muscle and joints.[1]

Most people recover within a week or so. In about 5% of cases, symptoms worsen and can become life-threatening. This is calledsevere dengue(formerly calleddengue hemorrhagic feverordengue shock syndrome).[21][23]Severe dengue can lead to shock, internal bleeding, organ failure and even death.[24]Warning signs include severe stomach pain, vomiting, difficulty breathing, and blood in the nose, gums, vomit or stools.[24]

During this period, there is leakage of plasma from the blood vessels, together with a reduction inplatelets.[24]This may result in fluid accumulation in thechestandabdominal cavityas well asdepletion of fluid from the circulationanddecreased blood supply to vital organs.[23]

The recovery phase usually lasts two to three days.[23]The improvement is often striking, and can be accompanied with severeitchingand aslow heart rate.[23]

The rash of dengue fever in the acute stage of the infectionblancheswhen pressed.
The rash that commonly forms during the recovery from dengue fever with its classic islands of white in a sea of red

Complications and sequelae

[edit]

Complicationsfollowing severe dengue include fatigue, somnolence, headache, concentration impairment and memory impairment.[21][25]A pregnant woman who develops dengue is at higher risk ofmiscarriage,low birth weight,andpremature birth.[26]

Children and older individuals are at a risk of developing complications from dengue fever compared to other age groups; young children typically suffer from more intense symptoms. Concurrent infections withtropical diseases[27]likeZika[28]virus can worsen symptoms and make recovery more challenging.[citation needed]

Cause

[edit]

Virology

[edit]
A transmission electron microscopy image showing dengue virus
ATEMmicrographshowing dengue virusvirions(the cluster of dark dots near the center)

Dengue virus (DENV) is anRNA virusof the familyFlaviviridae;genusFlavivirus.Other members of the same genus includeyellow fever virus,West Nile virus,andZika virus. Dengue virusgenome(genetic material) contains about 11,000nucleotide bases,whichcodefor the threestructural proteinmolecules (C, prM and E) that form thevirus particleand seven other protein molecules that are required for replication of the virus.[29][30]There are four confirmed strains of the virus, calledserotypes,referred to as DENV-1, DENV-2, DENV-3 and DENV-4. The distinctions between the serotypes are based on theirantigenicity.[31]

Transmission

[edit]
Close-up photograph of an Aedes aegypti mosquito biting human skin
The mosquitoAedes aegyptifeeding on a human host

Dengue virus is most frequently transmitted by the bite of mosquitos in theAedesgenus, particularlyA. aegypti.[32]They prefer to feed at dusk and dawn,[33]but they may bite and thus spread infection at any time of day.[34]OtherAedesspecies that may transmit the disease includeA. albopictus,A. polynesiensisandA. scutellaris.Humans are the primaryhostof the virus,[35]but it also circulates in nonhumanprimates,and can infect other mammals.[36][37]An infection can be acquired via a single bite.[38]

For 2 to 10 days after becoming newly infected, a person's bloodstream will contain a high level of virus particles (theviremicperiod). A female mosquito that takes a blood meal from the infected host then propagates the virus in the cells lining its gut.[39]Over the next few days, the virus spreads to other tissues including the mosquito'ssalivary glandsand is released into its saliva. Next time the mosquito feeds, the infectious saliva will be injected into the bloodstream of its victim, thus spreading the disease.[40]The virus seems to have no detrimental effect on the mosquito, which remains infected for life.[20]

Dengue can also be transmitted via infectedblood productsand throughorgan donation.[1]Vertical transmission(from mother to child) during pregnancy or at birth has been reported.[41]

Risk factors

[edit]

The principal risk for infection with dengue is the bite of an infected mosquito.[42]This is more probable in areas where the disease is endemic, especially where there is high population density, poor sanitation, and standing water where mosquitoes can breed.[42]It can be mitigated by taking steps to avoid bites such as by wearing clothing that fully covers the skin, usingmosquito nettingwhile resting, and/or the application ofinsect repellent(DEETbeing the most effective).[38]

Chronic diseases – such as asthma, sickle cell anemia, and diabetes mellitus – increase the risk of developing a severe form of the disease.[43]Other risk factors for severe disease include female sex, and highbody mass index,[21][30]Infection with one serotype is thought to produce lifelong immunity to that type, but only short-term protection against the other three.[22]Subsequent re-infection with a different serotype increases the risk of severe complications due to phenomenon known asantibody-dependent enhancement(ADE).[9][44]

In antibody-dependent enhancement (ADE), antibodies bind to both viral particles and Fc gamma receptors expressed on immune cells, increasing the likelihood that the viruses will infect those cells.

