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Dengue fever

Dengue fever is an illness that occurs in many tropical countries. You can’t get it in the UK, but you can if you travel abroad to affected areas. It’s spread by the bite of a mosquito and causes an illness which can be similar to flu. Most people with dengue fever have symptoms that can be managed at home. But, occasionally, it can be quite severe meaning you’ll need to go to hospital.

Map showing world dengue fever distribution

Details

  • About What is dengue fever?

    Dengue fever is a viral illness that’s passed on by the Aedes mosquito, which bites mainly during the daytime. This mosquito is found in many countries throughout the world, but not the UK. It’s particularly common in South-East Asia, India, the Caribbean, South and Central America, and Africa. If you travel to one of these areas and don't protect yourself against mosquito bites, you may be at risk of getting dengue fever.

    In 2014, 347 people were diagnosed with dengue fever in England, Wales, and Northern Ireland. All had recently returned from travelling abroad. More than half of cases were in people who’d travelled to South-East Asia. Almost another quarter of cases had travelled to India and Sri Lanka. The rest had been to the Caribbean, South and Central America and East Africa.

    There have recently been reports of dengue fever in Europe, with cases in Madeira, France and Croatia.

  • Symptoms Symptoms of dengue fever

    It generally takes between four and seven days for the first symptoms to start after you’ve been bitten. The maximum is 14 days. Symptoms that appear more than two weeks after you’ve been abroad are unlikely to be caused by dengue fever.

    The symptoms of dengue are similar to the flu. The exact symptoms you get may depend on your age. In some cases, the illness can be so mild that you don’t notice any symptoms at all.

    Children under 15 are most likely to have a fever and rash, but may not have any other symptoms.

    In older teenagers and adults, the most common symptoms of dengue are:

    • a fever that comes on quickly and lasts two to seven days
    • skin flushing, especially in the face – this can be the first sign of the illness
    • a headache and pain behind your eyes, which can be severe
    • severe back pain and pain in your muscles, joints and bones  – dengue fever is also known as ‘breakbone fever’
    • a red rash that can affect your whole body and typically starts on the third or fourth day of the infection
    • feeling or being sick
    • loss of appetite

    There are other symptoms that can suggest that the illness is becoming more serious. For more information, see our section on Complications of dengue fever.

    These symptoms can be caused by problems other than dengue fever. However, if you’ve recently travelled to an area that’s affected by dengue fever and have any of these symptoms, contact your GP. Remember to tell them where you’ve been abroad. This may help your GP to work out if you have dengue fever or another tropical disease.

  • Diagnosis Diagnosis of dengue fever

    Your GP will ask about your symptoms and examine you. Tell them if you’ve recently travelled abroad and whether you’ve been bitten by mosquitoes. It can be difficult for your GP to diagnose dengue fever because the symptoms are similar to more common bacterial and viral infections.

    If your GP suspects you have dengue fever, they’ll ask you to have a blood test and may contact a local tropical disease centre for specialist advice. Depending on your symptoms and where you have travelled, you may be asked to have further blood tests to check for signs of dengue fever and other tropical diseases.

    If your doctor suspects you’re one of the small number of people who develops more severe dengue fever, you may have other tests, such as a chest X-ray or abdominal ultrasound and will be admitted to hospital for emergency treatment.

  • Treatment Treatment of dengue fever

    There’s no specific treatment for dengue fever. However, your body will usually fight off the virus within three to four days of the rash appearing. You’ll need to rest and follow your doctor’s advice. For more information, see our section on Self-help.

    Most people make a full recovery. But it’s possible that you’ll continue to feel tired and have muscle and joint pain for some time after.

    Hospital treatment

    Dengue fever can become more serious in a small number of people. You may need to be admitted to hospital if:

    • you become severely dehydrated from being sick
    • your symptoms suddenly become worse
    • you develop signs of complications such as dengue haemorrhagic fever or dengue shock syndrome – see our Complications section for more information

    You may need to have fluids through a drip in your arm.

    You may also be admitted to hospital if you could be at higher risk of complications. This includes pregnant women, babies, older people or people who have other chronic illnesses, such as diabetes, heart disease or asthma.

    Most people make a full recovery if they receive the right treatment.

  • Bupa Travel Insurance

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  • Self-help How to help yourself

    There are things you can do to help your recovery.

    • Rest and drink plenty of fluids. Adults should try to have four pints (2½ litres) a day. Your GP may suggest that you take oral rehydration salts to help prevent you becoming dehydrated.
    • Take paracetamol to help relieve pain and reduce fever. Don’t take aspirin or ibuprofen as this can increase your risk of bleeding.

    Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

  • Causes Causes of dengue fever

    Dengue fever is caused by a type of virus called a flavivirus, which is transmitted by infected female Aedes mosquitoes. You can catch the virus if you get bitten by one. Mosquitoes become infected when they bite an infected person. They are able to pass on the virus for the rest of their life (two to three months). Dengue fever isn’t passed directly from person to person.

    Below is a picture of the Aedes mosquito – notice its characteristic black and white markings.

