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Understanding & Caring for Dengue Fever in Children

1.What is Dengue Fever?

Dengue is a mosquito-borne viral disease that has rapidly spread in Sri Lanka.  Dengue virus is transmitted by female mosquitoes mainly of the species of Aedes.  Once the mosquito is infected, it remains infected for its life span. There are distinct, but closely related, four types of 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 4-10days after infected mosquito bite. It is not transmitted by direct spread from one person to another.

 

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

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

Sometime, Dengue infection can present in the more serious form, known as Dengue haemorragic Fever(DHF) or Dengue  Shock Syndrome (DSS), whereby 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 given early.

 

3. How can a child 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 child passes enough urine for a day

 Give fluid with salt and sugar (Oral rehydration fluid, king coconut

water, soup, Kanji,   fruit juices, porridge)

      • Paracetamol   15mg/kg  6hrly can be given  to relieve pain and to control fever.

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 fever  Day 1or 2  

 

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

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

 

5. What do you do in the hospital?

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

 

 

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

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

 

7. How are the chances being reduced of getting 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 all possible containers where water can collect
      • Clean gullies and drainages  regularly
      • Maintain the garden 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. 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.