De Faakto Outbreak Intelligence

21 January 2019


  • The Caribbean Public Health Agency (CARPHA) issued a warning to Caribbean countries-‘to brace for a severe outbreak of the dengue fever”
  • CARPHA is advising Caribbean countries to implement enhanced measures to reduce mosquito breeding and prevent the spread of infectious diseases
  • This advice is important since the Aedes aegypti mosquito spreads dengue, and is present in all Caribbean territories
  • According to CARPHA, the current dengue fever outbreak in Jamaica has raised the level of concern throughout the Caribbean islands
  • The most effective way to avoid becoming ill from viruses spread by mosquitoes is to prevent mosquito bites. Research carried out by CARPHA and the Pan American Health Organization/World Health Organization (PAHO/WHO) show that drums and tyres are the main mosquito breeding sources
  • Actions include covering drums and tanks, cleaning the guttering, removing stagnant water sources, and individuals protecting themselves and their family from bites. Infants, young children, older adults and women who are pregnant or trying to get pregnant should take extra precautions to avoid mosquito bites by using insect repellents containing DEET, Picaridin, IR 3535, and Oil of Lemon Eucalyptus


What is Dengue Fever?

  • Dengue is a mosquito-borne viral infection causing a severe flu-like illness and, sometimes causing a potentially lethal complication called severe dengue. The incidence of dengue has increased 30-fold over the last 50 years. Up to 50-100 million infections are now estimated to occur annually in over 100 endemic countries, putting almost half of the world’s population at risk. (WHO, 2018)


What are the Symptoms of Dengue Fever?

A person infected by the dengue virus develops severe flu-like symptoms
Individuals should suspect dengue when a high fever (40°C/ 104°F) is accompanied by two of the following symptoms:

Severe headache
Pain behind the eyes
Nausea, Vomiting
Swollen glands
Muscle and joint pains
Symptoms usually last for 2-7 days, after an incubation period of 4-10 days after the bite from an infected mosquito
Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. The warning signs to look out for occur 3-7 days after the first symptoms in conjunction with a decrease in temperature (below 38°C/ 100°F) include:

Severe abdominal pain
Persistent vomiting
Rapid breathing
Bleeding gums
Blood in vomit
Fatigue, restlessness
The next 24-48 hours of the critical stage can be lethal; proper medical care is needed to avoid complications and risk of death (WHO, 2018)


There is no specific treatment for dengue fever.
Patients should seek medical advice, rest and drink plenty of fluids. Paracetamol can be taken to bring down fever and reduce joint pains. However, aspirin or ibuprofen should not be taken since they can increase the risk of bleeding.
For severe dengue, medical care by physicians and nurses experienced with the effects and progression of the disease can frequently save lives. Maintenance of the patient’s circulating fluid volume is the central feature of such care. (WHO, 2018)

Prevention and control

The only current method of controlling or preventing dengue virus transmission is to effectively combat the vector mosquitoes. (WHO, 2018)


Dengue Hemorrhagic Fever (DHF) – is a more severe form, seen only in a small proportion of those infected. DHF is a stereotypic illness characterized by 3 phases; febrile phase with high continuous fever usually lasting for less than 7 days; critical phase (plasma leaking) lasting 1-2 days usually apparent when fever comes down, leading to shock if not detected and treated early; convalescence phase lasting 2-5 days with improvement of appetite, bradycardia (slow heart rate), convalescent rash (white patches in red background), often accompanied by generalized itching (more intense in palms and soles), and diuresis (increase urine output). (WHO, 2018)

Dengue Shock Syndrome (DSS) — Shock syndrome is a dangerous complication of dengue infection and is associated with high mortality. Severe dengue occurs as a result of secondary infection with a different virus serotype. Increased vascular permeability, together with myocardial dysfunction and dehydration, contribute to the development of shock, with resultant multiorgan failure. (WHO 2018)

CARPHA  http://carpha.org/articles/ID/196/CARPHA-Urges-Region-to-Prepare-for-the-Possibility-of-a-Severe-Outbreak-of-Dengue-Fever

WHO  https://www.who.int/en/news-room/fact-sheets/detail/dengue-and-severe-dengue