Dengue is a mosquito-borne viral infection causing a severe flu-like illness and, sometimes causing a potentially lethal complication called severe dengue. The incidence of dengue has increased 30-fold over the last 50 years. Up to 50-100 million infections are now estimated to occur annually in over 100 endemic countries, putting almost half of the world’s population at risk.

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What is dengue fever and severe dengue?

Dengue is a vector-borne disease transmitted by the bite of an infected mosquito. There are 4 serotypes of the virus that causes dengue. These are known as DEN-1, DEN-2, DEN-3, DEN-4.

Severe dengue is a potentially lethal complication which can develop from dengue infections.

It is estimated that there are over 50-100 million cases of dengue worldwide each year and 3 billion people living in dengue endemic countries.

Where does the disease occur?

Dengue is mainly transmitted by a mosquito (Aedes aegypti) and is distributed across all tropical countries. Ae. aegypti and other species such as Ae. albopictus are highly adaptive and their combined distribution can spread dengue higher up north across Europe or North America during summer. (Note: Travellers already infected with the virus also spread the disease when they get bitten by the local Aedes mosquito population).

Dengue outbreaks can occur anytime, as long as the mosquitoes are still active. However, in general, high humidity and temperature are conditions that favour mosquito survival, increasing the likelihood of transmission.

What are the symptoms of dengue fever and severe dengue?

Dengue fever

Dengue causes flu-like symptoms and lasts for 2-7 days. Dengue fever usually occurs after an incubation period of 4-10 days after the bite of the infected mosquito.

High Fever (40°C/ 104°F) is usually accompanied by at least two of the following symptoms:

• Headaches
• Pain behind eyes
• Nausea, vomiting
• Swollen glands
• Joint, bone or muscle pains
• Rash

Severe dengue

When developing into severe dengue, the critical phase takes place around 3-7 days after the first sign of illness. Temperature will decrease; this does NOT mean the person is necessarily recovering. On the other hand, special attention needs to be given to these warning signs as it could lead to severe dengue:

• Severe abdominal pain
• Persistent vomiting
• Bleeding gums
• Vomiting blood
• Rapid breathing
• Fatigue/ restlessness

When severe dengue is suspected, the person should be rushed to the emergency room or to the closest health care provider as it causes:

• Plasma leaking that may lead to shock and/or fluid accumulation with/without respiratory distress;
• Severe bleeding;
• Severe organ impairment.

What is the treatment for dengue?

There is no vaccine or specific medication for dengue fever.

Patients should seek medical advice, rest and drink plenty of fluids. Paracetamol can be taken to bring down fever and reduce joint pains. However, aspirin or ibuprofen should not be taken since they can increase the risk of bleeding.

Patients who are already infected with the dengue virus can transmit the infection via Aedes mosquitoes after the first symptoms appear (during 4-5 days; maximum 12). As a precautionary approach, patients can adopt measures to reduce transmission by sleeping under a treated net especially during the period of illness with fever.

Infection with one strain will provide life-time protection only against that particular strain. However, it is still possible to become infected by other strains and develop into severe dengue.

When warning signs of severe dengue are present (listed above), it is imperative to consult a doctor and seek hospitalization to manage the disease.

With proper medical care and early recognition, case-fatality rates are below 1%. However, the overall experience remains very discomforting and unpleasant.

What should I do if I suspect I have dengue?

If you suspect you have dengue you need to see a doctor immediately. To diagnose dengue fever, your doctor will:

• Evaluate your signs and symptoms;
• Test your blood for evidence of a dengue virus;
• Review your medical and travel history.

Persons who had travelled to dengue endemic countries during the past two weeks should inform the doctor about it.

Who spreads dengue and severe dengue?

Dengue is spread through the bite of the female mosquito (Aedes aegypti). The mosquito becomes infected when it takes the blood of a person infected with the virus. After about one week, the mosquito can then transmit the virus while biting a healthy person. The mosquito can fly up to 400 meters looking for water-filled containers to lay their eggs but usually remains close to the human habitation.

