Hemorrhagic dengue

Dengue shock syndrome

Philippine hemorrhagic fever

Thai hemorrhagic fever

Singapore hemorrhagic fever

Dengue Hemorrhagic Fever is an acute
infectious viral disease usually affecting infants and
young children. This disease used to be called
break-bone fever
is a severe, potentially deadly infection spread
by certain species of mosquitoes (Aedes aegypti).
Philippine Hemorrhagic Fever was first reported in
1953. in 1958, hemorrhagic fever became a
notifiable disease in the country and was later
reclassified as Dengue Hemorrhagic Fever.
An acute febrile infection of
sudden onset with clinical
manifestation of 3 stages:
 high fever
 Abdominal pain and headache
 Later flushing which may
accompanied by vomiting,
conjunctival infection and
epistaxis
Lowering of temperature
Severe abdominal pain
Vomiting and frequent bleeding
from gastrointestinal tract in the
form of hematemesis or melena
Unstable BP
Narrow pulse pressure
shock
Generalized flushing with intervening
areas of blanching appetite regained

Blood pressure already stable

Severe, frank type – with flushing, sudden
high fever, severe hemorrhage, followed by
sudden drop of temperature, shock and
terminating in recovery or death.
Moderate – with high fever, but less
hemorrhage, no shock
Mild – with slight fever, with or without
petechial hemorrhage but epidemiologically
related to typical cases usually discovered in
the course of investigation of typical cases.
PETECHIAE
BRUISES
Flavivirus, Dengue Virus Types
1, 2, 3, & 4

Chikungunya Virus
Vector mosquito

Aedis Aegypti ,

Aedis albopictus,

The infected person

INCUBATION PERIOD
UNCERTAIN. Probably 6 days to 1
week
PERIOD OF COMMUNICABILITY
Unknown. Presumed to be on the
first week of illness when virus is still
present in the blood.
SUSCEPTIBILITY, RESISTANCE AND OCCURRENCE
All persons are susceptible. Bothe sexes are equally
affected. Age groups predominantly affected are
the preschool age and school age. Adults and
infants are not exempted. Peak age affected 5-9
years.
Occurrence is sporadic through out the year.
Epidemic usually occur during the rainy seasons
June – November. Peak months are September and
October.
Occurs wherever vector mosquito exists.
Susceptibility is universal.
Supportive and symptomatic treatment should be
provided
For fever, give paracetamol for muscle pains. For
headache, give analgesic. DON’T give ASPIRIN.
Rapid replacement of body fluids is the most
important treatment
Includes intensive monitoring and follow-up.
Give ORESOL to replace fluid as in moderate
dehydration at 75 ml/kg in 4-6 hours or up to 2-3L in
adults. Continue ORS intake until patient’s
condition improves.
The infected individual, contacts and
environment:
Recognition of the disease.
Isolation of patient (screening or sleeping
under the mosquito net)
Epidemiological investigation
Case finding and reporting
Health Education
1. Cover water drums and water pails at all times to
prevent mosquitoes from breeding.
2. Replace water in flower vases once a week.
3. Clean all water containers once a week. Scrub the
sides well to remove eggs of mosquitoes sticking to
the sides.
4. Clean gutters of leaves and debris so that rain water
will not collect as breeding places of mosquitoes.
5. Old tires used as roof support should be punctured or
cut to avoid accumulation of water.
6. Collect and dispose all unusable tin cans, jars, bottles
and other items that can collect and hold water.
1. Search and destroy
2. Self protection
3. Seek early consultation
4. Say no to indiscriminate
fogging
Report immediately to the municipal Health Office
any known case outbreak.
Refer immediately to the nearest hospital, cases
that exhibit symptoms of hemorrhage from any part
of the body no matter how slight.
Conduct a strong health education program
directed towards environmental sanitation
particularly destruction of all known breeding places
of mosquitoes.
Assist in the diagnosis of suspect based on the s/sx.
For those without signs of hemorrhage, the nurse
may do the “torniquet” test.
Conduct epidemiologic investigations as a means
of contacting families, case finding and individual as
well as community health education
POSITIVE TORNIQUET TEST
1. For hemorrhage – keep the px at rest during
bleeding episodes. For nose bleeding,
maintain an elevated position of trunk and
promote vasoconstriction in nasal mucosa
membrane through an ice bag over the
forehead. For melena, ice bag over the
abdomen. Avoid unnecessary movement. If
transfusion is given, support the patient during
the therapy. Observe signs of deterioration
(shock) such as low pulse, cold clammy
perspiration, weakness, fatigue.
2. For shock – prevention is the best treatment.
Dorsal recumbent position facilitates
circulation.
 Adequate preparation of the patient,
mentally and physically prevents occurrence
of shock.
1. Provision of warmth-through lightweight
covers (overheating causes vasodilation
which aggravates bleeding).
3. Diet – low fat, low fiber, non-irritating, non-
carbonated. Noodle soup may be given.
DENGUE VACCINE
 The DOH in partnership with the Department of
Education and the Department of Interior and
Local Government provide FREE vaccination to
all Grade IV pupils nine (9) years and older in all
public schools in Regions III, IV-A, and NCR
which started April 2016.