Dengue fever Considered as a public health problem of many Countries around the world Especially in Thailand That is tropical What we need to be aware of is dengue fever. Today, there is still no medicine to treat. Therefore, to fight against this disease must fight in a preventive manner against dengue vaccine. Therefore is the answer to this matter
Symptoms and treatment of dengue fever
After 5-8 days after being infected by mosquitoes (incubation period) the patient will begin to have symptoms of the disease. Which has different severity From dengue fever (DF) to severe symptoms of shock and death Dengue fever has 4 important symptoms which are quite specific.
In order of birth, first to last, as follows
- High fever floats 2-7 days
- Bleeding Mostly found on the skin.
- With enlarged liver, pain
- There is a circulatory failure, shock, fever, all patients with acute fever occur suddenly. Mostly the fever is higher than 38. 5 degrees Celsius, fever may reach 40-41 degrees Celsius, some of which may have seizures, especially in children who have had a history of seizures before. Or in young children younger than 6 months, patients often have flushed faces and examine the throat and may have injected pharynx. Most patients do not have a runny nose or cough. Which helps in the differential diagnosis of early measles and respiratory disease Older children may complain of headache. Pain around the eye socket during this fever phase. The most common gastrointestinal symptoms are anorexia, vomiting, and some may also have abdominal pain. In the initial stages, the pain will be generalized and the pain may be on the right rib during the liver growth. Mostly, the fever will stay high for 2-7 days. Approximately 15% may have a high fever for more than 7 days and some may be biphasic. The rash may have erythema or maculopapular rash. Which has a rubella-like appearance
- The most common bleeding symptoms are on the skin. The veins will be found to be fragile by performing a tourniquet test. Positive results from the first 2-3 days of the disease with small bleeding spots spread on the arms, legs, body, armpits, may have nosebleeds or bleeding. Tooth In severe cases, vomiting and bloody defecation may occur. Which is usually black (melena). Most gastrointestinal bleeding is associated with shock in long shock cases.
Most liver palpation will experience palpable liver for 3-4 days since the onset. The liver is soft and sore. Shock. About 1 in 3 of dengue patients have severe symptoms. Circulation failure occurs. As plasma leaks into the lung / peritoneal cavity, a hypovolemic shock occurs, most of which occurs at the same time as the fever rapidly decreases. The time of the shock therefore depends on the duration of the fever. May occur from the 3rd day of the disease (if the fever is 2 days) or the 8th day of the disease (if the fever is 7 days), the patient will worsen Onset is restless, cold hands and feet, rapid pulse, blood pressure changes with a pulse pressure narrow as or less than 20 mm Hg (usually 30-40 mm. Mercury) Most patients who are shocked are aware, conscious, can speak, and may complain thirsty. Some people may have a sudden stomachache before entering shock. Which sometimes may make a wrong diagnosis as a surgical condition The shock that occurs will change dramatically. If not treated, the patient will worsen around the mouth, green skin, purple skin, cold, pulse and cannot measure the profound shock. And will die within 12-24 hours after the onset of shock If the patient receives shock treatment immediately and correctly before going into the profound shock phase, most will recover quickly. In mild cases When the fever subsides, the patient may have slightly cold hands and feet together with changes of Pulse and blood pressure As a result of changes in the circulatory system Due to the leakage of the plasma but not so much that it causes shock
There is currently no specific antiviral drug for dengue fever. Treatment for this disease is symptomatic and supportive. Which is effective if the disease is diagnosed at an early stage The treating physician must understand the nature of the disease and provide close care for the patient. There must be good nursing care throughout the critical period, approximately 24-48 hours with plasma leakage.
Care for patients
with high fever may have seizures if the fever is very high. Especially children with a history of seizures Or in children younger than 6 months, it is necessary to give antipyretic drugs. Should use paracetamol drugs Do not use aspirin. Because it will cause platelets to lose function Will irritate the stomach, causing bleeding easier And most importantly, may cause Reye syndrome. Periodic medication should be given only when the fever is high. (In order to have a very high fever reduced to less than 39 degrees Celsius), over-use of antipyretics can lead to liver toxicity. Should be used to wipe the fever.
Allow patients to compensate for water Because most patients have high fever, anorexia and vomiting, resulting in dehydration and sodium salt. Should give the patient to drink fruit juice or The solution of mineral sugar (ORS) in vomiting should be drunk in small amounts and frequently.
Must closely monitor patient symptoms In order to be able to detect and prevent shock in time Shock usually occurs with fever reduced approximately from the 3rd day of illness onwards. Depending on the duration of the fever, if the fever is 7 days, it may shock on the 8th. Parents should be advised to know the symptoms of shock. Which may have more anorexia Do not eat or drink water at all Or have less urination Have sudden stomach pain Restlessness, cold hands and feet should be recommended to the hospital immediately with these symptoms.
When patients go to the hospital or hospital that provides treatment The doctor will check the blood for platelets and hematocrit and may make an appointment to check the changes of platelets and hematocrit periodically, because if the platelets begin to decrease and the hematocrit starts to rise, it is a sign that blood is leaking from the veins. And may be shocked Need to compensate the substance
Generally, it is not necessary to get all patients admitted to the hospital. Especially in the early stages of fever Can be treated as an outpatient By giving medicine to take And advise parents to observe the symptoms according to item 3 or make an appointment for a doctor to visit the hospital periodically By examining the changes according to item 4. If the patient shows signs of shock Must be admitted to every hospital And is considered an urgent matter for treatment
- The best prevention of dengue fever is Be careful not to be bitten by a mosquito.