Aedes aegypti is a daytime feeder: The peak biting periods are early in the morning and in the evening before dusk.

Dengue cannot be spread directly from person to person. However, a person infected and suffering from dengue fever can infect other mosquitoes. Humans are known to carry the infection from one country to another or from one area to another during the stage when the virus circulates and reproduces in the blood system.

Aedes aegypti has evolved into an intermittent biter and prefers to bite more than one person during the feeding period. This mechanism has made Aedes aegypti a very highly efficient epidemic vector mosquito.

Where do the mosquitoes breed?

The mosquitoes thrive in areas close to human population (urban areas).

The dengue mosquito lays its eggs in water-filled containers inside the house and surrounding areas of dwellings (this includes non-used bottles, containers, discarded waste, tyres etc… which hold water).

The eggs hatch when in contact with water. Eggs can withstand very dry conditions and survive for months. Female mosquitoes lay dozens of eggs up to 5 times during their lifetime.

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Adult mosquitoes “usually” rest indoors in dark areas (closets, under beds, behind curtains). Here it is protected from wind, rain and most predators, which increases its life expectancy and the probability that it will live long enough to pick up a virus from one person and pass it on to the next.

What can be done to reduce the risk of acquiring dengue?

The best preventive measure for areas infested with Aedes mosquito is to eliminate the mosquitoes’ egg laying sites – called source reduction. Lowering the number of eggs, larvae and pupae will reduce the number of emerging adult mosquitoes and the transmission of the disease. Examples of the following habitats are listed:

• Indoor
• Ant traps
• Flower vases and saucers
• Water storage tank (domestic drinking water, bathroom, etc…)
• Plastic containers
• Bottles
• Outdoor
• Discarded bottles and tins
• Discarded tyres
• Artificial containers
• Tree holes, potholes, construction sites
• Drums for collecting rainwater
• Shells, husks, pods from trees
• Leaf axils of various plants
• Boats, equipment

Items that collect rainwater or are used to store water should be covered or properly discarded. The remaining essential containers should be emptied and cleaned and scrubbed (to remove eggs) at least once a week. This will avoid the adult mosquitoes to emerge from the egg/ larva/ pupa stage.

In fact, the community participation is the key to dengue prevention. As every household aims to reduce vector density, the transmission rate will decrease or maybe even stop.

Personal and household protection

Protecting yourself from mosquito bites is most effective by reducing exposed skin to mosquitoes to bite on. Long-sleeved clothing and mosquito repellents (containing DEET, IR or Icaridin) are the most viable options.

Window and door screens, air conditioning reduces the risk of mosquitoes coming into contact with the household members. Mosquito nets (and/or insecticide-treated nets) will also provide additional protection to people sleeping during the day, or protect against other mosquitoes which can bite at night (such as malaria). Household insecticides aerosols, mosquito coils or other insecticide vaporizers maybe also reduce biting activity.

Dengue Fever Test

What is a dengue fever test?

Dengue fever is a viral infection spread to people through bites from infected mosquitos. You can't catch the virus from a person who is sick with dengue fever.

A dengue fever test checks a sample of your blood to see if you have the virus. The test is used if you have symptoms of dengue fever and have been in an area where mosquitos carry the virus.

The dengue virus is most common in parts of the world with tropical and subtropical climates, including:

• South and Central America
• The Caribbean, including Puerto Rico and the U.S. Virgin Islands
• Asia
• The Middle East
• The Pacific Islands
• Africa

Outbreaks of dengue fever are rare in the U.S. mainland. But small outbreaks have been reported in parts of Florida and Texas.

Most people who get the dengue virus won't become sick. People who do get sick may have mild to severe symptoms that usually begin four to ten days after a bite from an infected mosquito. The most common symptom is a sudden high fever. There is no specific medicine that can cure or treat dengue fever, but most people will recover after about a week.

