Merck Manual

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Thomas M. Yuill

, PhD, University of Wisconsin-Madison

Reviewed/Revised Jun 2023
Topic Resources
  • About 50 to 100 million cases of dengue and about 20,000 deaths occur worldwide.

  • Symptoms vary in severity but may include fever, chills, a severe headache, pain when the eyes are moved, extreme fatigue, and severe generalized body aches.

  • A more severe form, called dengue hemorrhagic fever, may cause bleeding from the nose, mouth, gastrointestinal tract, and puncture wounds.

  • To diagnose dengue, doctors do blood tests to check for the virus or antibodies to the virus.

  • Treatment of dengue focuses on relieving symptoms and, for dengue hemorrhagic fever, fluids and blood products given intravenously.

Dengue is common in the tropics and subtropics worldwide. It is most common in Southeast Asia but has become more common in Central and South America and other countries. It has occurred in the Caribbean (including Puerto Rico and the U.S. Virgin Islands), in Oceania, and in the Indian subcontinent. Dengue-endemic areas include the United States territories of American Samoa, Puerto Rico, and the U.S. Virgin Islands, and freely associated states, including the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau. The infection is caused by a flavivirus that is spread by mosquitoes.

Many factors have contributed to the spread of dengue:

Each year, about 50 to 100 million cases and about 20,000 deaths occur worldwide. However, in the United States, only about 100 to 200 cases occur yearly, nearly all brought in by travelers returning from affected areas. If these travelers live in an area of the United States with Aedes mosquitoes, the mosquitoes may bite them, then bite other people living in the area. The dengue virus is thus spread to other people (called local transmission). Individual infected mosquitoes may bite more than one person, putting multiple people at risk of infection. A few cases of locally transmitted dengue have occurred in Hawaii, Florida, and Texas.

Although uncommon, a pregnant woman can pass the dengue virus to her fetus during pregnancy or around the time of birth (see World Health Organization [WHO]: Dengue and severe dengue). There has been one report of dengue virus passing through breast milk.

There are four types of dengue virus (serotypes). Infection with one of the serotypes protects against infection with that serotype for a long time but provides only limited and temporary protection against infection with the other serotypes.

Symptoms of Dengue

Symptoms of dengue typically begin about 3 to 15 days after being bitten by an infected mosquito.

Dengue varies in severity. Dengue usually begins suddenly, causing a fever, chills, a severe headache, pain when the eyes are moved, extreme fatigue, and severe generalized body aches, particularly in the back, legs, and joints. These aches are often so painful that the disease has been called breakbone fever.

Lymph nodes are swollen, and a rash that makes the face look flushed and red may appear briefly.

Symptoms last for 2 or 3 days, then subside. People usually feel well for about 24 hours. Then, the fever may return, and a blotchy red rash may appear first on the back of the hands and top of the feet, then spread to the arms, legs, and torso.

People with more severe disease may feel weak for several weeks. Death is rare.

Dengue hemorrhagic fever

Dengue hemorrhagic fever is a more severe form of dengue. This disorder occurs mainly in children who are under 10 years old and who live in areas where dengue is common. Dengue hemorrhagic fever can result from a second infection with a dengue virus. The person's immune system Overview of the Immune System The immune system is designed to defend the body against foreign or dangerous invaders. Such invaders include Microorganisms (commonly called germs, such as bacteria, viruses, and fungi) Parasites... read more reacts aggressively to the second infection. This reaction damages blood vessels, which then leak fluid and/or blood. Sometimes blood vessels leak fluid into the lungs, causing difficulty breathing.

Bleeding from the nose, mouth, gastrointestinal tract, and puncture wounds may occur. People may vomit blood or have blood in their stool. Bleeding may occur under the skin as purplish spots or patches.

Without treatment, illness can worsen rapidly, and blood pressure may become very low, resulting in shock Shock Shock is a life-threatening condition in which blood flow to the organs is low, decreasing delivery of oxygen and thus causing organ damage and sometimes death. Blood pressure is usually low... read more . When treated by experienced doctors, dengue hemorrhagic fever is fatal in less than 1% of people. However, without such care, as many as 30% of people die.

Diagnosis of Dengue

  • Blood tests

Doctors suspect dengue fever when typical symptoms occur in people who live or have traveled in an area where the infection is common.

