View source for Dengue fever

{{Short description|Mosquito-borne disease}}
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{{Use dmy dates|date=August 2025}}
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{{Infobox medical condition (new)
| name            = Dengue fever
| image           = Denguerash.JPG
| alt             = Photograph of a person's back with the skin exhibiting the characteristic rash of dengue fever
| caption         = Typical rash seen in dengue fever
| pronounce       = {{IPAc-en|ˈ|d|ɛ|ŋ|ɡ|i|,_|-|ɡ|eɪ}}<ref>[https://www.merriam-webster.com/dictionary/dengue dengue] {{Webarchive|url=https://web.archive.org/web/20220717162940/https://www.merriam-webster.com/dictionary/dengue |date=17 July 2022 }} in the Merriam-Webster Dictionary</ref><ref name="lexico-definition">[https://web.archive.org/web/20210624095957/https://www.lexico.com/definition/dengue dengue] in Oxford Dictionaries</ref>
| field           = [[Infectious disease (medical specialty)|Infectious disease]]
| synonyms        = Dengue, breakbone fever<ref name="WHO-Dengue-2023"/><ref name="Kularatne-2015" />
| symptoms        = Fever, headache, muscle and joint pain, rash. Can be severe, mild or asymptomatic<ref name="WHO-Dengue-2023"/><ref name="Kularatne-2015" />
| complications   = [[Bleeding]], [[thrombocytopenia|low levels of blood platelets]], [[Shock (circulatory)|dangerously low blood pressure]]<ref name="Kularatne-2015" />
| onset           = 3–14 days after exposure<ref name="Kularatne-2015" />
| duration        = 2–7 days<ref name="WHO-Dengue-2023"/>
| causes          = [[Dengue virus]] by ''[[Aedes]]'' [[mosquito]]s<ref name="WHO-Dengue-2023"/>
| risks           =
| diagnosis       = Detecting [[antibodies]] to the virus or its [[RNA]]<ref name="Kularatne-2015" />
| differential    = [[Malaria]], [[yellow fever]], [[viral hepatitis]], [[leptospirosis]]<ref>{{cite book|title=Nelson Textbook of Pediatrics: The field of pediatrics|date=2016|publisher=Elsevier Health Sciences|isbn=978-1-4557-7566-8|page=1631|url=https://books.google.com/books?id=mseNCgAAQBAJ&pg=PA1631|url-status=live|archive-url=https://web.archive.org/web/20170910145008/https://books.google.com/books?id=mseNCgAAQBAJ&pg=PA1631|archive-date=10 September 2017}}</ref>
| prevention      = [[Dengue fever vaccine]], decreasing mosquito exposure<ref name="WHO-Dengue-2023"/><ref>{{cite news|author= East S|title=World's first dengue fever vaccine launched in the Philippines|url=https://edition.cnn.com/2016/04/06/health/dengue-fever-vaccine-philippines/|access-date=17 October 2016|publisher=CNN|date=6 April 2016|url-status=live|archive-url=https://web.archive.org/web/20161018224555/http://edition.cnn.com/2016/04/06/health/dengue-fever-vaccine-philippines/|archive-date=18 October 2016}}</ref>
| treatment       = [[Therapy#Supportive therapy|Supportive care]], [[intravenous fluids]], [[blood transfusion]]s<ref name="Kularatne-2015" />
| medication      =
| prognosis       =
| frequency       = 5 million per year (2023)<ref name="WHO-Global-Situation-2024" />
| deaths          = 5,000 per year (2023)<ref name="WHO-Global-Situation-2024" />
}}
[[File:En.MD.Video-Dengue fever.webm|thumb|Video summary]]
'''Dengue fever''' is a [[Mosquito-borne disease|mosquito-borne]] [[tropical disease|disease]] caused by [[dengue virus]], prevalent in [[Tropics|tropical]] and [[Subtropics|subtropical]] areas. Most cases of dengue fever are either [[asymptomatic]] or manifest mild symptoms.<ref>{{cite journal | last1=De Santis | first1=Olga | last2=Bouscaren | first2=Nicolas | last3=Flahault | first3=Antoine | title=Asymptomatic dengue infection rate: A systematic literature review | journal=Heliyon | volume=9 | issue=9 | date=2023 | pmid=37809992 | pmc=10559824 | doi=10.1016/j.heliyon.2023.e20069 | doi-access=free | article-number=e20069 | bibcode=2023Heliy...920069D | url=http://www.cell.com/article/S2405844023072778/pdf | access-date=2 April 2025}}</ref><ref name="WHO-Global-Situation-2024" /> Symptoms typically begin 3 to 14 days after infection. They may include a high [[fever]], [[headache]], [[vomiting]], [[Myalgia|muscle]] and [[Arthralgia|joint pains]], and a characteristic skin itching and [[skin rash]]. Recovery generally takes two to seven days. In a small proportion of cases, the disease develops into '''severe dengue''' (previously known as dengue hemorrhagic fever or dengue shock syndrome)<ref>{{cite journal | vauthors = Alejandria MM | title = Dengue haemorrhagic fever or dengue shock syndrome in children | journal = BMJ Clinical Evidence | volume = 2015 | page = 0917 | date = April 2015 | pmid = 25860404 | pmc = 4392842 }}</ref> with [[bleeding]], [[Thrombocytopenia|low levels of blood platelets]], [[blood plasma]] leakage, and [[Shock (circulatory)|dangerously low blood pressure]].<ref name="WHO-Dengue-2023">{{cite web |date=17 March 2023 |title=Dengue and severe dengue |url=https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue |access-date=10 February 2024 |website=World Health Organization |archive-date=14 March 2024 |archive-url=https://web.archive.org/web/20240314173620/https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue |url-status=live }}</ref><ref name="Kularatne-2015">{{cite journal | vauthors = Kularatne SA | title = Dengue fever | journal = BMJ | volume = 351 | article-number = h4661 | date = September 2015 | pmid = 26374064 | doi = 10.1136/bmj.h4661 | s2cid = 1680504 }}</ref>

