Review
Dengue: an update

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Summary

This review is an update of dengue and dengue haemorrhagic fever (DHF) based on international and Cuban experience. We describe the virus characteristics and risk factors for dengue and DHF, and compare incidence and the case fatality rates in endemic regions (southeast Asia, western Pacific, and the Americas). The clinical picture and the pathogenesis of the severe disease are explained. We also discuss the viral, individual, and environmental factors that determine severe disease. Much more research is necessary to clarify these mechanisms. Also reviewed are methods for viral isolation and the serological, immunohistochemical, and molecular methods applied in the diagnosis of the disease. We describe the status of vaccine development and emphasise that the only alternative that we have today to control the disease is through control of its vector Aedes aegypti.

Section snippets

Disease burden and global situation

Dengue fever (DF) and dengue haemorrhagic fever (DHF) are increasingly important public health problems in the tropics and subtropics. Dengue has been recognised in over 100 countries and 2–5 billion people live in areas where dengue is endemic. Yearly, an estimated of 50–100 million cases of DF and several hundred thousand cases of DHF occur, depending on epidemic activity. About 250 000–500 000 cases of DHF are officially notified annually; however, the true incidence is not very well known.5

Clinical picture

Most dengue infections are symptomless or very mild characterised by undifferentiated fever with or without rash mainly in infants and young children. Older children and adults may develop a mild febrile syndrome or typical DF consisting of high fever, severe headache, myalgia, arthralgia, retro-orbital pain, and maculopapular rash. Signs of skin bleeding such as positive tourniquet test, petechiae, or ecchymosis are observed in some patients. DF cases with bleeding complications such as

Dengue diagnosis–still a need

Three factors have been fundamental in dengue diagnosis: development of ELISAs for dengue-specific IgM detection; mosquito cell lines and monoclonal antibody development for viral isolation and identification; and, most recently, the introduction of reverse transcriptase PCR for molecular diagnosis and strain characterisation. These three methods cover the serological, virological, and molecular diagnosis of dengue.30

Once an individual is infected, an incubation period of 7–10 days occurs. 2

What we know about DHF and what we don't

For years, DHF pathogenesis has been a controversial matter. Some workers argued that secondary infection was the main factor in the severity of this disease, whereas others pointed to viral virulence.60, 61, 62, 63, 64, 65 Today, the majority view is that secondary infection is the main risk factor for DHF; however, other factor such as viral virulence and host characteristics are also of utmost importance.

DHF occurs as a consequence of a very complex mechanism where virus, host, and host

Dengue control—a challenge?

Today we are closer to getting a dengue vaccine, although problems remain to be solved. For decades, scientists have considered that a dengue vaccine should provide protective immunity to the four serotypes to avoid the ADE phenomenon.105 However, we are facing a new challenge. The report of DHF 20 years after the primary infection and the higher severity observed when secondary infection occurs after long interval compared with shorter interval give a new dimension to this disease and

Search strategy and selection criteria

The references covered in this review come mostly from a search of journals and books published in English and Spanish in the past decades. The review includes the most advance knowledge on dengue today.

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