The exact mechanism of ADE is not fully understood.[45]It appears that ADE occurs when the antibodies generated during an immune response recognize and bind to a pathogen, but they fail to neutralize it. Instead, the antibody-virus complex has an enhanced ability to bind to theFcγreceptors of the target immune cells, enabling the virus to infect the cell and reproduce itself.[44][46]

Mechanism of infection

[edit]

When a mosquito carrying dengue virus bites a person, the virus enters the skin together with the mosquito's saliva. The virus infects nearby skin cells calledkeratinocytes,as well as specialized immune cell located in the skin, called aLangerhans cells.[47]The Langerhans cells migrate to thelymph nodes,where the infection spreads towhite blood cells,and reproduces inside the cells while they move throughout the body.[48]

The white blood cells respond by producing several signaling proteins, such ascytokinesandinterferons,which are responsible for many of the symptoms, such as the fever, the flu-like symptoms, and the severe pains. In severe infection, the virus production inside the body is greatly increased, and many more organs (such as theliverand thebone marrow) can be affected. Fluid from the bloodstream leaks through the wall of small blood vessels into body cavities due to increasedcapillary permeability.As a result,blood volumedecreases, and the blood pressure becomes so low that it cannot supply sufficient blood to vital organs. The spread of the virus to the bone marrow leads to reduced numbers of platelets, which are necessary for effective blood clotting; this increases the risk of bleeding, the other major complication of dengue fever.[48]

Prevention

[edit]

Vector control

[edit]
A black and white photograph of people filling in a ditch with standing water
A 1920s photograph of efforts to disperse standing water and thus decrease mosquito populations

The principal risk for infection with dengue is the bite of an infected mosquito.[1]This is more probable in areas where the disease is endemic, especially where there is high population density, poor sanitation, and standing water where mosquitoes can breed.[42]It can be mitigated by taking steps to avoid bites such as by wearing clothing that fully covers the skin, using mosquito netting while resting, and/or the application of insect repellent (DEET being the most effective);[49]it is also advisable to treat clothing, nets and tents with 0.5%permethrin.[50]

Protection of the home can be achieved with door and window screens, by using air conditioning, and by regularly emptying and cleaning all receptacles both indoors and outdoors which may accumulate water (such as buckets, planters, pools or trashcans).[50]

The primary method of controllingA. aegyptiis by eliminating itshabitats.This is done by eliminating open sources of water, or if this is not possible, by addinginsecticidesorbiological control agentsto these areas. Generalized spraying withorganophosphateorpyrethroidinsecticides, while sometimes done, is not thought to be effective.[51]Reducing open collections of water through environmental modification is the preferred method of control, given the concerns of negative health effects from insecticides and greater logistical difficulties with control agents. Ideally, mosquito control would be a community activity, e.g. when all members of a community clear blocked gutters and street drains and keep their yards free of containers with standing water.[52]If residences have direct water connections this eliminates the need for wells or street pumps and water-carrying containers.[52]

Vaccine

[edit]

As of March 2024, there are two vaccines to protect against dengue infection; Dengvaxia and Qdenga.[53]

Subcutaneous injection
Illustration of a subcutaneous injection

Dengvaxia(formerly CYD-TDV) became available in 2015, and is approved for use in the US, EU and in some Asian and Latin American countries.[54]It is an attenuated virus, is suitable for individuals aged 6–45 years and protects against all four serotypes of dengue.[55]Due to safety concerns aboutantibody-dependent enhancement(ADE), it should only be given to individuals who have previously been infected with dengue, in order to protect them from reinfection.[56]It is given subcutaneously as three doses at six month intervals.[57]

Qdenga(formerly TAK-003) completed clinical trials in 2022 and was approved for use in the European Union in December 2022;[53]it has been approved by a number of other countries including Indonesia and Brazil, and has been recommended by theSAGE committeeof the World Health Organization.[58]It is indicated for the prevention of dengue disease in individuals four years of age and older, and can be administered to people who have not been previously infected with dengue. It is a liveattenuatedvaccine containing the four serotypes of dengue virus, administered subcutaneously as two doses three months apart.[53]

Severe disease

[edit]

TheWorld Health Organization'sInternational Classification of Diseasesdivides dengue fever into two classes: uncomplicated and severe.[18]Severe dengueis defined as that associated with severe bleeding, severe organ dysfunction, or severe plasma leakage.[59]

Severe dengue can develop suddenly, sometimes after a few days as the fever subsides.[24]Leakage of plasma from the capillaries results in extremelow blood pressureandhypovolemic shock;Patients with severe plasma leakage may have fluid accumulation in thelungsorabdomen,insufficient protein in the blood,orthickening of the blood.Severe dengue is a medical emergency which can cause damage to organs, leading to multiple organ failure and death.[60]

Diagnosis

[edit]

Mild cases of dengue fever can easily be confused with several common diseases includingInfluenza,measles,chikungunya,andzika.[61][62]Dengue, chikungunya and zika share the same mode of transmission (Aedesmosquitoes) and are often endemic in the same regions, so that it is possible to beinfected simultaneouslyby more than one disease.[63]For travellers, dengue fever diagnosis should be considered in anyone who develops a fever within two weeks of being in thetropicsorsubtropics.[21]

Graph of when laboratory tests for dengue fever become positive. Day zero refers to the start of symptoms, 1st refers to in those with a primary infection, and 2nd refers to in those with a secondary infection.[21]

