2024 is not over yet and the number of confirmed cases of dengue in Coahuila has already exceeded the previous two years. So far this year, the State Health Secretariat has reported 914 infections compared to 151 registered in 2023 and 572 reported in 2022.
According to the World Health Organization (WHO), the incidence of dengue has increased worldwide in recent decades, representing today the greatest public health problem, since, according to reported data, there are between 50 and 100 million infections per year and thousands of deaths in more than 100 countries with some 2.5 billion people at risk (more than 40% of the world’s population).
The National Committee for Epidemiological Surveillance (Conave) explains that dengue has a seasonal behavior, that is, in the Southern Hemisphere the majority of cases occur during the first half of the year, while in the Northern Hemisphere, cases occur mostly in the second half of the year, this behavior corresponds to the warmest and rainiest months in tropical and subtropical regions of the world.
In Mexico, Dengue is the main vector-borne disease (VBD) and all probable cases must be reported to the Vector-borne Diseases Platform of the National Epidemiological Surveillance System (Sinave).
In an epidemiological notice dated May 20, 2024, Conave detailed that Dengue viruses (DENV) belong to the Flaviviridae family, are composed of positive-stranded single-stranded RNA; are transmitted by the bite of the female mosquito of the Aedes species (Ae. aegypti y Ae. albopictus), which in turn becomes infected after biting a person infected with DENV. There are four known serotypes of DENV that are antigenically distinct and have a nucleotide variability of approximately 30%.
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Incubation period and phases
After the mosquito bite, The typical period ranges from 5 to 7 days after infection (with a range of 3 to 14 days). As regards the clinical picture, it begins after the incubation period. The disease begins and can be completed in 3 phases:
The Febrile phase which is characterized by temperature greater than 38°C which is usually accompanied by headache, vomiting, myalgia, arthralgia and sometimes a transient macular or maculopapular rash. This phase lasts approximately 3 to 7 days, after which the patient can recover without complications.
Warning signs: They may occur in the latter part of the febrile phase; they include persistent vomiting, severe abdominal pain, ascites, capillary hemorrhage, dyspnea, lethargy, restlessness, postural hypotension, hepatomegaly, and a progressive increase in hematocrit.
Critical phase: It may appear at the end of the fever and generally lasts 24 to 48 hours. Most patients improve during this phase; however, those with severe plasma extravasation may present within a few hours with pleural effusions, ascites, hypoproteinemia, or hemoconcentration, as well as early signs of hypotension that rapidly progress to shock and severe hemorrhagic manifestations such as hematemesis, melena, and/or menorrhagia. Vascular patency is reestablished within 48 to 72 hours.
Convalescence phase: It is characterized by low extravasation and the beginning of reabsorption of extravasated intravenous fluids (pleural and abdominal effusions); with a clear hemodynamic improvement and diuresis.
As part of laboratory surveillance, a blood sample is taken in the acute phase (0-5 days) and there are acceptance and rejection criteria. It is important to clarify that there is no specific treatment for dengue, but early detection and access to adequate medical care greatly reduce the fatality rates of severe dengue.
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Operational definition
Probable case of DNG: Any person of any age who resides or comes, in the 14 days prior to the onset of signs and symptoms, from a region where there is transmission of the disease and who has fever and 2 or more signs and symptoms from the following groups:
– Group 1: nausea and/or vomiting
– Group 2: exanthema
– Group 3: myalgias and/or arthralgias
– Group 4: headache and/or retro-ocular pain
– Group 5: petechiae and/or positive tourniquet test
– Group 6: leukopenia
Conave explains that, in children under 5 years of age, the only sign to consider is fever.
DCSA Probable Case: Any probable case of GND that presents one or more of the following warning signs: intense and continuous abdominal pain; persistent or uncontrollable vomiting; fluid accumulation (ascites, pleural effusion, pericardial effusion); mucosal bleeding (epistaxis, gingivorrhagia); lethargy or irritability; postural hypotension; hepatomegaly greater than 2 cm; progressive increase in hematocrit; progressive decrease in hemoglobin and platelet count less than 100,000 platelets per microliter or progressive decrease in platelets. If an alarm sign is identified at the first level, the patient must be immediately sent to the second level for care.
DG Probable Case: Any probable case of Dengue that presents one or more of the following data: Shock due to severe plasma extravasation evidenced by: tachycardia, cold extremities and capillary refill equal to or greater than three seconds, weak or undetectable pulse, convergent differential pressure of ≤20 mm, late-phase arterial hypotension, fluid accumulation leading to respiratory failure.
As well as severe bleeding, according to the evaluation of the treating physician (examples: hematemesis, melena, voluminous metrorrhagia, bleeding from the central nervous system).
Likewise, serious organ involvement should be considered, such as: significant liver damage (AST or ALT >1000), kidney disease, central nervous system (altered consciousness), heart (myocarditis) or other organs. In all cases of dengue with warning signs and severe dengue, a serum sample should be taken for laboratory diagnosis at the first contact with health care services.
Confirmatory laboratory diagnosis is carried out at the Institute of Epidemiological Diagnosis and Reference (InDRE) and in the laboratories of the National Network of Public Health Laboratories (RNLSP) verified and trained by InDRE for diagnosis.
Recommendations for the population
Federal health authorities recommend that the population seek immediate medical attention if signs and symptoms appear, especially if they are pregnant, children under 5 years of age, and/or people with comorbidities.
It is necessary not to self-medicate, not to sleep outdoors and to stay inside homes at dusk and dawn, to wear long-sleeved clothing and long pants, to apply insect repellent authorized for use on humans in the country and to use mosquito nets on doors and windows.
Also use a canopy when sleeping (greater protection is obtained if it is impregnated with insecticide) and eliminate or manage (wash, cover and turn over) containers that accumulate water and that can become breeding grounds for vectors in their homes. The epidemiological notice is public and is available on the official website of the federal Ministry of Health.
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2024-09-13 04:32:59