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Dengue_Serotype

So we have Dengue Fever in the Keys.  

First records for Dengue in the states do date back to 1948, but they are vague and based on physical exam, not serology (blood test).  In the 1980’s CDC and Department of Health did a much better job monitoring Dengue as a world-wide phenomenon. 

The first week in February, we had our first case this year next door to Mrs. Mac’s restaurant (the old one, bayside). He was an isolated case and made a full recovery.

In June, we started to see more, from Harry Harris Park to mile marker 106.  I total of 12 cases to date, with possibly 4 more.

Much of the literature skirts around the long term sequel of Dengue.  I have the references from the below articles if you want, just ask.

Dengue Fever has four serotypes are classified as; 

  • DENV-1; DENV-2; DENV-3; DENV-4.
  • The bad one is DENV-2. 
  • Currently we have DENV-1 in Florida.

Bottom line.  

Signs and Symptoms

  • Low grade fever (99-100.8)
  • Diffuse aches and pains
  • Rash that starts in feet and lower legs. Can involve hands
    • Looks like red dots with a viral exanthema. 
  • Abnormal blood work within the first 10 days
    • Low WBC (normal 4-9K with this 1-2K)
    • Low Platelets (normal 150-350 with this 30-60)
    • At times elevated hepatic enzymes (more rare)
  • Most dengue virus infections produce mild, nonspecific symptoms or classic dengue fever (DF). 
  • Severe dengue, dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS), occurs in less than 1 percent of all dengue virus infections
    • Risk Factors for DSS:  Age, Nutritional status, genetics, and PREVIOUS INFECTION 
  • Yes it mimics COVID, except the abnormal lab work

If infected by Dengue Fever

  • You actually have a relative immunity from that type of Dengue fever for 1-2 years; i.e., if you get DENV-4 you are immune to that one for a couple of years but not the others
  • If you get any of the other serotypes after infected by one, particularly DENV-2; you will get much sicker than normally with a higher potential of death.

If infected by Serotype DENV-1:

  • You have an immunity to DENV-1 from 6 years to life. 
  • You should not travel anywhere that is endemic to DENV-2 strain (see map below).  
  • After six years, you can travel anywhere you want.
    • This is based on what I could find in the literature.  
    • Unlike DENV 2,3,4; after 6 years you may not get that life threatening reaction that is associated with re-infection or termed secondary infection.

Interesting Facts.  

Primary vs Secondary infection.  

  • A primary infection is the first time you get Dengue in your lifetime.  Secondary is when you get it again.  Secondary is the one that kills.
  • You can get a secondary infection of Dengue with type 2, 3, or 4.  Type 2 carries some increased risk inherent to the strain, and technically does not carry additional risk to you; however this is where the literature gets wonky. 
  • There is little information from human studies to allow comparisons of virus distribution or titer in primary and secondary infections
    • It does have to do with each individuals T-cell response or hyper-response and the related inflammatory markers.

I can find many cohort studies written from Australia, Asia, and Central America, printed in the infectious disease literature which clearly state that there is an increased risk of developing severe disease if DENV-2 is your secondary illness with HIGHER chance of complications because you have a primary infection. 

It is NOT supported by cross-sectional statistical reports. However, it concerned me enough to recommend not going to areas that have known DENV-2 strains.  The last page offers a link of where to not go.  After 6 years the risk normalizes and you can travel anywhere. 

Link to the map of Dengue Fever

Where DENV-2 is now.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946041/

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