Dengue is spread by several species of female [[mosquito]]es of the ''[[Aedes]]'' [[genus]], principally ''[[Aedes aegypti]]''.<ref name="WHO-Dengue-2023" /> The virus has four confirmed [[serotype]]s; infection with one type usually gives lifelong [[Immunity (medical)|immunity]] to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications, so-called [[Antibody-dependent enhancement#Dengue|antibody-dependent enhancement]].<ref name="CDC-YellowBook-2024">{{Cite web |date=1 May 2023 |title=Dengue {{!}} CDC Yellow Book 2024 |url=https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/dengue |access-date=14 February 2024 |website=Centers for Disease Control and Prevention |archive-date=14 February 2024 |archive-url=https://web.archive.org/web/20240214221957/https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/dengue |url-status=live }}</ref> The symptoms may resemble those of [[malaria]], [[influenza]], or [[Zika fever|Zika]].<ref>{{cite book | vauthors = Schaefer TJ, Panda PK, Wolford RW | chapter = Dengue Fever | title = StatPearls |date=14 November 2022 | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK430732/ |access-date=13 February 2022 | location =  Treasure Island (FL) |publisher=StatPearls Publishing |pmid=28613483 |archive-date=14 December 2021 |archive-url= https://web.archive.org/web/20211214061113/https://www.ncbi.nlm.nih.gov/books/NBK430732/ |url-status=live }}</ref> Blood tests to confirm the diagnosis including detecting viral [[RNA]], or specific [[antibodies]].<ref name="CDC-Diagnosis-2019">{{Cite web |date=13 June 2019 |title=Dengue Diagnosis {{!}} CDC |url=https://www.cdc.gov/dengue/healthcare-providers/diagnosis.html |access-date=14 February 2024 |website=Centers for Disease Control and Prevention |language=en-us |archive-date=14 February 2024 |archive-url=https://web.archive.org/web/20240214221955/https://www.cdc.gov/dengue/healthcare-providers/diagnosis.html |url-status=live }}</ref>