    A tiger mosquito
  • Complications Complications of dengue fever

    Dengue fever can sometimes develop into a serious, potentially fatal illness. Progressions of dengue fever include.

    • Dengue haemorrhagic fever (DHF) – symptoms include bleeding from under your skin, your gums and nose, and you may also vomit blood or pass blood in your faeces.
    • Dengue shock syndrome (DSS) – symptoms include severe pain in your abdomen (tummy), a weak and rapid pulse, vomiting, feeling irritable and feeling cold and clammy.

    You’re more likely to develop serious illness if you’ve been infected with dengue virus more than once and with the different types of the virus. So, people who live in areas where dengue fever is regularly found are more likely to be affected. Children under the age of 15 are also more at risk.

    You can learn more about the different types of the dengue virus in our FAQ: Dengue, previous infection and immunity below.

    If you have any of these symptoms, seek urgent medical attention.

  • Prevention Prevention of dengue fever

    At the moment, there aren’t any vaccines or medicines available in the UK to prevent dengue fever. There’s a new vaccine, but it’s only for use in areas where dengue fever is common. The only way to prevent catching it is to protect yourself from getting bitten by mosquitoes.

    Advice for avoiding mosquito bites

    • Wear loose-fitting, protective clothing that covers as much of your body as possible during the daytime and especially at dawn and dusk.
    • Use an insect repellent on areas of your skin that are exposed and on clothing made from natural fibres – especially around loose parts such as collars or cuffs. Repellents containing a chemical known as DEET (N, N-diethylmetatoluamide) are thought to be the best. Picaridin is a newer repellent that is said to work as well as DEET. Permethrin is a repellent that you can spray on your clothes.
    • If you are using sunscreen during the day, put insect repellent on afterwards and reapply each time you’ve reapplied your sunscreen.
    • You can use plug-in devices with insecticides in them or mosquito coils to kill mosquitoes, but only use coils outdoors.
    • Sleep under a mosquito net treated with insecticides to avoid being bitten while in bed.
    • The mosquito that transmits dengue fever prefers to breed in water-filled domestic containers. If there are any nearby, try to get them removed or covered up. Be aware also that small pools of water around building sites in tourist resorts are attractive places for these mosquitoes to reside.

    It's most important to follow these precautions around dawn and dusk because this is when the Aedes mosquito is most likely to bite. However, it's important to remember that they can bite at any time of the day or night. Make sure you always take the necessary precautions to help reduce your risk of catching dengue fever.

  • FAQ: Is dengue fever contagious? Can I catch dengue fever from another person?

    No, you can't catch dengue fever from another person just by being in close contact with them. Very rarely, dengue fever can be passed on through organ transplants, blood transfusions or from an infected mother to her unborn child. There was one case in the UK in 2014 caused by a needle-stick injury but this is extremely rare.

    Dengue fever is passed on through the bite of an infected Aedes mosquito. This is a type of mosquito that lives in tropical areas so you can’t catch dengue fever in the UK.

    If you have dengue fever, you should take extra care to avoid being bitten by mosquitoes because that mosquito could become infected and pass dengue fever on to other people it bites. For more information on ways to prevent getting bitten, see our section on Prevention of dengue fever.

    There’s some evidence that the virus may be able to pass from pregnant, infected women to their unborn babies, but this is very unlikely to happen. If you're pregnant and think you may have dengue fever, contact your GP.

    If you need more information, contact your GP practice or a health professional at a travel clinic.

    What are my chances of getting dengue fever if I travel to an affected area?

    Answer

    There are several different factors that can affect your chances of getting dengue fever. These include where you're travelling to, how long you're staying and what time of the year you travel.

    Explanation

    It's difficult to say for certain what your individual risk of catching dengue fever is – everyone who travels to an area where the virus is present is at some level of risk. Dengue fever is becoming more common worldwide. It’s now in over 100 countries, with cases increasing by 30 times over the last 50 years. Travellers who spend a long time in areas where dengue fever is common (such as expatriates or aid workers) have a greater risk. However, even short-term visitors may still be at risk.

    The seasons can affect how active mosquitoes are and how many there are. If you’re in a country that has dengue fever and you’re there during the rainy season, there’s a chance your risk may be higher.

    The best advice is to always protect yourself from getting mosquito bites if you're travelling to an affected area. For measures to avoid being bitten by mosquitoes see prevention of dengue fever.

    What concentration of DEET should I use?

    Answer

    This depends on the amount of exposure to dengue fever you're likely to have and the type of protection from mosquito bites you prefer.

    Explanation

    Products containing DEET are available in several different concentrations – the higher the concentration, the longer the duration of protection. Concentrations of 20 percent DEET have been shown to provide about one to three hours of protection and higher concentrations provide longer-lasting protection. However, the duration of action appears to level off at a concentration of about 50 percent. This means that concentrations above 50 percent don't give you any added benefit. Therefore, it's generally not necessary to use products of a higher concentration than this.

    The use of DEET-containing products isn't advised for babies under two months. DEET-based products are considered safe if you're pregnant or breastfeeding; however, it’s advisable to stick to those with a concentration of 50 percent or less.

