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Understanding & Caring for Dengue Fever in Children

1. What is Dengue Fever?

Dengue is a mosquito-borne viral disease that is wide spread in Sri Lanka. The Dengue virus is transmitted by female mosquitoes mainly of the species of Aedes. When a mosquito is infected, it remains infected for its entire life span. 

There are four types of distinct, but closely related, viruses that cause dengue. Recovery from infection by one provides lifelong immunity against that particular type. However, subsequent infections by other types increase the risk of developing severe dengue. Symptoms appear 4 – 10 days after being bitten by an infected mosquito. It is not transmitted directly from person to person. 

 

2. What are the symptoms and signs of Dengue fever?

      • High Fever 
      • Headache and pain behind the eyes
      • Nausea and vomiting
      • Muscle and joint aches
      • Rash - different types of rash (usually diffused, red patches), may be itchy and appears a few days after the onset of fever.
      • Bleeding tendency – from nose , gums and bruises 
      • Facial Flushing

 

Sometimes the Dengue infection can be present in the more serious form, known as Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS). This is when serious complications can occur, resulting in:

      • Widespread bleeding
      • Low Blood Pressure/shock due to bleeding or leaking blood vessels
      • Organ (liver, Kidney) failure

 

The risk of dying from dengue complications is very low. It is less than 1%, if supportive treatment is given early.

 

3. How can a child with Dengue be managed at home?

      • Rest in bed and reduce activities
      • Fluid replacement
        • Children about 1 year old or >10kg – at least one liter a day
        • Children >40kg - at least two liters a day 
      • Make sure the child passes enough urine for a day
      • Give fluids with salt and sugar (Oral rehydration fluid, king coconut water, soup, Kanji, fruit juices, porridge)
      • Paracetamol can be given to relieve pain and to control fever - 15mg/kg, 6hrly
      • Tepid sponging can be done to control fever
      • Don’t give any other drug to control fever
      • Medication may be given for nausea and vomiting
      • May need a blood test (Full Blood Count) daily to assess the progress of the disease
      • Get the Dengue Antigen test done on day 1 or 2 of having fever

 

4. When does a child need to get admitted to the hospital?

      • Day 3 fever
      • If the platelet count drops below 150000
      • Abdominal pain/vomiting
      • Any evidence of bleeding
      • Unwell (lethargy, drowsy/breathing difficulty)
      • Poor feeding/drinking
      • Cold extremities

 

5. What care does a hospital offer?

      • Blood tests are done daily to assess the platelet level and blood concentration (PCV/HCT)
      • Vital signs (pulse rate, Blood pressure, urine volume) are monitored to detect any complications of Dengue fever
      • Intravenous Fluid drip (IV saline) may be needed
      • Platelet or blood transfusions may be given if there is spontaneous bleeding or if the platelet count is critically low

 

 6. When is it safe for a child to return home?

      • No fever for preferably for 48hrs without any paracetamol
      • Good general condition with improving appetite
      • Blood concentration (PCV/HCT) is normal
      • When the platelet count which is definitely rising and has risen above 50,000
      • When more urine is passed
      • No other complications

 

7. How do you reduce the chances of being infected by Dengue fever?

      • Change water in vases/bowls (including pet water containers) on alternate days
      • Remove water from flowerpot plates on alternate days
      • Dispose properly of all possible containers where water can collect
      • Clean gullies and drains regularly
      • Maintain gardens properly to prevent mosquitos accessing egg laying habitats
      • Using of personal household protection such as window screens, long-sleeved clothes, insecticide treated materials, coils and vaporizers
      • Improve community participation and mobilization for sustained mosquito control

 

8. What is Dengue Immunization?

No dengue vaccine is available in the Sri Lankan market yet. The first Dengue vaccine, Dengvaxia (CYD-TDV) by Sanofi Pastteur, was registered in several countries for use in individuals 9-45 years of age living in endemic areas. This is not registered in Sri Lanka. Sri Lanka is one of the locations for the upcoming Phase iii Takeda dengue vaccine clinical trial.