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Table of Contents
Dengue fever was initially considered to be a rare disease with a small prevalence rate in the world population. Being mosquito-borne, it is particularly widespread in the tropical areas where mosquitoes are a major problem. In the recent times, the global statistics indicated over 400 million dengue infections each year, although less than 100 million culminate in dengue hemorrhagic fever (Centers for Disease Control and Infection, 2016). Even though most people are able to fight the infection before it turns into a full blown fever, those who yield to the virus end up with painful and debilitating symptoms reminding influenza, except that they are often worse. Such include high fever, headache, muscle and joint aches, pain inside or behind the eyes, nausea, and vomiting, mild rash as well as mild bleeding in severe cases.
Dengue fever could just as easily develop into dengue hemorrhagic fever, especially when a patient has a weakened immune system or the level of infection is simply too high for their body. The Dengue is currently a major threat because, at the beginning, it mostly affected people who had traveled to the tropical regions, but, currently, frequent outbreaks are observed along the Mexican border in Texas, thus implying some significant changes in the underlying assumptions on the disease. Consequently, in this paper, the subject of research is Dengue fever. The analysis covers the history of Dengue fever, Epidemiological data, and ways of how it can be prevented according to the CDC strategies.
History
The first records of the Dengue fever can be traced back to China during the Jin dynasty (265-450 AD). At the time, the only known information cited the condition as ‘water poison’ and it was simply associated with ‘flying insects’ as recorded in the Chinese medical encyclopedia. In the late 1700s, a case of Dengue virus was reported in many instances across Asia, Africa and North America (Gubler, Ooi, Vasudevan & Farrar, 2014). Back then it was termed as the ‘breakbone’ fever due to the symptoms of joint and muscle aches along with severe fatigue. In addition, victims of the disease could barely walk.
The accurate reality about it was uncovered and publicized in the 20th century, when mosquitoes were found as the culprits responsible for spreading the infection (Gubler et al., 2014). During the Second World War, the Dengue fever spread widely and many people from various parts of the world were infected. This is because they were moving from one place to another and often faced the exposure to the mosquitoes. In most cases the living conditions did not allow for the people to protect themselves from mosquitoes to the necessary extent. The growing prevalence of the Dengue fever during the Second World War thus brought the disease to the mainstream and it became known for its dangers. Presently, more than 40% of the world population is known to live within an area that has a high risk for the fever based on its epidemiology (CDC, 2016).
Before 1970, only about 9 countries had experienced the Dengue fever outbreak. This, however, changed swiftly with the current spreading around about 128 countries across the globe, including the Americas, the Pacific islands, the Caribbean, Africa, Asia, and India among others. In 2008, more than 1.2 million cases of the fever were reported, with 2.4 million in 2010, and 3 million in 2013 only from the WHO (World Health Organization) database across three regions (CDC, 2016). In 2009, the Key West area of the US witnessed an outbreak of Dengue fever as well (CDC, 2016).
Epidemiological Data
Dengue fever has been reported in over 128 countries up to date. This means that the incidents are spread out across the globe (Gubler et al., 2014). The estimated infections on an annual basis are up to 500 million with more than 20,000 deaths each year. Only about half a million of Dengue fever patients get hospitalized considering that most people are able to get over the infection with no major effects. It is transmitted by the Aedes mosquito, which acts as a vector carrying the virus until it is ready to be transmitted to another human being. At this point, it should be noted that there are four different variations of the dengue virus named as DEN-1, DEN-2, DEN-3 and DEN-4 (Gubler et al., 2014). If a person contracts DEN-1 and they survive it, they acquire an automatic immunity against future infections. It, however, does not protect them from the other serotypes of the disease, but rather increases their chances of catching the more deathly hemorrhagic version of the fever. Moreover, its fatality rate is at 1-5%, with higher levels for individuals with low blood pressure (CDC, 2016).
Patterns
Initially, the disease was presumed to be only prevalent in the tropical regions of the world. For one reason or another, cases of the dengue fever have been reported in places located far from the tropics, as in Florida, USA. Furthermore, the most definitive pattern associated with the disease is in relation to how fast it spreads. Infected patients may take up to ten days after contamination to exhibit any symptoms, even though they can transmit the virus to other mosquitoes from as early as the fourth day after they get bitten. In other words, the disease can start spreading well before the infected patient knows their condition. So far, the epidemics start out with very few patients and after some time, the number of accidents starts rising exponentially. The more there are contagious people, the more there are mosquitoes carrying the virus, as a consequence, the more others around the same area are likely to get infected.