Warning symptoms of severe dengue include abdominal pain, persistent vomiting, odema, bleeding, lethargy, and liver enlargement. Once again, these symptoms can be confused with other diseases such as malaria, gastroenteritis, leptospirosis, and typhus.[61]

Blood tests can be used to confirm a diagnosis of dengue. During the first few days of infection, enzyme-linked immunosorbent assay (ELISA) can be used to detect theNS1 antigen;however this antigen is produced by all flaviviruses.[63][11]Four or five days into the infection, it is possible to reliably detect anti-dengueIgMantibodies, but this does not determine the serotype.[63]Nucleic acid amplification testsprovide the most reliable method of diagnosis.[11]

Treatment

[edit]

As of July 2024, there is no specific antiviral treatment available for dengue fever.[64]

Most cases of dengue fever have mild symptoms, and recovery takes place in a few days.[1]No treatment is required for these cases.Acetaminophen(Paracetamol,Tylenol) may be used to relieve mild fever or pain. Other common pain relievers, includingaspirin,ibuprofen(Advil, Motrin IB, others) andnaproxen sodium(Aleve) should be avoided as they can increase the risk of bleeding complications.[64]

For moderate illness, those who can drink, are passing urine, have no warning signs and are otherwise reasonably healthy can be monitored carefully at home.Supportive carewith analgesics, fluid replacement, and bed rest are recommended.[65][23]

Severe dengue is a life-threatening emergency, requiring hospitalization and potentially intensive care.[24]Warning signs includedehydration,decreasing platelets and increasinghematocrit.[66]Treatment modes include intravenous fluids, and transfusion with platelets or plasma.[65]

Prognosis

[edit]

Most people with dengue recover without any ongoing problems. The risk of death among those with severe dengue is 0.8–2.5%,[67]and with adequate treatment this is less than 1%. However, those who develop significantly low blood pressure may have a fatality rate of up to 26%.[23]The risk of death among children less than five years old is four times greater than among those over the age of 10.[67]Elderly people are also at higher risk of a poor outcome.[67]

Epidemiology

[edit]
Dengue fever deaths per million persons in 2012
0
1
2
3
4–8
9–561

As of March 2023, dengue isendemicin more than 100 countries with cases reported in every continent with the exception of Antarctica.[1][68]The Americas, Southeast Asia and the Western Pacific regions are the most seriously affected.[1][69]It is difficult to estimate the full extent of the disease, as many cases are mild and not correctly diagnosed. WHO currently estimates that 3.9 billion people are at risk of dengue infection.[1][69]In 2013, it was estimated that 390 million dengue infections occur every year, with 500,000 of these developing severe symptoms and 25,000 deaths.[70][71]

External image
An online map showing reports of dengue fever
image iconhttps:// healthmap.org/dengue/en/

Generally, areas where dengue is endemic have only one serotype of the virus in circulation. The disease is said to behyperendemicin areas where more than one serotype is circulating; this increases the risk of severe disease on a second or subsequent infection.[72]

Infections are most commonly acquired in urban environments where the virus is primarily transmitted by the mosquito speciesAedes aegypti.[73]This species has adapted to the urban environment, is generally found close to human habitation, prefers humans as its host, and takes advantage of small bodies of standing water (such astanksand buckets) in which to breed. In rural settings the virus is transmitted to humans byA. aegyptiand other related mosquitoes such asAedes albopictus.[73]Both these species have expanding ranges.[21]There are two subspecies ofAedes aegypti,whereAedes aegypti formosuscan be found in natural habitats such as forests andAedes Aegypti aegyptihas adapted to urban domestic habitats.[74]

Dengue has increased in incidence in recent decades, with WHO recording a ten fold increase between 2010 and 2019 (from 500,000 to 5 million recorded cases).[1]This increase is tied closely to the increasing range of Aedes mosquitoes, which is attributed to a combination ofurbanization,population growth, andan increasingly warm climate.[75][76]In endemic areas, dengue infections peak when rainfall is optimal for mosquito breeding.[77]In October 2023, the first confirmed symptomatic case of locally acquired dengue (i.e. not while travelling) in the US was identified in California.[78]

The disease infects all races, sexes, and ages equally. In endemic areas, the infection is most commonly seen in children who then acquire a lifelong partial immunity.[71]

History

[edit]

The first historical record of a case of probable dengue fever is in a Chinese medical encyclopedia from theJin dynasty (266–420)which referred to a "water poison" associated with flying insects.[79][80]

The principal mosquito vector of dengue,Aedes aegypti,spread out of Africa in the 15th to 19th centuries due to theslave tradeand consequent expansion of international trading.[21]There have been descriptions of epidemics of dengue-like illness in the 17th century, and it is likely that epidemics inJakarta,Cairo,andPhiladelphiaduring the 18th century were caused by dengue.[79][81]