Infection can be prevented by mosquito elimination and the prevention of mosquito bites.<ref name="Unicef-Dengue-2024">{{Cite web |title=Dengue: How to keep children safe {{!}} UNICEF South Asia |url=https://www.unicef.org/rosa/stories/dengue-how-keep-children-safe |access-date=13 February 2024 |website=www.unicef.org |language=en |archive-date=13 February 2024 |archive-url=https://web.archive.org/web/20240213182120/https://www.unicef.org/rosa/stories/dengue-how-keep-children-safe |url-status=live }}</ref> Two types of [[dengue vaccine]] have been approved and are commercially available. Dengvaxia became available in 2016, but it is only recommended to prevent re-infection in individuals who have been previously infected.<ref>{{cite journal |date=7 September 2018 |title=Dengue vaccine: WHO position paper – September 2018 |url=https://apps.who.int/iris/bitstream/handle/10665/274315/WER9336.pdf?ua=1 |journal=Weekly Epidemiological Record |volume=36 |issue=93 |pages=457–476 |access-date=12 April 2019 |archive-date=5 January 2019 |archive-url=https://web.archive.org/web/20190105130352/http://apps.who.int/iris/bitstream/handle/10665/274315/WER9336.pdf?ua=1 |url-status=live }}</ref> The second vaccine, Qdenga, became available in 2022 and is suitable for adults, adolescents and children from four years of age.<ref>{{Cite web |title=Qdenga {{!}} European Medicines Agency |url=https://www.ema.europa.eu/en/medicines/human/EPAR/qdenga |access-date=14 February 2024 |website=European Medicines Agency |date=16 December 2022 |archive-date=27 February 2024 |archive-url=https://web.archive.org/web/20240227073545/https://www.ema.europa.eu/en/medicines/human/EPAR/qdenga |url-status=live }}</ref> Treatment is [[Symptomatic treatment|symptomatic]], as there is no specific treatment for dengue fever. In mild cases, treatment focuses on treating pain. Severe cases of dengue require hospitalisation; treatment of acute dengue is supportive and includes giving fluid either by mouth or [[Intravenous therapy|intravenously]].<ref name="WHO-Dengue-2023" /><ref name="Kularatne-2015" />

The earliest descriptions of a dengue outbreak date from 1779; its viral cause and spread were understood by the early 20th century.<ref>{{cite journal | vauthors = Henchal EA, Putnak JR | title = The dengue viruses | journal = Clinical Microbiology Reviews | volume = 3 | issue = 4 | pages = 376–396 | date = October 1990 | pmid = 2224837 | pmc = 358169 | doi = 10.1128/CMR.3.4.376 }}</ref> Already [[Endemic (epidemiology)|endemic]] in more than one hundred countries, dengue is spreading from tropical and subtropical regions to the Iberian Peninsula and the southern states of the US, partly attributed to climate change.<ref name="WHO-Global-Situation-2024">{{Cite web |title=Dengue- Global situation |url=https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON498 |access-date=13 February 2024 |website=World Health Organization |language=en |archive-date=13 February 2024 |archive-url=https://web.archive.org/web/20240213182201/https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON498 |url-status=live }}</ref><ref>{{cite journal | vauthors = Paz-Bailey G, Adams LE, Deen J, Anderson KB, Katzelnick LC | title = Dengue | journal = Lancet | volume = 403 | issue = 10427 | pages = 667–682 | date = February 2024 | pmid = 38280388 | doi = 10.1016/S0140-6736(23)02576-X | pmc = 12372472 | s2cid = 267201333 }}</ref> It is classified as a [[neglected tropical disease]].<ref>{{Cite web |title=Neglected tropical diseases |url=https://www.who.int/news-room/questions-and-answers/item/neglected-tropical-diseases |access-date=13 February 2024 |website=World Health Organization |language=en |archive-date=26 January 2024 |archive-url=https://web.archive.org/web/20240126193108/https://www.who.int/news-room/questions-and-answers/item/neglected-tropical-diseases |url-status=live }}</ref> During 2023, more than 5&nbsp;million infections were reported, with more than 5,000 dengue-related deaths.<ref name="WHO-Global-Situation-2024" /> As most cases are asymptomatic or mild, the actual numbers of dengue cases and deaths are under-reported.<ref name="WHO-Global-Situation-2024" />