Causes
The Dengue fever epidemic in Southeast Asia soon after the Second World War was attributed to the changing ecosystem as a result of the rampant urbanization of the region. Since more people were moving into the cities from all over the continent, the poor living conditions prevailed. Hence, with the considerably widespread exposure to mosquitoes, being infected with Dengue became more like a usual thing. Almost everyone in the region was at a direct risk from the virus. Furthermore, the postwar outbreak was mainly attributed to the movement of soldiers as well. Some were returning from the tropical regions being already bitten by infected mosquitoes, and, once at home, they also transmitted it to other mosquitoes that ended up infecting more people. This means that while the virus is not directly contagious, one infected person is enough to start an epidemic, provided they are exposed to the Aedes mosquito.
Effects
The known symptoms of the Dengue fever include many influenza symptoms along with the mild bleeding, severe nausea, and vomiting. Some more serious incidents may also be followed by severe abdominal discomfort. A case of virus often raises fear and panic considering how fast the disease can spread and how bad it can get especially for people who have been exposed to a different serotype of the virus. Other than the growing panic, the cost of treating the condition and trying to prevent an outbreak are also elevated. According to Centers for Disease Control and Infection (2016), there are less than 30,000 deaths annually resulting from this condition. Yet the number is too high considering that the disease can be controlled and defeated even without a definitive prevention or treatment regimen (Adelman, 2015).
Application of the Levels of Prevention According to the CDC and Healthy People 2020 Goals
There are three levels of averting the dengue fever. The primary prevention entails eliminating the breeding grounds as a way of controlling the vectors. The secondary step focuses on monitoring and effective responding to potential epidemics. The third level is about dealing with the advanced cases that have fatal complications. The application of each of these stages has to be reviewed from a wide perspective since the Dengue is a global problem that may have originated from the tropical regions, but is now a threat to over 40% of the world population (Adelman, 2015).
Primary Prevention
It is a rather basic step that involves approaching the transmitting vector itself. Mosquitoes are very common and the best way to deal with them is to eliminate their breeding ground. Stagnant water, bushes, and excessively long grass, as well as damp and dark rooms, all promote their growth and existence, especially around residential areas (Adelman, 2015). To contribute towards the prevention of the disease, it is important for the people together with health care industry to exclude every opportunity for the vector’s breeding. People simply have to be informed and advised about the significance of eliminating all the breeding grounds around their immediate surroundings at home, at school, and at work.
Secondary Prevention
This involves monitoring infections and working towards responding effectively to any epidemics. In order to practice secondary prevention, it is important to participate in the gathering of information about the Dengue. Considering that a large number of people get infected with the fever and these victims do not even show severe symptoms, it is important to report any cases that are suspected to be connected with the issue. The patients may not be sick, but if they are infected, they could spread the virus. Information, in this case, is critical for preparing for and preventing an epidemic within a specific area.
Tertiary Prevention
It must be noted that there are currently no vaccines or treatment regimens for Dengue fever and most of the health care efforts for a patient are directed towards dealing with the symptoms to prevent death. Hence, the third level of prevention presupposes learning as much as possible about how to deal with the disease once a patient in a bad condition is brought in. All in all, even though the Dengue fever is a viral challenge that is rather difficult to address effectively, by keeping abreast with the research on the subject, a nurse should be able to do their best to prevent fatalities amongst their patients.
Conclusion
Dengue fever is a dangerous disease that claims close to 30,000 lives annually with hundreds of millions of those who are infected. From a reductionist perspective, one may appreciate the relatively low mortality rate based on the prevalence rate of the virus. However, the number is too high considering that the disease could be prevented through disposing of the vector issue. The exposure to the Aedes mosquitoes needs to be significantly reduced so that people no longer get bitten and infected by the Dengue serotype that causes the fever. In order to effectively eliminate the problem, the world would have to work together, more now when the virus spreads to countries that are at large distances from the place of origin of the disease.