It is assumed that dengue wasconstantly presentin many tropical urban centres throughout the 19th and early 20th centuries, even though significant outbreaks were infrequent.[79]The marked spread of dengue during and after theSecond World Warhas been attributed partly to disruption caused by the war, and partly to subsequent urbanisation in south-east Asia.[79]As novel serotypes were introduced to regions already endemic with dengue, outbreaks of severe disease followed. The severe hemorrhagic form of the disease was first reported in thePhilippinesin 1953; by the 1970s, it had become recognised as a major cause ofchild mortalityin Southeast Asia.[79]

In Central and South America, the Aedes mosquito had been eradicated in the 1950s; however the eradication program was discontinued in the 1970s and the disease re-established itself in the region during the 1980s, becoming hyperendemic and causing significant epidemics.[79]

Dengue has continued to increase in prevalence during the 21st century, as the mosquito vector continues to expand its range. This is attributed partly to continuing urbanisation, and partly to the impact of a warmer climate.[82]

Etymology

[edit]

The name came into English in the early 19th century fromWest Indian Spanish,which borrowed it from theKiswahilitermdinga/denga,meaning "cramp-like seizure" – the full term of the condition beingki-dinga pepo:"a sort of cramp-like seizure (caused by) an evil spirit".[83]The borrowed term changed todenguein Spanish due to this word existing in Spanish with the meaning "fastidiousness" and thisfolk etymologyreferring to the dislike of movement by affected patients.[4][84]Slaves in the West Indies having contracted dengue were said to have the posture and gait of adandy,and the disease was known as "dandy fever".[85][86]

The termbreak-bone feverwas applied by physician andUnited States Founding FatherBenjamin Rush,in a 1789 report of the 1780 epidemic inPhiladelphia,due to the associated muscle and joint pains. In the report title he uses the more formal term "bilious remitting fever".[87]The term dengue fever came into general use only after 1828.[86]Other historical terms include "breakheart fever" and "la dengue".[86]Terms for severe disease include "infectious thrombocytopenic purpura" and "Philippine", "Thai", or "Singapore hemorrhagic fever".[86]

Research

[edit]

Research directions include denguepathogenesis(the process by which the disease develops in humans), as well as the biology, ecology and behaviour of the mosquito vector. Improveddiagnosticswould enable faster and more appropriate treatment.[88]Attempts are ongoing to develop anantiviralmedicine targeting the NS3 or NS5 proteins.[89]

In addition to the two vaccines which are already available, several vaccine candidates are in development.[90]

Society and culture

[edit]

Blood donation

[edit]

Outbreaks of dengue fever increase the need for blood products while decreasing the number of potentialblood donorsdue to potential infection with the virus.[91]Someone who has a dengue infection is typically not allowed to donate blood for at least the next six months.[91]

Public awareness

[edit]
A poster inTampines,Singapore, notifying people that there are ten or more cases of dengue in the neighbourhood (November 2015)

International Anti-Dengue Day is observed every year on 15 June in a number of countries.[92]The idea was first agreed upon in 2010 with the first event held inJakarta,Indonesia, in 2011.[92]Further events were held in 2012 inYangon,Myanmar, and in 2013 inVietnam.[92]Goals are to increase public awareness about dengue, mobilize resources for its prevention and control and, to demonstrate the Southeast Asian region's commitment in tackling the disease.[93]Efforts are ongoing as of 2019 to make it a global event.[94]

The Philippines has an awareness month in June since 1998.[95][96]

A National Dengue Day is held in India annually on 16 May.[97]

Economic burden

[edit]

A study estimated that the global burden of dengue in 2013 amounted to US$8.9 billion.[98]

See also

[edit]

