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Dengue Warning Signs: When to See a Doctor Right Away

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Dengue is a viral illness spread by mosquito bites. Many people recover in about a week, but some become seriously ill, sometimes just when they seem to be getting better. Knowing the dengue warning signs helps people get checked and monitored in time. This article is based on guidance from Vietnam's Ministry of Health (Bộ Y tế), WHO and CDC.

How does dengue spread?

According to the Ministry of Health's guideline on diagnosing and treating dengue, the virus passes from a sick person to a healthy person through mosquito bites, mainly by the Aedes aegypti mosquito. WHO notes that Aedes albopictus can also spread it.

A person with dengue can pass the virus to mosquitoes from about 2 days before symptoms start until 2 days after the fever ends (WHO). You can get dengue more than once, and WHO notes that people infected a second time are at greater risk of severe dengue.

Common symptoms

WHO says that when symptoms occur, they usually begin 4 to 10 days after infection and last 2 to 7 days. The Ministry of Health guideline describes the fever phase with these signs:

  • Sudden, continuous high fever.
  • Headache, loss of appetite, nausea.
  • Flushed skin.
  • Muscle and joint pain, pain behind the eyes.
  • Sometimes small red spots under the skin, bleeding gums or nosebleeds.

WHO also lists vomiting, swollen glands and rash. Most people have mild or no symptoms and recover in 1 to 2 weeks.

Why the time after the fever drops still matters

The Ministry of Health describes three phases:

  1. Fever phase: sudden high fever and the symptoms above.
  2. Critical phase: usually days 3 to 7 of the illness. The person may still have a fever or the fever may have come down. Plasma leakage (fluid leaking out of the blood vessels, usually lasting 24 to 48 hours) can happen now. If the leakage is large, it can lead to shock.
  3. Recovery phase: usually days 7 to 10. The fever is gone, the person feels better, regains appetite and passes more urine.

WHO says severe symptoms often come after the fever has gone away. CDC also notes that warning signs usually begin in the 24 to 48 hours after the fever has gone. So a fever that has gone does not always mean the illness is over. These are the days to watch most closely.

Warning signs: get medical care now

Under the Ministry of Health guideline, a person being cared for at home should come back to be seen immediately if they have any of these signs:

  • Feeling worse even though the fever has dropped or gone.
  • Unable to eat or drink.
  • Vomiting a lot.
  • Severe abdominal pain.
  • Cold, clammy hands and feet.
  • Extreme tiredness or restlessness.
  • Bleeding from the nose or mouth, or vaginal bleeding.
  • No urine for more than 6 hours.
  • Changes in behaviour, such as confusion, irritability, agitation or unusual drowsiness.

WHO adds: persistent vomiting, rapid breathing, blood in vomit or stool, being very thirsty, pale and cold skin, and feeling weak. CDC stresses that severe dengue is a medical emergency.

If you see these signs, take the person to the nearest health facility straight away. If they are very drowsy, hard to wake, have cold hands and feet, or cannot walk on their own, call 115.

Who may need hospital care earlier?

For people without warning signs, the Ministry of Health guideline asks doctors to consider hospital admission for anyone who:

  • Lives alone.
  • Lives far from a health facility and could not get to hospital in time if they got worse.
  • Has no family member able to watch them closely.
  • Is an infant.
  • Is overweight or obese.
  • Is pregnant.
  • Is aged 60 or over.
  • Has a long-term condition such as kidney, heart or liver disease, asthma or diabetes.

If someone in your family is in one of these groups, tell the doctor clearly.

Home care, as your doctor advises

The Ministry of Health advises going to a health facility as soon as you have a fever, to be examined and advised, and not treating yourself at home. If the doctor says you can be cared for at home:

  • Rest: stay in bed and avoid moving around a lot (Ministry of Health; CDC).
  • Drink plenty of fluids: oral rehydration solution (oresol) or fruit juice (Ministry of Health). CDC suggests water or drinks with added electrolytes.
  • Bring the fever down safely: use only single-ingredient paracetamol, as a doctor or pharmacist advises. For a high fever, loosen clothing and sponge with lukewarm water. Do not use ice water (Ministry of Health).
  • Do not take aspirin, ibuprofen or analgin (metamizole): the Ministry of Health says these can cause bleeding and acidosis. WHO notes that aspirin and ibuprofen increase the risk of bleeding.
  • Avoid brown or red food and drinks, such as sarsaparilla soda or chocolate (Ministry of Health).
  • Go to follow-up visits as scheduled. For children, the Ministry of Health guideline says to return for a check every day.
  • Protect the sick person from mosquito bites: CDC says the virus is in the blood during the first week of illness and can pass to mosquitoes. Let the person sleep under a mosquito net, including during the day.

Preventing dengue at home

A weekly checklist, based on Ministry of Health and WHO advice:

  • Cover every water container tightly so mosquitoes cannot lay eggs.
  • Kill larvae: put fish in large water containers, scrub medium and small containers, turn over containers that are not in use, and change the water in flower vases.
  • Remove anything around the house that holds water: bottles, jars, broken glass, coconut shells, broken jar pieces, old tyres, bamboo stumps, leaf sheaths.
  • Sleep under a mosquito net and wear long clothing, even during the day.
  • Use repellents containing DEET, picaridin or IR3535, and screens on windows (WHO).
  • Cooperate with local health workers during disease-control activities.

WHO says one vaccine is licensed in some countries and is recommended for children aged 6 to 16 in places with high transmission. Ask your doctor or a vaccination centre if you want to know more.

Clinics can share this article with patients and their families during dengue season.

Sources

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