Following on from Dr Trish’s articles https://osler-health.com/news/dengue-is-on-the-rise-what-to-look-out-for and https://osler-health.com/news/family-doctor/the-dengue-vaccine
What is dengue?
Dengue is usually a self-limiting, mosquito-borne flu-like tropical viral illness, transmitted by female mosquito-bites mainly from the Aedes aegypti species. Human to human direct spread is not known to occur other than during pregnancy from mother in baby on occasion. Most cases are mild, and symptoms will resolve on its own in a week. Rarely, severe dengue can occur and be life threatening due to bleeding and organ failure, needing urgent medical treatment.
Dengue has become a global public health concern and continues to be endemic in Singapore. There are currently at least five different ‘strains’ of the dengue virus, although only the first four seem to infect humans. You can get dengue more than once and repeat infections tend to be more serious. Many cases are in children less than 15 years of age and the incidence of dengue has increased rapidly in the last few years. Singapore is currently seeing the highest cases in 5 years even before reaching the traditional peak season from June to October as per the National Environmental Agency – NEA.
What are the symptoms?
As per the 2009 World Health Organisation (WHO) classification:
Non-severe dengue without warning signs (lasting 2-7 days):
• High fever (40C/104F)
• Pain behind the eyes
• Muscle and joint pains
• Nausea and vomiting, particularly in children
• Rash – can be itchy and present a few days after the onset of fever
• Swollen glands
Dengue with warning signs (developing 3-7 days into the illness needing regular monitoring):
• Continuous vomiting
• Severe tummy pains
• Fast breathing
• Bleeding – nose bleeds/bleeding gums/heavier periods
• Low blood pressure
• Changes in heart rate
• Fluid retention
Severe dengue (life threatening illness needing urgent medical management):
• Very unwell very quickly
• Organs affected – heart, liver, lungs, and circulation
Managing dengue and when should help be sought?
There is no specific treatment for dengue. Most cases are mild and self-limiting, not needing hospitalisation, and can be managed at home.
• Control the fever and relieve pain with paracetamol (avoid ibuprofen, diclofenac, aspirin, or similar anti-inflammatory medication) and tepid water sponging – this is very important to reduce the risk of children having seizure associated with a high fever
• Prevent dehydration by drinking clear fluids in small volumes often. More information on assessing and managing dehydration can be found via https://patient.info/digestive-health/nausea-and-vomiting/dehydration
• Bleeding prevention and control – avoid running or sports to reduce the risk of falls or injury; children may need to avoid brushing their teeth or blowing their nose if the platelet count is very low to reduce the risk of bleeding gums and nose bleeds
As many infants and children can be affected, please consult your doctor early if there is a persistently high fever for 1-2 days or any of the above-mentioned symptoms.
Dengue is legally notifiable in Singapore, so it is important to seek help early. Your doctor can make an assessment and organise the relevant blood tests (can be daily) and monitoring needed. If a hospital admission is needed, this can be arranged early to reduce the risk of complications (post-viral fatigue; inflammation of the liver) and severe disease.
Who can have the dengue vaccine?
As per the Singapore Ministry of Health – MOH, Dengvaxia is currently the only licensed dengue vaccine approved for the prevention of dengue in those aged 12 to 45 years. It is, however, not suitable for individuals who have not previously been infected. Singapore currently does not fall into the category of requiring population vaccination without screening (as the overall numbers are below the WHO threshold), and as such, the current recommendation is that any individual who wishes to be vaccinated, should consult their doctor first. It is also not included in the national immunisation schedule and as such, is not eligible for government subsidy.
How do you prevent mosquito bites and reduce the risk of dengue infection?
As per the NEA, everyone must ‘Do the Mozzie Wipeout – B-L-O-C-K steps’ regularly (at least once a week in high cluster areas) to remove stagnant water:
In addition, residents in dengue cluster areas are urged to ‘S-A-W – Spray, Apply, Wear’
1. Spray insecticide in dark corners around the house
2. Apply insect repellent regularly
3. Wear long-sleeved tops and long trousers
Specifically in children, as these mosquitoes are commonly present in our daily surroundings, they are likely to be bitten whilst continuing with their daily activities both indoors and out. Therefore, limit the amount of time spent outside during the day, especially in the hours around dawn and dusk, when mosquitoes are most active. Find the right repellent to use on your child and opt for one with DEET or oil of lemon eucalyptus where appropriate.
Finally, monitor the NEA Website and download the MyENV app to review live data on dengue clusters. Please contact your doctor if you, a child, or a family member is showing any symptoms.
Dr Tash Mirando is a UK trained family doctor. For appointments please call: 6332 2727
1. Verhagen, L M; de Groot, R – Dengue in Children. 10.1016/j.jinf.2014.07.020.Epub 2014 Sep 13.
2. World Health Organisation (WHO) – Dengue January 2022 (https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue)
3. Patient.info – Dengue (https://patient.info/travel-and-vaccinations/dengue-leaflet)
4. Singapore National Centre for Infection Disease (NCDI) – Dengue (www.ncid.sg/Health-Professionals/Diseases-and-Conditions/Pages/Dengue.aspx)
5. Singapore National Environment Agency (NEA) – Dengue cases and clusters (www.nea.gov.sg/dengue-zika/dengue/dengue-cases and https://www.nea.gov.sg/dengue-zika/dengue/dengue-clusters)
6. Singapore Ministry of Health (MOH) – Dengue vaccine (www.moh.gov.sg/news-highlights/details/subsidies-for-dengue-vaccine)