References

[edit]
  1. ^abcdefghijklmnopqrs"Dengue and severe dengue".World Health Organization.17 March 2023.Archivedfrom the original on 14 March 2024.Retrieved10 February2024.
  2. ^abcdefghKularatne SA (September 2015). "Dengue fever".BMJ.351:h4661.doi:10.1136/bmj.h4661.PMID26374064.S2CID1680504.
  3. ^dengueArchived17 July 2022 at theWayback Machinein the Merriam-Webster Dictionary
  4. ^abdenguein Oxford Dictionaries
  5. ^Nelson Textbook of Pediatrics: The field of pediatrics.Elsevier Health Sciences. 2016. p. 1631.ISBN978-1-4557-7566-8.Archivedfrom the original on 10 September 2017.
  6. ^East S (6 April 2016)."World's first dengue fever vaccine launched in the Philippines".CNN.Archivedfrom the original on 18 October 2016.Retrieved17 October2016.
  7. ^abcde"Dengue- Global situation".World Health Organization.Archivedfrom the original on 13 February 2024.Retrieved13 February2024.
  8. ^Alejandria MM (April 2015)."Dengue haemorrhagic fever or dengue shock syndrome in children".BMJ Clinical Evidence.2015:0917.PMC4392842.PMID25860404.
  9. ^ab"Dengue | CDC Yellow Book 2024".Centers for Disease Control and Prevention.1 May 2023.Archivedfrom the original on 14 February 2024.Retrieved14 February2024.
  10. ^Schaefer TJ, Panda PK, Wolford RW (14 November 2022)."Dengue Fever".StatPearls.Treasure Island (FL): StatPearls Publishing.PMID28613483.Archivedfrom the original on 14 December 2021.Retrieved13 February2022.
  11. ^abc"Dengue Diagnosis | CDC".Centers for Disease Control and Prevention.13 June 2019.Archivedfrom the original on 14 February 2024.Retrieved14 February2024.
  12. ^ab"Dengue: How to keep children safe | UNICEF South Asia".unicef.org.Archivedfrom the original on 13 February 2024.Retrieved13 February2024.
  13. ^"Dengue vaccine: WHO position paper – September 2018"(PDF).Weekly Epidemiological Record.36(93): 457–76. 7 September 2018.Archived(PDF)from the original on 5 January 2019.Retrieved12 April2019.
  14. ^"Qdenga | European Medicines Agency".European Medicines Agency.16 December 2022.Archivedfrom the original on 27 February 2024.Retrieved14 February2024.
  15. ^Henchal EA, Putnak JR (October 1990)."The dengue viruses".Clinical Microbiology Reviews.3(4): 376–396.doi:10.1128/CMR.3.4.376.PMC358169.PMID2224837.
  16. ^Paz-Bailey G, Adams LE, Deen J, Anderson KB, Katzelnick LC (February 2024). "Dengue".Lancet.403(10427): 667–682.doi:10.1016/S0140-6736(23)02576-X.PMID38280388.S2CID267201333.
  17. ^"Neglected tropical diseases".World Health Organization.Archivedfrom the original on 26 January 2024.Retrieved13 February2024.
  18. ^abcWhitehorn J, Farrar J (2010)."Dengue".British Medical Bulletin.95:161–173.doi:10.1093/bmb/ldq019.PMID20616106.S2CID215154729.
  19. ^abReiter P (March 2010)."Yellow fever and dengue: a threat to Europe?".Euro Surveillance.15(10): 19509.doi:10.2807/ese.15.10.19509-en.PMID20403310.Archivedfrom the original on 7 July 2011.
  20. ^abGubler DJ (2010)."Dengue viruses".In Mahy BW, Van Regenmortel MH (eds.).Desk Encyclopedia of Human and Medical Virology.Boston: Academic Press. pp. 372–82.ISBN978-0-12-375147-8.Archivedfrom the original on 9 June 2016.
  21. ^abcdefghSimmons CP, Farrar JJ, Nguyen V, Wills B (April 2012)."Dengue"(PDF).The New England Journal of Medicine.366(15): 1423–1432.doi:10.1056/NEJMra1110265.hdl:11343/191104.PMID22494122.Archivedfrom the original on 28 August 2021.Retrieved24 September2019.
  22. ^abChen LH, Wilson ME (October 2010). "Dengue and chikungunya infections in travelers".Current Opinion in Infectious Diseases.23(5): 438–444.doi:10.1097/QCO.0b013e32833c1d16.PMID20581669.S2CID2452280.
  23. ^abcdefRanjit S, Kissoon N (January 2011). "Dengue hemorrhagic fever and shock syndromes".Pediatric Critical Care Medicine.12(1): 90–100.doi:10.1097/PCC.0b013e3181e911a7.PMID20639791.S2CID10135251.
  24. ^abcde"Dengue fever - Symptoms and causes".Mayo Clinic.Archivedfrom the original on 26 February 2024.Retrieved25 February2024.
  25. ^Kalimuddin S, Teh YE, Wee LE, Paintal S, Sasisekharan R, Low JG, et al. (August 2022)."Chronic sequelae complicate convalescence from both dengue and acute viral respiratory illness".PLOS Neglected Tropical Diseases.16(8): e0010724.doi:10.1371/journal.pntd.0010724.PMC9426910.PMID35981059.
