Dang It, It’s Dengue

By Peter Galvin, MD

Dengue, previously known as dengue fever, is a viral infection spread to humans by mosquitos of the Aedes genus. Most people with dengue have no symptoms. About one-quarter of people have mild symptoms that develop four to seven days after being bitten. The most common symptom is fever, which may be accompanied by pain in the eyes, bones, joints, and muscles, as well as nausea, vomiting, and rash. About 5% of patients with dengue develop severe symptoms such as persistent vomiting, severe abdominal pain, gastrointestinal or vaginal bleeding, shortness of breath, low blood pressure, and lethargy. Those at the highest risk of severe symptoms include pregnant women and those who have had prior infection with a different dengue strain.

There are four different dengue viruses, so people can be infected more than once in their lifetime. Dengue affects people in Central and South America, Africa, the Middle East, Southeast Asia, and the Pacific Islands. Among U.S. territories and freely associated states, dengue is found in Puerto Rico, the U.S. Virgin Islands, Micronesia, the Marshall Islands, and Palau. Each year, up to 400 million people worldwide are infected with dengue, and 4 billion people live in areas with a risk of dengue. In 2023, the CDC reported 1709 cases of travel-associated dengue, and 1,206 cases of dengue acquired in the U.S.

Testing for dengue is performed in specialized labs. During the first five days, it is diagnosed by detecting the virus in the blood using a polymerase chain reaction (PCR) test. After the fourth day of infection, testing for antibodies in the blood can be performed. There is no effective antiviral medication for dengue. Those with mild illness should drink plenty of fluids to prevent dehydration. Fever can be treated with acetaminophen (paracetamol outside the U.S.). Those with severe symptoms require hospitalization for close support and monitoring.

People who live in or travel to areas with dengue need to avoid mosquito bites by using recommended insect repellants (those with DEET or other FDA-approved repellants) and by wearing loose-fitting (mosquitos can bite through tight clothing), long-sleeved shirts and pants treated with permethrin. Window screens and the use of air conditioning can decrease contact with mosquitos. Avoiding and eliminating sources of standing water (such as flowerpot saucers, buckets, and birdbaths) is important in controlling the mosquito population.

In 2021, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended dengue vaccination for children aged 9 to 16 years who live in American Samoa, Puerto Rico, or the U.S. Virgin Islands and have evidence of prior dengue infection. Vaccination is not recommended for children who have never been infected with dengue or for travelers (who never had dengue) to areas where dengue is common. For more information go to the CDC website at:      www.cdc.gov/dengue/index.html

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