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Dengue Fever

What is Dengue Fever?
Dengue fever is a viral illness spread by certain types of mosquitoes. Classic dengue, known for its low mortality but very uncomfortable symptoms, occurs mainly in the South Pacific and tropical Asia, Africa and the Caribbean. It is most common during rainy seasons in areas infested with infected mosquitoes. Occasionally, persons arriving from other countries may enter the United States with dengue fever. Up until September 2001, there hadn't been a confirmed transmission of dengue fever in Hawaii in decades.

Transmission of Virus
The dengue fever virus is transmitted to people as a result of being bitten by an infected Aedes mosquito. Aedes aegypti, flourishing in mankind's urban to suburban environments, has spread the disease to many parts of the world. Another mosquito, Aedes albopictus, a less important urban vector, has helped maintain the prevalence of dengue in Asian regions. Aedes albopictus is the species being blamed for the dengue cases in Hawaii. Mosquitoes cause more human suffering than any other organism with over one million people dying from mosquito-borne diseases every year. Mosquito vectored diseases include protozoan diseases, i.e. malaria, filarial diseases such as dog heartworm and viruses such as dengue, encephalitis and yellow fever. In Asia, more than 50,000 cases of Japanese encephalitis (JE) are reported annually. Yellow fever, dengue and malaria were once prevalent in the United States, but now they are rare.

Symptoms of Dengue Fever
The symptoms of dengue fever include the sudden onset of fever, painful headaches, eye, joint and muscle pain and rash. The rash typically begins on the arms or legs three to four days after the onset of the fever. The symptoms usually resolve completely within one to two weeks. Occasionally, individuals with dengue fever experience a blood-clotting problem. When this occurs, the illness is called dengue hemorrhagic fever. Dengue hemorrhagic fever is a very serious illness characterized by abnormal bleeding and very low blood pressure (shock). Symptoms usually start five or six days after being bitten by an infected Aedes mosquito, but the onset can range from two to 15 days.

Treatment
There is no specific treatment for dengue fever. Bed rest and common drugstore pain and fever medications are recommended. Because of the risk of bleeding and complications with Reye's syndrome in children, avoid aspirin. This virus has four types, called serotypes, which are named 1,2,3 and 4. Getting infected with one serotype does not protect you against the other serotypes; in fact, getting a second dengue infection, particularly with type 2, leads to an even worse infection. This manifests as either Dengue Hemorrhagic Fever or Dengue Shock Syndrome, which can be fatal. These are particularly dangerous in children, who suffer the most and who are at the greatest risk of dying from dengue. Still, most cases of dengue are benign (not-serious), ending after approximately 7 days. The Hawaii Department of Health has confirmed the dengue virus isolated from the Maui cases was the Type 1 virus.

Prevention/Precautions
• Try to avoid exposure to mosquitoes during their hours of highest activity. Aedes mosquitoes are usually most active in the early morning hours and in the later afternoon before dusk. In shady areas or indoors, they may be active at all times of the day.

• Use mosquito netting over beds and screens on windows and doorways.

• Avoid wearing dark clothing. Mosquitoes are attracted to dark clothing.

• Use mosquito coils. They do work; Vitamin B and garlic do not work. Aggressively control mosquitoes at your home. Eliminate mosquito breeding sites or standing water (planters, old tires, pet dishes). Windows and door screens should be checked for holes or tears.

• Use repellents and wear appropriate clothing such as long-sleeved shirts and long pants that reduce exposure to mosquito bites. To keep from over-heating and from aggressive mosquito punctures, wear loose-fitting clothes.

• Change standing water in birdbaths and rain barrels at least once a week.

• Empty children's pools and store them when they are not in use.

• Clean out your rain gutters regularly.

• Keep your lawn and hedges well trimmed to reduce shady areas where mosquitoes tend to rest.

• Use bleach in your family pool to help kill mosquito larvae.

• Try to pick a breezy location when enjoying the outdoors. Mosquitoes have a hard time flying even in light wind.

• Avoid using heavily scented shampoos and toiletries.