  26. ^Paixão ES, Teixeira MG, Costa MD, Rodrigues LC (July 2016)."Dengue during pregnancy and adverse fetal outcomes: a systematic review and meta-analysis".The Lancet. Infectious Diseases.16(7): 857–865.doi:10.1016/S1473-3099(16)00088-8.PMID26949028.Archivedfrom the original on 28 August 2021.Retrieved5 December2019.
  27. ^Rothman AL (July 2011). "Immunity to dengue virus: a tale of original antigenic sin and tropical cytokine storms".Nature Reviews. Immunology.11(8): 532–543.doi:10.1038/nri3014.PMID21760609.
  28. ^Zanluca, C., & Duarte dos Santos, C. N. (2016). Zika virus – an overview. Microbes and Infection, 18(5), 295-301.Retrieved 27 September 2024
  29. ^Rodenhuis-Zybert IA, Wilschut J, Smit JM (August 2010)."Dengue virus life cycle: viral and host factors modulating infectivity"(PDF).Cellular and Molecular Life Sciences.67(16): 2773–2786.doi:10.1007/s00018-010-0357-z.PMC11115823.PMID20372965.S2CID4232236.Archived(PDF)from the original on 9 October 2022.
  30. ^abGuzman MG, Halstead SB, Artsob H, Buchy P, Farrar J, Gubler DJ, et al. (December 2010)."Dengue: a continuing global threat".Nature Reviews. Microbiology.8(12 Suppl): S7-16.doi:10.1038/nrmicro2460.PMC4333201.PMID21079655.
  31. ^Solomonides T (2010).Healthgrid applications and core technologies: proceedings of HealthGrid 2010([Online-Ausg.] ed.). Amsterdam: IOS Press. p. 235.ISBN978-1-60750-582-2.Archivedfrom the original on 1 May 2016.
  32. ^"Aedes aegypti – Factsheet for experts".ecdc.europa.eu.9 June 2017.Archivedfrom the original on 10 July 2017.Retrieved25 February2024.
  33. ^Global Strategy For Dengue Prevention And Control(PDF).World Health Organization. 2012. pp. 16–17.ISBN978-92-4-150403-4.Archived(PDF)from the original on 30 October 2012.
  34. ^"Travelers' Health Outbreak Notice".Centers for Disease Control and Prevention. 2 June 2010. Archived fromthe originalon 26 August 2010.Retrieved27 August2010.
  35. ^Gould EA, Solomon T (February 2008)."Pathogenic flaviviruses".Lancet.371(9611): 500–509.doi:10.1016/S0140-6736(08)60238-X.PMID18262042.S2CID205949828.Archivedfrom the original on 28 August 2021.Retrieved6 June2020.
  36. ^Gwee SX, St John AL, Gray GC, Pang J (June 2021)."Animals as potential reservoirs for dengue transmission: A systematic review".One Health.12:100216.doi:10.1016/j.onehlt.2021.100216.PMC7868715.PMID33598525.
  37. ^"Vector-borne viral infections".World Health Organization. Archived fromthe originalon 3 February 2011.Retrieved17 January2011.
  38. ^abCenter for Disease Control and Prevention."Chapter 5 – dengue fever (DF) and dengue hemorrhagic fever (DHF)".2010 Yellow Book.Archivedfrom the original on 29 December 2010.Retrieved23 December2010.
  39. ^St Georgiev V (2009).National Institute of Allergy and Infectious Diseases, NIH(1 ed.). Totowa, N.J.: Humana. p. 268.ISBN978-1-60327-297-1.Archivedfrom the original on 1 May 2016.
  40. ^"Dengue Transmission | Learn Science at Scitable".© 2014 Nature Education.Archivedfrom the original on 28 February 2024.Retrieved28 February2024.
  41. ^Wiwanitkit V (November 2009)."Unusual mode of transmission of dengue".Journal of Infection in Developing Countries.4(1): 51–54.doi:10.3855/jidc.145.PMID20130380.
  42. ^abcBisen PS, Raghuvanshi R (22 July 2013).Emerging Epidemics: Management and Control(1 ed.). Wiley.doi:10.1002/9781118393277.ch8.ISBN978-1-118-39323-9.Archivedfrom the original on 23 February 2024.Retrieved23 February2024.
  43. ^"Host Response to the Dengue Virus | Learn Science at Scitable".nature.Archivedfrom the original on 23 February 2024.Retrieved23 February2024.
  44. ^abTeo A, Tan HD, Loy T, Chia PY, Chua CL (March 2023)."Understanding antibody-dependent enhancement in dengue: Are afucosylated IgG1s a concern?".PLOS Pathogens.19(3): e1011223.doi:10.1371/journal.ppat.1011223.PMC10062565.PMID36996026.
  45. ^Teo A, Tan HD, Loy T, Chia PY, Chua CL (March 2023)."Understanding antibody-dependent enhancement in dengue: Are afucosylated IgG1s a concern?".PLOS Pathogens.19(3): e1011223.doi:10.1371/journal.ppat.1011223.PMC10062565.PMID36996026.
  46. ^"Antibody-dependent Enhancement (ADE) and Vaccines".The Children's Hospital of Philadelphia.7 December 2020.Archivedfrom the original on 29 February 2024.Retrieved29 February2024.
  47. ^"Host Response to the Dengue Virus | Learn Science at Scitable".© 2014 Nature Education.Archivedfrom the original on 23 February 2024.Retrieved28 February2024.
  48. ^abMartina BE, Koraka P, Osterhaus AD (October 2009)."Dengue virus pathogenesis: an integrated view".Clinical Microbiology Reviews.22(4): 564–581.doi:10.1128/CMR.00035-09.PMC2772360.PMID19822889.
