Prevention of Dengue

1. DENGUE FEVER
Dr.N.C.Nanda
Jt.Director, HOD- Paediatrics
IGH,Rourkela

2. Aedes Mosquito

3. Burden of Dengue Illness
• Predilection for Paed- age group& high mortality
• One disease entity with wide spectrum of Clinical
Presentation
• Unpredictable clinical evolution & outcome
• WHO System for classifying DEN. Syndromes to 5
grades
• Three arbitrary phases (DHF/DSS)
(Febrile Leaky Congestive)

4. World Distribution of Dengue Fever and the Principal Epidemic
Vector, Aedes aegypti

5. Average Annual No. Of DF & DHF Cases
Reported to WHO & Countries Reporting Dengue

6. Dengue Case Classification & Levels of Severity
Non Severe Dengue

7. Course of Dengue Illness
Febrile Phase
Defervescence Defervescence
Phase Phase
Critical Phase
Critical Phase
Recovery Phase Recovery Phase
Recovery
Normal Death Normal Death

8. WHO System for Classifying Dengue Syndromes

9. The Course of Dengue Illness

10. Clinical Observation
• Febrile Phase - Fever,Hepatomegaly
Bleeding Sites
• Leaky Phase - Restlessness,Serous effusion,
(Around defervescence) Oligaria,Hypotension,Shock,
DIVC,MOI
• Congestive Phase - 12-24 Hrs
• Convalescence - Bradycardia
Confluent Rash
• Unusual Manifestation- Hepatic and Cardiac failure
CNS involvement

11. Diagnosis
• Clinical
• Haematological - TLC,Platelet count, HCT,
Se.protein,Enzymes,
Coag.profile,E/O DIC
• Virological
Virus isolation - Mosquito
Antigen detection - NS1 DV ag (ELISA)
Molecular Method - PCR
Serology - HAI, CF,NT,EIA, MAC-ELISA,
IF,Immunoblot.
• Others : ECG – Bradycardia
CXR – PL.Effusion

12. Frequently Observed
Clinical Sign Lab Findings
• Fever • HCT, Thrombocytopenia
• Flushing • SGPT & SGOT
• Hepatomegaly
• Hypoalbuminimia
• Vomiting
• Ascitis & Pl.Effusion
• Hyponatrimia
• Pain Abd. • Hyperkalimia
• Bleeding SIGNS • Hypernatrimia
• Encephalitis • Hyperkalimia
• Bradycardia • + ve CRP
• ARDS

13. Differential Diagnosis of Dengue Fever

14. Warning Signs

15. Admission Criteria

16. Haemodynamic assessment: Continuum of Haemodynamic Changes

17. Management
• Entirely symptomatic and supportive but early
• Careful monitoring of physical signs and Lab result
• Early recognition and active intervention of ominous signs
OPD SETTINGS : Limited drugs
Counsel parents
HOSPITAL MANAGEMENT :IV line and CVP line
Lab sample
IV fluid therapy
Clinical monitoring
Transfusion of platelet/blood
Use of vasopressor and steroids
Monitor and intervene in cong.ph

18. Algorithm For Fluid Management In Hypotensive Shock

19. Algorithm For Fluid Management in Compensated Shock

20. Good Clinical Practice & Bad Clinical Practice

21. Prognosis Favourable
• High index of suspicion
• Early recognition of plasma leak
• Close monitoring Thrombocyte count and
HCT
• Early transfusion of platelet when needed

22. REASONS OF MORTALITY
DHF/DSS
FAILURE TO RECOGNISE:
Shock
Concealed haemorrhage
Congestive failure

23. MESSAGE
• A complex disease, has a set clinical pattern
and fixed time bound course of events.
• Management relatively simple, inexpensive &
very effective in saving lives - so long as high
index of suspicion, early recognition understanding
different phases, correct timely monitoring leading
to rational supportive management leads to good
clinical outcome

24. Breeding Sites of Dengue Vectors

25. PREVENTION
• Dengue is preventable.
• Information, Education and Communication
• Key Messages
Prevent Mosquito breeding
(Proper water storage, Dry water storage containers, Remove
disposables, Fill up ditches, Cover water with oil, Larvivorous fish)
Prevent Mosquito biting
(Proper clothing, Wiring doors and windows, ITB)
• Local Health Department Involvement.
Observe One dry Day Every Week

26. THANK YOU