DENGUE AND OTHER CONTIGOUS DISEASES AND VACCINE AND EPI

• DENGUE Benign syndrome caused by several arthropod-borne viruses and is characterized by

  ○ Biphasic fever ○ Myalgia or arthralgia ○ Rash ○ Leukopenia ○ Lymphadenopathy
• ● Severe, often fatal, febrile disease caused by one of four dengue viruses

  Dengue Hemorrhagic Fever
• Characteristics of dengue hemmorhagic fever

  Capillary permeability ○ Abnormalities of hemostasis ○ Dengue shock syndrome
• Severe dengue those cases accompanied by

  ○ Fluid loss leading to shock ○ Fluid loss with respiratory distress ○ Liver damage ○ Severe bleeding ○ Altered consciousness or significant heart abnormalities
• There are four different serotypes of the dengue virus, and being infected with one serotype does not provide immunity to the other serotypes

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• mild in majority of instances, ranging from an inapparent infection through an undifferentiated upper respiratory tract or dengue-like disease but may also progress to dengue hemorrhagic fever

  SECONDARY DENGUE INFECTIONS
• Incubation period

  1 - 7 days
• Young Children

  ● Fever for 1-5 days ● Pharyngeal inflammation ● Rhinitis ● Mild cough
• Older Children

  ● Sudden onset of fever, (rapidly increasing to 39.4-41.1 C) ● Frontal or retro orbital pain
• Precedes Fever

  severe back pain (back-break fever)
• First 24-48 hr of fever

  transient, macular, generalized rash that blanches under pressure ○ Pulse rate may be slow relative to the degree of fever.
• Soon after onset of fever

  Myalgia, Arthralgia
• Second-6th day of fever

  Nausea and vomiting, Generalized lymphadenopathy , Cutaneous hyperesthesia or hyperalgesia, Taste aberrations, Anorexia
• 1-2 days after defervescence

  Generalized, morbilliform, maculopapular rash, Disappears in 1-5 days
• About the time second rash appears

  The body temperature, which has previously decreased to normal, may have become slightly elevated and demonstrate the characteristic biphasic temperature pattern.
• Febrile Phase

  Typical duration of 0-7 days ○ Biphasic fever is possible, Progressive decrease of total white blood cell count
• Critical Phase

  Typically begins around the time of defervescence but it might begin as early as the third day after fever onset in patients who are still febrile.
• Recovery Phase

  Gradual reabsorption of extravascular compartment fluid takes place in the following 48-72 hours
• DIAGNOSTIC TEST

  NS1 ANTIGEN, IgM and IgG, Tourniquet test, Complete Blood test, Decreased platelet count
• Blood pressure monitoring

  Measure blood pressure as indicated
• Monitoring pain


  1. Note client's report of pain in specific areas

  2. Whether pain is increasing, diffused, or localized
• Vascular access


  Maintain patency of vascular access for fluid administration or blood replacement as indicated
• Medication regimen


  Periodic review of the medication regimen of the client to identify medications that might exacerbate bleeding problems
• Fluid replacement


  Establish 24-hour fluid replacement needs
• Managing nose bleeds


  1. Elevate the position of the patient

  2. Apply an ice bag to the bridge of the nose and to the forehead
• Trendelenburg position

  Place the patient in Trendelenburg position to restore blood volume to the head
• Avoid diuretics

  Avoid caffeine and alcohol as indicated to reduce effects of diuresis
• Follow-up appointments


  Comply with the recommended medical and laboratory follow-ups
• Oral care


  Recommend use of soft toothbrush to reduce risk of injury to the oral mucosa
• Diet


  • Foods rich in vitamin K should be recommended to promote blood clotting
  • AVOID dark colored foods and liquids
• Education


  Educate the patient on the use of mosquito nets and insecticides
• FULLY IMMUNIZED CHILD


  1 BCG ● 3 Hepa B ● 3 Pentavalent HiB ● 3 OPV ● 1 IPV ● 3 PCV ● 1 measles ● 1 MMR before 1 year old
• CLINICAL MANIFESTATIONS OF DENGUE

  Fever and malaise ● cough, coryza, and conjunctivitis ● Koplik's spot (tiny white dots on the inside of the mouth) ● Generalized maculopapular rash behind the ears and on the neck and hairline ● Headache, abdominal pain, vomiting, diarrhea, and myalgia