Some people who get sick with dengue will develop severe dengue disease. Severe dengue can cause internal bleeding and shock, which can be life-threatening.

Infants and pregnant women have a higher risk for developing severe dengue. The risk is also higher for people who have had dengue and then get it again. That's why it's so important to get a dengue fever test if you have symptoms after being in an area where the virus is common.

There are two main types of dengue fever blood tests:

• Antibody tests check your blood sample for proteins, called antibodies, that your immune system makes to fight viruses and other germs. Your body needs time to make specific antibodies to fight dengue. So, these tests are most accurate when they are done four days or more after your symptoms begin.
• Molecular tests look for genetic material from the dengue virus in your blood sample. A PCR test (polymerase chain reaction) is a type of molecular test that's used to check for dengue. These tests can be done during the first seven days after your symptoms begin. Tests done later than that may not have accurate results.

One type of PCR test can check for dengue along with two other viruses that mosquitos carry. These viruses, chikungunya and zika, are common in the same places as the dengue virus, and they cause similar symptoms. Your provider can order this test from your state or local public health department.

Other names: dengue virus antibody, dengue virus by PCR

What is it used for?

A dengue fever test is used to find out if you have the dengue virus. It is mostly used for people who have symptoms related to dengue fever and have recently traveled to an area where dengue infections are common.

Why do I need a dengue fever test?

You may need to be tested for the dengue virus if you have symptoms of dengue fever and have been in an area where the virus is common. Symptoms usually show up four to ten days after being bitten by an infected mosquito.

Symptoms of dengue fever include a sudden high fever (104°F or higher) with any of these other symptoms:

• Nausea and vomiting
• Rash
• Eye pain, typically behind the eyes
• Headache
• Joint, bone or muscle pain

Symptoms of severe dengue may begin 24 to 48 hours after the fever has gone away. Get medical help right away if you or a family member has any of these warning signs of severe dengue:

• Abdominal (belly) pain or tenderness
• Vomiting (at least 3 times in 24 hours)
• Bleeding from the nose or gums
• Vomiting blood or blood in stool (poop)
• Feeling tired, restlessness, or irritable

What happens during a dengue fever test?

Your health care provider will ask about your symptoms and your recent travels. If an infection is suspected, you will get a blood test to check for the dengue virus.

During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Will I need to do anything to prepare for the test?

You don't need any special preparations for a dengue fever test.

Are there any risks to the test?

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

What do the results mean?

If you had a molecular test (a PCR test):

• A positive test result means that the test found genetic material from the virus in your blood sample. You most likely have a dengue infection.
• A negative test result means that the dengue virus wasn't found in your blood sample. You probably don't have dengue. But it's possible that there wasn't enough virus in your blood sample for the test to find. That might happen if the test was done more than seven days after your symptoms began. If your molecular test result is negative, your provider will usually order an antibody test to confirm that you don't have dengue.

If you had an antibody test, your test results may be reported as positive or negative. Or they may be given as a measurement of the dengue antibodies found in your blood sample.

• A positive test result means that antibodies for the dengue virus were found. You probably have a dengue infection, but you may need another test to confirm the results. That's because the antibody test may have found antibodies that fight other similar viruses that mosquitos carry. Your provider may order another type of blood test to find out exactly which type of viral infection you have.
• A negative test result means that dengue antibodies weren't found in your blood sample. Dengue may not be causing your symptoms. But a negative result could mean that you were tested before your body had time to make enough antibodies to show on the test. So, your provider may order another antibody test to check again.

If you have dengue fever, your provider can tell you how to treat your symptoms. Always follow your provider's instructions. In general, care for dengue fever includes:

• Getting plenty of rest.
• Drinking lots of fluids.
• Taking acetaminophen to control fever and relieve pain. Do not take aspirin, ibuprofen, or naproxen sodium, because they can increase the risk of bleeding.
• Watching carefully for symptoms of severe dengue. Dengue fever can become severe within hours. Get medical help right away if you develop the symptoms of severe dengue.