  49. ^Center for Disease Control and Prevention."Chapter 5 – dengue fever (DF) and dengue hemorrhagic fever (DHF)".2010 Yellow Book.Archivedfrom the original on 29 December 2010.Retrieved23 December2010.
  50. ^abCDC (20 October 2023)."Traveling? Avoid Dengue".Centers for Disease Control and Prevention.Archivedfrom the original on 8 March 2024.Retrieved8 March2024.
  51. ^Reiter P (March 2010)."Yellow fever and dengue: a threat to Europe?".Euro Surveillance.15(10): 19509.doi:10.2807/ese.15.10.19509-en.PMID20403310.Archivedfrom the original on 7 July 2011.
  52. ^ab"Controlling Dengue Outbreaks | Learn Science at Scitable".nature.Archivedfrom the original on 8 March 2024.Retrieved8 March2024.
  53. ^abc"Factsheet about dengue".ecdc.europa.eu.7 August 2023.Archivedfrom the original on 25 February 2024.Retrieved8 March2024.
  54. ^"Information on Dengvaxia®".sanofi.Archivedfrom the original on 8 March 2024.Retrieved8 March2024.
  55. ^"Dengvaxia: EPAR - Medicine overview"(PDF).European Medicines Agency.Archived(PDF)from the original on 9 March 2024.Retrieved9 March2024.
  56. ^"Sanofi restricts dengue vaccine but downplays antibody enhancement | CIDRAP".Center for Infectious Disease Research & Policy.1 December 2017.Archivedfrom the original on 9 March 2024.Retrieved9 March2024.
  57. ^"Administering the Dengue Vaccine".cdc.gov.26 April 2023.Archivedfrom the original on 8 March 2024.Retrieved8 March2024.
  58. ^"Message by the Director of the Department of Immunization, Vaccines and Biologicals at WHO - September 2023".World Health Organization.Archivedfrom the original on 16 March 2024.Retrieved8 March2024.
  59. ^"International Classification of Diseases (ICD-11)".World Health Organization.1 January 2022.Archivedfrom the original on 20 September 2023.Retrieved28 February2024.
  60. ^CDC (13 April 2023)."Dengue Clinical Presentation | CDC".Centers for Disease Control and Prevention.Archivedfrom the original on 29 February 2024.Retrieved29 February2024.
  61. ^abOrganization WH (21 April 2009).Dengue guidelines, for diagnosis, treatment, prevention and control.World Health Organization. p. 46.ISBN978-92-4-154787-1.Archivedfrom the original on 16 March 2024.Retrieved7 March2024.Textbox B and Textbox C.
  62. ^"Dengue - Infectious Diseases".MSD Manual Professional Edition.Archivedfrom the original on 4 March 2024.Retrieved4 March2024.
  63. ^abcBeltrán-Silva SL, Chacón-Hernández SS, Moreno-Palacios E, Pereyra-Molina JÁ (1 July 2018)."Clinical and differential diagnosis: Dengue, chikungunya and Zika".Revista Médica del Hospital General de México.81(3): 146–153.doi:10.1016/j.hgmx.2016.09.011.ISSN0185-1063.Archivedfrom the original on 4 March 2024.Retrieved7 March2024.
  64. ^ab"Dengue fever - Diagnosis and treatment".Mayo Clinic.5 October 2022.Archivedfrom the original on 10 March 2024.Retrieved10 March2024.
  65. ^abSmith DS, Mariano DJ, Trautwein ML (16 November 2022). Bronze MS (ed.)."Dengue Treatment & Management".Medscape.Archivedfrom the original on 10 March 2024.Retrieved10 March2024.
  66. ^"Dengue Case Management"(PDF).Centers for Disease Control and Prevention.Archived(PDF)from the original on 10 March 2024.Retrieved10 March2024.
  67. ^abcKularatne SA (September 2015). "Dengue fever".BMJ.351:h4661.doi:10.1136/bmj.h4661.PMID26374064.S2CID1680504.
  68. ^CDC (21 September 2023)."Dengue Areas of Risk Around the World | CDC".Centers for Disease Control and Prevention.Retrieved17 March2024.
  69. ^abTidy C (22 June 2022). Vakharia K (ed.)."Dengue (Causes, Symptoms, and Treatment)".patient.info.Retrieved14 March2024.
  70. ^Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, et al. (April 2013)."The global distribution and burden of dengue".Nature.496(7446): 504–507.Bibcode:2013Natur.496..504B.doi:10.1038/nature12060.PMC3651993.PMID23563266.
  71. ^abJing Q, Wang M (June 2019)."Dengue epidemiology".Global Health Journal.3(2): 37–45.doi:10.1016/j.glohj.2019.06.002.ISSN2414-6447.
  72. ^Smith DS."What is characteristic of hyperendemic dengue?".Medscape.Retrieved23 June2021.
  73. ^abGubler DJ (2010)."Dengue viruses".In Mahy BW, Van Regenmortel MH (eds.).Desk Encyclopedia of Human and Medical Virology.Boston: Academic Press. pp. 372–82.ISBN978-0-12-375147-8.Archivedfrom the original on 9 June 2016.