It is usually diagnosed by blood tests for antibodies to the virus. (Antibodies Antibodies One of the body's lines of defense ( immune system) involves white blood cells (leukocytes) that travel through the bloodstream and into tissues, searching for and attacking microorganisms and... read more Antibodies are proteins produced by the immune system to help defend the body against a particular attacker, such as the dengue virus.)

Treatment of Dengue

  • Pain relievers

  • For dengue hemorrhagic fever, fluids

There are no effective antiviral medications for dengue. Treatment focuses on relieving symptoms. Acetaminophen can be used to lower the fever and relieve muscle aches. But aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) should not be used because they may make bleeding more likely. Also, aspirin is not given to children because it increases the risk of Reye syndrome Reye Syndrome Reye syndrome is a very rare but life-threatening disorder that causes inflammation and swelling of the brain and impairment and loss of function of the liver. The cause of Reye syndrome is... read more .

For dengue hemorrhagic fever, people are given fluids intravenously to increase and maintain blood pressure and thus prevent shock.

Prevention of Dengue

People who live in areas where dengue is common should try to prevent mosquito bites.

To prevent mosquito bites, people should take the following precautions:

  • Wear long-sleeved shirts and long pants.

  • Stay in places that have air conditioning or that use window and door screens to keep mosquitoes out.

  • Sleep under a mosquito net in places that are not adequately screened or air-conditioned.

  • Use strong insect repellents—those with ingredients such as DEET (diethyltoluamide) or other approved active ingredients—on exposed skin surfaces.

  • Treat clothing and gear with permethrin insecticide (do not apply it directly to the skin).

People who have dengue are kept under mosquito netting until the second bout of fever resolves. This measure helps prevent further spread of the infection by mosquitoes.

For children, the following precautions are recommended:

  • Do not use insect repellent on infants under 2 months old.

  • Do not use products containing oil of lemon eucalyptus (para-menthane-diol) on children under 3 years old.

  • For older children, adults should spray repellent on their own hands and then apply it to the children's skin.

  • Dress children in clothing that covers their arms and legs, or cover the crib, stroller, or baby carrier with mosquito netting.

  • Do not apply insect repellent to the hands, eyes, mouth, or cut or irritated skin of children.

Dengue vaccine

In the United States, the dengue vaccine CYD-TDV is approved for use in children and adolescents 9 to 16 years of age who have laboratory-confirmed previous dengue virus infection and are living in an area where dengue is endemic. The vaccine is also available in Mexico, Brazil, Thailand, and some other countries.

Vaccinating people who previously had a mild case of dengue reduces their risk of developing the severe form of the disease (dengue hemorrhagic fever) if they are infected again. However, vaccinating people who never had dengue appears to increase their risk of more severe disease if they are infected with dengue later. Thus, doctors prefer to use the vaccine only in people who have previously had dengue. However, in many countries where dengue is common, it is not always possible for doctors to do a dengue blood test before they give the vaccine.

Another dengue vaccine (TAK-003) is being evaluated in the United States and is already approved for use in Indonesia, the European Union, and the United Kingdom. This vaccine can be used for individuals who have not had prior dengue infections as well as those who have. Several other dengue vaccines are under investigation.

Drugs Mentioned In This Article

Generic Name Select Brand Names
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Apra, Children's Acetaminophen, Children's Pain & Fever , Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
Anacin Adult Low Strength, Aspergum, Aspir-Low, Aspirtab , Aspir-Trin , Bayer Advanced Aspirin, Bayer Aspirin, Bayer Aspirin Extra Strength, Bayer Aspirin Plus, Bayer Aspirin Regimen, Bayer Children's Aspirin, Bayer Extra Strength, Bayer Extra Strength Plus, Bayer Genuine Aspirin, Bayer Low Dose Aspirin Regimen, Bayer Womens Aspirin , BeneHealth Aspirin, Bufferin, Bufferin Extra Strength, Bufferin Low Dose, DURLAZA, Easprin , Ecotrin, Ecotrin Low Strength, Genacote, Halfprin, MiniPrin, St. Joseph Adult Low Strength, St. Joseph Aspirin, VAZALORE, Zero Order Release Aspirin, ZORprin
Acticin, Elimite, Nix Lice Killing Creme Rinse
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