    You should always use any DEET-containing products according to the manufacturer's instructions, especially since some manufacturers will advise about their own age restrictions.

  • FAQ: Dengue fever and risk of infection What are the chances of me getting dengue fever?

    There are several different factors that can affect your chances of getting dengue fever. These include where you're travelling to, how long you're staying and what time of the year you travel.

    It's difficult to say for certain what your individual risk is – everyone who travels to an area where the virus is present is at some level of risk. Dengue fever is becoming more common worldwide. There were three and a half times as many cases across the world in the 2000s as in the 1990s. It’s also likely that dengue fever is underreported as many cases are so mild.

    Travellers who spend a long time in areas where dengue fever is common (such as expatriates or aid workers) have a greater risk. However, even short-term visitors may still be at risk.

    The seasons can affect how active mosquitoes are and how many there are. If you’re in a country that has dengue fever and you’re there during the rainy season, your risk may be higher.

    The best advice is to always protect yourself from getting mosquito bites if you're travelling to an affected area. For more information on how to avoid being bitten by mosquitoes see our section on Prevention of dengue fever.

  • FAQ: Dengue and DEET What concentration of DEET should I use?

    DEET is an insect repellent that can stop mosquitoes from biting and so prevent infection with dengue fever and other mosquito-borne illnesses. It is thought to be the most effective insect repellent.

    Products containing DEET are available in several different concentrations – the higher the concentration, the longer the duration of protection.

    • Less than 10 per cent DEET gives you between one and three hours of protection.
    • 10–20 per cent DEET gives you between four and six hours of protection.
    • 40 per cent DEET gives you around 10 hours of protection.

    You don’t need to use a concentration higher than 50 per cent, as tests have shown that higher concentrations don’t protect you for longer.

    You shouldn’t use DEET-containing products on babies under two months old. DEET is considered safe if you're pregnant or breastfeeding, but the advice is not to use concentrations over 50 per cent.

    Always use DEET-containing products according to the manufacturer's instructions, making sure you don’t get it into your eyes or mouth.

  • FAQ: Dengue, previous infection and immunity Am I immune if I’ve already had the infection?

    There are four different but closely related types of the flavivirus that causes dengue fever. Once you've been infected by one type of the virus you’re immune to re-infection with that type for the rest of your life.

    Your infection will also protect you against catching one of the other three types for a few months. But after that, you’re just as likely to be infected with the other virus types as anyone else.

    It’s extremely important to continue to use protection against mosquito bites if you’ve had dengue fever. If you’re infected with a second type of the virus, you’re at increased risk of developing a more severe illness. You’ll also protect yourself against other diseases spread by mosquitoes.

    For more information, see our sections on Prevention of dengue fever and Complications of dengue fever above.

  • Other helpful websites Other helpful websites

    Further information


    Sources

    • Dengue fever. BMJ Best Practice. bestpractice.bmj.com, last updated June 2016
    • Dengue factsheet. Travel Health Pro. travelhealthpro.org.uk, last updated September 2015
    • Dengue guidelines for diagnosis, treatment, prevention and control. World Health Organisation (WHO) and the Special Programme for Research and Training in Tropical Diseases (TDR). www.who.int, last updated 2009
    • Dengue reported in England, Wales and Northern Ireland: 2014. Public Health England. www.gov.uk, published November 2015
    • Dengue clinical presentation. Medscape. emedicine.medscape.com, last updated October 2015
    • Dengue treatment and management. Medscape. emedicine.medscape.com, last updated October 2015
    • Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever. World Health Organisation (WHO), Regional Office for South-East Asia.  apps.searo.who.int, published 2011
    • Dengue fever. PatientPlus. patient.info/patientplus, last updated November 2016
    • Dengue. Medscape. emedicine.medscape.com, last updated October 2015
    • Insect and tick bite avoidance. Travel Health Pro. travelhealthpro.org.uk, last updated May 2016
    • Dengue. Centers for Disease Control and Prevention (CDC) www.cdc.gov, last updated June 2014
    • Find the insect repellent that is right for you. United States Environmental Protection Agency. www.epa.gov, accessed February 2017
    • Seet RC, Quek AM, Lim EC. Post-infectious fatigue syndrome in dengue infection. J Clin Virol 2007; 38(1):1–6
    • Garcia G, Gonzalez N, Perez AB, et al. Long-term persistence of clinical symptoms in dengue-infected persons and its association with immunological disorders. Int J Infect Dis 2011; 15(1):e38–43. doi: 10.1016/j.ijid.2010.09.008
    • Personal communication, Professor Martin Wiselka, Consultant in Infectious Diseases, March 2017
    • Dengue and the Aedes aegypti mosquito. Centres for Disease Control and Prevention. www.cdc.gov, accessed April 2014
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    Reviewed by Laura Blanks, Specialist Health Editor, Bupa Health Content Team, March 2017
    Expert reviewer Professor Martin Wiselka, Consultant in Infectious Diseases
    Next review due March 2020

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