  74. ^"Aedes aegypti - Factsheet for experts".ecdc.europa.eu.9 June 2017.Retrieved18 October2024.
  75. ^Whitehorn J, Farrar J (2010)."Dengue".British Medical Bulletin.95:161–173.doi:10.1093/bmb/ldq019.PMID20616106.S2CID215154729.
  76. ^"Climate Change Will Expose Half of World's Population to Disease-Spreading Mosquitoes By 2050".Yale Environment 360.5 March 2019.Retrieved17 March2024.
  77. ^"Dengue increase likely during rainy season: WHO warns".World Health Organization.Retrieved17 March2024.
  78. ^Feaster M, Patrick R, Oshiro M, Kuan M, Goh YY, Carmona M, et al. (October 2024)."Notes from the Field: First Locally Acquired Dengue Virus Infections - Pasadena, California, October-December 2023".MMWR. Morbidity and Mortality Weekly Report.73(42): 955–956.doi:10.15585/mmw.mm7342a4.PMC11500840.PMID39446691.
  79. ^abcdefGubler DJ (July 1998)."Dengue and dengue hemorrhagic fever".Clinical Microbiology Reviews.11(3): 480–496.doi:10.1128/cmr.11.3.480.PMC88892.PMID9665979.
  80. ^Anonymous (2006)."Etymologia: dengue"(PDF).Emerg. Infect. Dis.12(6): 893.doi:10.3201/eid1206.ET1206.PMC3373045.S2CID29398958.Archived(PDF)from the original on 3 December 2013.
  81. ^Kuno G (November 2015)."A Re-Examination of the History of Etiologic Confusion between Dengue and Chikungunya".PLOS Neglected Tropical Diseases.9(11): e0004101.doi:10.1371/journal.pntd.0004101.PMC4643049.PMID26562299.1779–1780: 'Knokkel-koorts' in Batavia (now Jakarta, Indonesia) and 'break bone fever' in Philadelphia
  82. ^"As Temperatures Rise, Dengue Fever Spreads and Cases Rise".Yale E360.Retrieved20 March2024.
  83. ^Christie J. On Epidemics of Dengue Fever: Their Diffusion and Etiology. Glasgow Med J. 1881;16(3):161-176.
  84. ^Anonymous (2006)."Etymologia: dengue"(PDF).Emerg. Infect. Dis.12(6): 893.doi:10.3201/eid1206.ET1206.PMC3373045.S2CID29398958.Archived(PDF)from the original on 3 December 2013.
  85. ^Anonymous (15 June 1998)."Definition of Dandy fever".MedicineNet.Archivedfrom the original on 5 June 2011.Retrieved25 December2010.
  86. ^abcdHalstead SB (2008).Dengue (Tropical Medicine: Science and Practice).River Edge, N.J: Imperial College Press. pp. 1–10.ISBN978-1-84816-228-0.Archivedfrom the original on 21 May 2016.
  87. ^Barrett AD, Stanberry LR (2009).Vaccines for biodefense and emerging and neglected diseases.San Diego: Academic. pp. 287–323.ISBN978-0-12-369408-9.Archivedfrom the original on 12 May 2016.
  88. ^Laughlin CA, Morens DM, Cassetti MC, Costero-Saint Denis A, San Martin JL, Whitehead SS, et al. (October 2012)."Dengue research opportunities in the Americas".The Journal of Infectious Diseases.206(7): 1121–1127.doi:10.1093/infdis/jis351.PMC3499110.PMID22782946.
  89. ^Obi JO, Gutiérrez-Barbosa H, Chua JV, Deredge DJ (September 2021)."Current Trends and Limitations in Dengue Antiviral Research".Tropical Medicine and Infectious Disease.6(4): 180.doi:10.3390/tropicalmed6040180.PMC8544673.PMID34698303.
  90. ^Kariyawasam R, Lachman M, Mansuri S, Chakrabarti S, Boggild AK (20 April 2023)."A dengue vaccine whirlwind update".Therapeutic Advances in Infectious Disease.10:20499361231167274.doi:10.1177/20499361231167274.PMC10126642.PMID37114191.
  91. ^abTeo D, Ng LC, Lam S (April 2009)."Is dengue a threat to the blood supply?".Transfusion Medicine.19(2): 66–77.doi:10.1111/j.1365-3148.2009.00916.x.PMC2713854.PMID19392949.
  92. ^abc"Marking ASEAN Dengue Day".Archived fromthe originalon 17 June 2015.Retrieved16 June2015.
  93. ^ACTION AGAINST DENGUE Dengue Day Campaigns Across Asia.World Health Organization. 2011.ISBN978-92-9061-539-2.
  94. ^"Calling for a World Dengue Day".The International Society for Neglected Tropical Diseases.Archivedfrom the original on 7 January 2019.Retrieved7 January2019.
  95. ^"Dengue Awareness Month | GOVPH".Official Gazette of the Republic of the Philippines.Official Gazette. 2 June 2011. Archived fromthe originalon 7 January 2019.Retrieved7 January2019.
  96. ^"Did you know: Dengue Awareness Month | Inquirer News".newsinfo.inquirer.net.9 June 2015.Archivedfrom the original on 7 January 2019.Retrieved7 January2019.
  97. ^"National Dengue Day".6 June 2018. Archived fromthe originalon 7 January 2019.Retrieved7 January2019.
  98. ^Shepard DS, Undurraga EA, Halasa YA, Stanaway JD (August 2016). "The global economic burden of dengue: a systematic analysis".The Lancet. Infectious Diseases.16(8): 935–941.doi:10.1016/s1473-3099(16)00146-8.PMID27091092.
[edit]