- Eliminate or reduce breeding places of Aedes mosquitoes.
- Vaccinated against dengue fever
Therefore, the vaccine against dengue fever Therefore it is one thing that is necessary to prevent the said disease. With answers to know
1. What is the cause of dengue fever in Thailand? – Dengue fever in Thailand is caused by all 4 strains of Dengue virus which are DENV-1, DENV-2, DENV-3, DENV-4.
2. In Thailand, the most common type of dengue fever is found – dengue fever can be found in every age group. In Thailand, found that 80 percent Of infected people who have symptoms Belonging to the age group between 5-34 years
. How is severe dengue?
3. Severe dengue has the following symptoms
- Vomiting never stops
- Severe stomachache (Due to abnormal water retention)
- Rapid breathing due to fluid retention in the pleura
- low blood pressure Restless or very depressed
- Bleeding in various organs, severe scurvy Vomiting blood Blood transfusion
- Impaired internal organs function, such as the liver, kidneys
- There are disorders in the brain.
- Shocked and may die
4. Do you currently have a vaccine to prevent dengue fever? – Currently, there is only one type of dengue vaccine that has been approved for use as a CYD-TDV or DENGVAXIA vaccine. Under research trial
5. What is CYD-TDV or Denvaxia? – CYD-TDV or DENGVAXIA is the first dengue vaccine that has been approved. Which was first certified in Mexico in December last year To be used in people aged 9-45 years old in dengue hemorrhagic fever outbreak Is a life-threatening vaccine. There is a dengue virus that is the cause of all 4 strains. It is prescribed to be injected 3 times. 0-6-12 months is currently approved for use in 13 countries including Thailand.
6. Who should be vaccinated – everyone aged 9-45 years and in areas with dengue fever outbreaks. And is a person who has no contraindications The contraindications prescribed by the vaccine manufacturer are as follows:
- People with a history of severe allergic reactions in one of the components in a vaccine Or have an allergic reaction to this vaccine that was first received Or allergic to other vaccines that have the same components
- Congenital immune deficiency Or occur later, such as genetic disorders, HIV (AIDS), or receiving immunosuppressants (such as high-dose steroid drugs or chemotherapy)
- Women who are pregnant or currently breastfeeding
- People with moderate to high fever Or having an acute illness Should postpone the vaccination until healed
7. If I am not in the 9-45 year old group, can I vaccinate? – I don’t deserve it. Because the available clinical data is not enough
8. Efficiency of the vaccine – DENGVAXIA vaccine is effective in protecting against all 4 strains of the virus, can prevent dengue fever by 65.6%, reduce the severity of the disease 93.2%, reduce the hospital stay rate 80.8%
9. Recommendations for pregnant women – since this vaccine is live-attenuated. vaccine), like general vaccines Therefore do not use in women who are pregnant or breastfeeding And suggest that Women who are vaccinated should be at least 1 month before pregnancy.
10. If the patient has been exposed to the dengue virus before Whether there is only mild fever or serious illness Can patients be vaccinated again? – DENGVAXIA vaccine can be used to prevent dengue fever virus from both strains 1, 2, 3, and 4 in people aged 9-45 years in the epidemic area. Whether or not the dengue virus has been infected before The effectiveness of the vaccine injected to people who have been exposed to the dengue virus before is higher and can help prevent other types of dengue virus as well.
11. Have any diseases such as kidney disease, heart disease, diabetes can be vaccinated or not – injection is up to the doctor’s discretion.
12. Vaccination against dengue fever How many dengue fever can be prevented? – DENGVAXIA is a vaccine used to prevent dengue hemorrhagic fever caused by dengue virus type 1, 2, 3 and 4.It can be used in children aged 9 – 45 years. Living in an area with an outbreak
13. How to get vaccinated against dengue fever – DENGVAXIA vaccination under the skin. (subcutaneous injection) Vaccination 3 times 0.5 ml each time, injected 6 months apart at the beginning of the first injection as the first dose. The second needle will inject after the first needle for 6 months and the third needle to inject after the second needle for 6 months.
14. Safety of vaccines Potential side effects – Adverse reactions that may occur after vaccination similar to other vaccines such as pain at the injection site. Muscle pain, headache, low fever, red skin, hematoma, swelling and itching, all symptoms are mild. Most occur within 3 days after vaccination.
15. When will the immune system occur ? – The immune system will be fully formed after the vaccination.
16. Will the injection be able to prevent dengue fever for life? – Until now, after 3 injections, in accordance with theoretical principles of immunity should remain for a long time. Must be followed up to see whether it can be covered for life or not.
17. Vicin injection in children and adults Different or not – not different In the age range between 9 – 45 years old
18. Injection No. 2 or 3, if not injected on the scheduled date. Can be injected or not Or have to start counting as the 1st needle – no need to start again Can add, subtract 20 days
19. Can it be injected together with other vaccines on the same day? – No studies have been conducted. For safety reasons, it should be 4 weeks away from other vaccines.
20. Before and after receiving the vaccine What should be done – before receiving the vaccine must not have fever. And after the vaccination is to stimulate the body to develop its own immunity with weak pathogens or parts of the pathogen have the ability to stimulate immunity. Therefore, after receiving the vaccine, some side effects may occur. This is because the body reacts to vaccines which generally do not have many symptoms. And will disappear by itself.