What are the management and prevention strategies for dengue fever in the Philippines?

Management and Prevention Strategies for Dengue Fever in the Philippines

The most effective management and prevention of dengue fever in the Philippines requires implementing early warning systems for outbreaks, enhanced vector surveillance, and following standardized clinical management protocols focusing on fluid management and monitoring for warning signs. 1, 2

Diagnosis and Assessment

• Key diagnostic criteria:

  • Fever plus one or more: nausea/vomiting, rash, headache, retro-orbital pain, myalgia/arthralgia, positive tourniquet test, leukopenia, or warning signs 2
  • Laboratory findings: thrombocytopenia, leukopenia, elevated hematocrit, elevated liver enzymes 2
  • Diagnostic tests: RT-PCR for dengue virus RNA, NS1 antigen detection (acute phase), IgM antibody detection or demonstration of fourfold rise/fall in IgG/IgM titers (convalescent phase) 2

• Warning signs requiring close monitoring:

  • Abdominal pain/tenderness
  • Persistent vomiting
  • Clinical fluid accumulation
  • Mucosal bleeding
  • Lethargy/restlessness
  • Liver enlargement
  • Increasing hematocrit with rapid decrease in platelet count 2

Clinical Management

Fluid Management (Critical Component)

• Initial resuscitation for shock: crystalloid fluid bolus of 20 ml/kg as rapidly as possible (may need to be repeated 2-3 times in profound shock) 2
• Maintenance fluid rate: 5-10 ml/kg/hour, adjusted according to clinical response 2
• Monitor vital signs every 15-30 minutes during rapid fluid administration 2
• Adjust fluid rates based on clinical response rather than using fixed protocols 2
• Consider early use of colloids in severe cases with significant plasma leakage 2

Warning Signs of Fluid Overload

• Increasing respiratory rate with normal/falling hematocrit
• New crackles on lung examination
• Rising JVP
• New onset hepatomegaly
• Peripheral edema 2

Medication Management

• Use acetaminophen for fever and pain relief
• Avoid aspirin and NSAIDs due to bleeding risk 2
• No specific antiviral therapy is recommended for routine use

Special Population Considerations

• Children:

  • Require closer monitoring
  • More susceptible to fluid overload
  • Initial fluid bolus of 20 mL/kg for dengue shock syndrome 2

• Pregnant women:

  • Higher risk of complications
  • Require more intensive surveillance 2

• Older adults:

  • Higher risk of developing severe dengue due to comorbidities
  • May require more aggressive management 2

Prevention Strategies for the Philippines

1. Early Warning Systems:

   • Develop and implement dengue early warning systems specifically designed for the Philippines 1
   • Integrate climate and meteorological factors with non-climate factors (socioeconomic variations, land use changes, urbanization) 1

2. Enhanced Surveillance:

   • Strengthen vector-borne disease monitoring and surveillance systems 1
   • Make human case data publicly available for research purposes 1
   • Synchronize efforts across national disease surveillance systems and meteorological departments 1

3. Vector Control Measures:

   • Environmental management and enhanced vector control 1
   • Focus on vulnerable communities 1
   • Implement integrated vector management (IVM) 1

4. Interdisciplinary Collaboration:

   • Enhance collaboration between climate studies and health services 1
   • Foster partnerships with local communities to integrate local knowledge 1
   • Promote collaboration between meteorologists, biologists, climate scientists, social scientists, and epidemiologists 1

5. Patient Protection:

   • Protect patients from further mosquito exposure to prevent transmission 2

Discharge Criteria

Patients can be discharged when they have:

• No fever for 48 hours without antipyretics
• Improving clinical status
• Increasing platelet count
• Stable hematocrit
• No respiratory distress
• Good urine output 2

Key Pitfalls to Avoid

1. Inadequate fluid management:

   • Insufficient fluid resuscitation in shock
   • Failure to adjust fluid rates based on clinical response
   • Overlooking signs of fluid overload

2. Delayed recognition of warning signs:

   • Missing early indicators of severe disease progression
   • Failure to monitor vital signs and hematocrit frequently enough

3. Inappropriate medication use:

   • Using NSAIDs or aspirin, increasing bleeding risk

4. Incomplete immunity awareness:

   • After an initial dengue infection, individuals are not fully immune as there are four distinct serotypes
   • Infection with one serotype provides lifelong immunity against that specific serotype but only temporary cross-immunity to others 2

5. Climate factors:

   • Failure to consider seasonal patterns in the Philippines, with peak incidence typically occurring towards the end of the rainy season 3, 4

The Philippines has experienced varying severity of dengue outbreaks, with studies showing that while hemorrhagic manifestations are common (89% in one study), progression to severe dengue hemorrhagic fever appears less frequent than in some other Southeast Asian countries 3.