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about a dengue fever test?

A vaccine is available for children ages 9 to 16 who:

• Have already had dengue fever. The vaccine helps protect against future dengue infections or from getting severe dengue disease. Before getting the vaccine, a child must have a blood test to confirm a past dengue infection. That's because the vaccine can be harmful to a child who has never had dengue fever.
• Live in areas where dengue is common. These areas include Puerto Rico, the U.S, Virgin Islands, the U.S. territories of American Samoa, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. The vaccine isn't approved for children traveling to these areas to visit.

If you travel to an area where dengue is common, you can reduce the risk of infection by preventing mosquito bites.

References

1. Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health and Human Services; Dengue: Dengue Vaccine; [cited Dec 16]; [about 1 screens]. Available from: https://www.cdc.gov/dengue/vaccine/index.html
2. Centers for Disease Control and Prevention [Internet]. Atlanta: U.S. Department of Health and Human Services; Preventing Dengue; [updated May 17; cited Nov 8]; [about 2 screens]. Available from: https://www.cdc.gov/dengue/prevention/
3. FDA: US Food and Drug Administration [Internet]. Silver Spring (MD): U.S. Department of Health and Human Services; First FDA-approved vaccine for the prevention of dengue disease in endemic regions; May 1 [cited Nov 8]; [about 3 screens]. Available from: https://www.fda.gov/news-events/press-announcements/first-fda-approved-vaccine-prevention-dengue-disease-endemic-regions
4. Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c-. Dengue Fever; [cited Nov 9]; [about 8 screens]. Available from: https://www.mayoclinic.org/diseases-conditions/dengue-fever/symptoms-causes/syc-
5. Mayo Clinic: Mayo Medical Laboratories [Internet]. Mayo Foundation for Medical Education and Research; c-. Test ID: DENGM: Dengue Virus Antibody, IgG and IgM, Serum: Clinical and Interpretive; [cited Nov 9]; [about 3 screens]. Available from: https://www.mayocliniclabs.com/test-catalog/overview/#Clinical-and-Interpretive
6. Merck Manual Consumer Version [Internet]. Kenilworth (NJ): Merck & Co. Inc.; c. Dengue; [reviewed Aug; cited Nov 9]; [about 2 screens]. Available from: https://www.merckmanuals.com/home/infections/arboviruses-arenaviruses-filoviruses/dengue
7. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; c. Health: Blood Test; [cited Nov 17]; [about 3 screens]. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/blood-test
8. Schaefer TJ, Panda PK, Wolford RW. Dengue Fever. [Updated Apr 22; cited Nov 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK/
9. Testing.com [Internet]. Seattle (WA): OneCare Media; c. Dengue Fever Testing; [modified Nov 9; cited Nov 9]; [about 7 screens]. Available from: https://www.testing.com/tests/dengue-fever-test/
10. Testing.com [Internet]. Seattle (WA): OneCare Media; c. Shock; [cited Nov 9]; [about 1 screen]. Available from: https://www.testing.com/glossary/#shock
11. UF Health: University of Florida Health [Internet]. Gainesville (FL): University of Florida Health; c. Dengue fever: Overview; [reviewed Aug 25; cited Nov 9]; [about 3 screens]. Available from: https://ufhealth.org/dengue-fever
12. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c. Health Encyclopedia: Dengue Fever; [cited Nov 9]; [about 6 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85&contentid=P
13. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c. Health Information: Dengue Fever; [updated Feb 9; cited Nov 9]; [about 2 screens]. Available from: https://patient.uwhealth.org/healthwise/article/en-us/abk
14. World Health Organization [Internet]. Geneva (SUI): World Health Organization; c. Dengue and severe dengue; Jan 10 [cited Nov 9]; [about 4 screens]. Available from: http://www.who.int/en/news-room/fact-sheets/detail/dengue-and-severe-dengue

The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

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