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Course: Pediatric Nursing�Topic: Nursing Management of Dengue Fever

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Module Goals

Learners will be able to:

Explain causes and risk factors of Dengue Fever
Describe clinical manifestations and complications of Dengue Fever
Identify common diagnostic tests for Dengue Fever
Identify preventive measures for Dengue Fever
Discuss the nursing management of a child with Dengue Fever

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Dengue

WHO, 2022

Dengue is a viral infection transmitted to humans through the bite of infected mosquitoes

The primary vectors are:

Aedes aegypti mosquitoes
Aedes albopictus (to a lesser extent)

Found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas

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Dengue: Causes

Caused by a virus of the Flaviviridae family
There are four distinct, closely related serotypes of the the virus:

DENV-1
DENV-2
DENV-3
DENV-4

WHO, 2022

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

How is Dengue fever transmitted to humans?

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Dengue: Transmission

Transmitted to human through the bites of infected female mosquito, Aedes aegypti

After feeding on infected individual, the virus replicates in the mosquito midgut, before it disseminates to secondary tissues, including the salivary glands

The extrinsic incubation period (EIP) takes about 8-12 days when the ambient temperature (25-28°C)

WHO, 2022

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Dengue: Transmission ( Continued)

Human-to-mosquito transmission

Mosquitoes can become infected from viremic people with DENV with symptomatic, pre-symptomatic and asymptomatic infections
Transmission may occur:

Up to 2 days before someone shows symptoms of the illness and
Up to 2 days after the fever has resolved

WHO, 2022

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

What does veremic mean?

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Dengue: Classification

The World Health Organization classifies dengue into 2 major categories:

Dengue (with / without warning signs) and
Severe dengue

WHO, 2022

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Dengue: Sign and Symptoms

Dengue is suspected when a high fever (40°C/104°F) is accompanied by 2 of the following symptoms during the febrile phase (2-7 days):

Severe headache
Pain behind the eyes
Muscle and joint pains
Nausea
Vomiting
Swollen glands
Rash

WHO, 2022

CDC, 2021

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Severe Dengue: Sign and Symptoms

Enters critical phase normally about 3-7 days after illness onset
Warning signs begin within 24 to 48 hrs of critical phase when fever is dropping to below 38 degrees C and include:

Severe abdominal pain, Persistent vomiting
Rapid breathing
Bleeding gums or nose
Fatigue, Restlessness
Liver enlargement
Blood in vomit or stool

WHO, 2022

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Dengue: Diagnosis

Virus isolation methods:

Detected a virus-produced protein, called NS1 during the first few days of infection

Serological methods

Enzyme-linked immunosorbent assays (ELISA):

IgM antibodies detectable ~1 week after infection and remain detectable for about 3 months (indicative of a recent infection)
IgG takes longer to develop and remains in the body for years (indicative of a past infection)

WHO, 2022

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Dengue: Treatment

No specific treatment for dengue fever
Rest, hydration and seek medical care
Supportive care:

Acetaminophen or paracetamol

NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen and aspirin should be avoided

These drugs act by thinning the blood- In a disease with risk of hemorrhage, blood thinners may exacerbate the prognosis

WHO, 2022

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Dengue: Prevention

Prevention of mosquito breeding:

Prevent mosquitoes from accessing egg-laying habitats by environmental management and modification
Dispose of solid waste properly
Remove artificial man-made habitats that hold water
Cover, emptying and cleaning of domestic water storage containers on a weekly basis
Apply appropriate insecticides to water storage outdoor containers

WHO, 2022

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Dengue: Prevention

Personal protection from mosquito bites:

Use of personal household protection measures

window screens, repellents, coils and vaporizers
must be observed during the day both inside and outside of the home (work/school)

Wearing clothing that minimises skin exposure to mosquitoes

WHO, 2022

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Dengue: Prevention

Community engagement:

Educate the community about the risks of mosquito-borne diseases
Engage with the community to improve participation and mobilization for sustained vector control

WHO, 2022

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Dengue: Prevention

Active mosquito and virus surveillance:

Active monitoring and surveillance of vector abundance.
Prospectively monitor prevalence of virus in the mosquito population, with active screening of sentinel mosquito collections.
Vector surveillance can be combined with clinical and environment surveillance.

WHO, 2022

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Dengue: Nurse Role

Monitor vital signs
Monitor warning signs of dengue
Fever management

Warm sponge, Paracetamol
Discourage for taking NSAIDs (Ibuprofen, Aspirin)

Encourage rest
Prevent dehydration:

Assess for the sign of dehydration
Encourage fluid intake, breastmilk, juice

Education (Disease, preventive measures)
Psychological support

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Case Study/ Critical Thinking Question/ What Would the Nurse Do?

A nurse is designing a community based education presentation for prevention of Dengue fever and for treatment.

What should be included?

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Active mosquito and virus surveillance:

Active monitoring and surveillance of vector abundance
Prospectively monitor prevalence of virus in the mosquito population, with active screening of sentinel mosquito collections

Vector surveillance can be combined with clinical and environment surveillance

Community: Engage with the community to improve participation and mobilization for sustained vector control

Prevention of mosquito breeding:gement:

Educate the community about the risks of mosquito-borne diseases

Preventing mosquitoes from accessing egg-laying habitats by environmental management and modification
Disposing of solid waste properly
Removing artificial man-made habitats that hold water
Covering, emptying and cleaning of domestic water storage containers on a weekly basis
Applying appropriate insecticides to water storage outdoor containers

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Red Flags

Warning sign of dengue fever

Severe abdominal pain, Persistent vomiting
Rapid breathing
Bleeding gums or nose
Fatigue, Restlessness
Liver enlargement
Blood in vomit or stool

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur
Health customs: In some cultures family members play a large role in health care decision-making
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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References:

CDC. (2021 September, 20). Dengue: Symptoms and Treatment. https://www.cdc.gov/dengue/symptoms/

CDC. (2019 October 31). Caring for a Child or Family Member Sick with Dengue. https://www.cdc.gov/dengue/symptoms/family.html

WHO. (2022 January 10). Dengue and Severe Dengue. https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

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