== Signs and symptoms ==
{{multiple image
 | align             = right
 | direction         = vertical
 | total_width       = 400
 | image1            = Dengue fever symptoms.svg
 | alt1              = Outline of a human torso with arrows indicating the organs affected in the various stages of dengue fever
 | caption1          = Schematic depiction of the symptoms of dengue fever
 | image2            = Course of Dengue illness vectorized.svg
 | alt2              =
 | caption2          = Clinical course of dengue fever
}}
Typically, people infected with dengue virus are [[asymptomatic]] or have only mild symptoms such as an uncomplicated fever (80%).<ref name="Whitehorn-2010">{{cite journal | vauthors = Whitehorn J, Farrar J | title = Dengue | journal = British Medical Bulletin | volume = 95 | pages = 161–173 | year = 2010 | pmid = 20616106 | doi = 10.1093/bmb/ldq019 | s2cid = 215154729 | doi-access = free }}</ref><ref name="Reiter-2010">{{cite journal | vauthors = Reiter P | title = Yellow fever and dengue: a threat to Europe? | journal = Euro Surveillance | volume = 15 | issue = 10 | page = 19509 | date = March 2010 | pmid = 20403310 | doi = 10.2807/ese.15.10.19509-en | url = http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19509 | url-status = live | doi-access = free | archive-url = https://web.archive.org/web/20110707070425/http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19509 | archive-date = 7 July 2011 }}</ref> Others have more severe illness (5%), and in a small proportion it is life-threatening.<ref name="Whitehorn-2010"/><ref name="Reiter-2010"/> The [[incubation period]] (time between exposure and onset of symptoms) ranges from 3 to 14 days, but most often it is 4 to 7 days.<ref name="Gubler-2010">{{cite book| vauthors = Gubler DJ | veditors = Mahy BW, Van Regenmortel MH |title=Desk Encyclopedia of Human and Medical Virology|chapter=Dengue viruses|publisher=Academic Press|location=Boston|year=2010|isbn=978-0-12-375147-8|chapter-url=https://books.google.com/books?id=nsh48WKIbhQC&pg=PA372|pages=372–382|url-status=live|archive-url=https://web.archive.org/web/20160609195355/https://books.google.com/books?id=nsh48WKIbhQC&pg=PA372|archive-date=9 June 2016}}</ref>

The characteristic symptoms of mild dengue are sudden-onset fever, headache (typically located behind the eyes), muscle and joint pains, nausea, vomiting, swollen glands and a rash.<ref name="WHO-Dengue-2023" /><ref name="Unicef-Dengue-2024" /> If this progresses to severe dengue the symptoms are  severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums or nose, fatigue, restlessness, blood in vomit or stool, extreme thirst, pale and cold skin, and feelings of weakness.<ref name="WHO-Dengue-2023" />

=== Clinical course ===
The course of infection is divided into three phases: febrile, critical, and recovery.<ref name="Simmons-2012">{{cite journal | vauthors = Simmons CP, Farrar JJ, Nguyen V, Wills B | title = Dengue | journal = The New England Journal of Medicine | volume = 366 | issue = 15 | pages = 1423–1432 | date = April 2012 | pmid = 22494122 | doi = 10.1056/NEJMra1110265 | url = http://minerva-access.unimelb.edu.au/bitstream/11343/191104/1/Current%20Concepts%20-%20Dengue.pdf | access-date = 24 September 2019 | url-status = live | hdl-access = free | archive-date = 28 August 2021 | archive-url = https://web.archive.org/web/20210828054832/http://minerva-access.unimelb.edu.au/bitstream/handle/11343/191104/Current | hdl = 11343/191104 }}</ref>

The febrile phase involves [[high fever]] (40–41&nbsp;°C; 104–105.8&nbsp;°F), and is associated with generalized pain and a headache; this usually lasts two to seven days.<ref name="WHO-Dengue-2023" /><ref name="Chen-2010">{{cite journal | vauthors = Chen LH, Wilson ME | title = Dengue and chikungunya infections in travelers | journal = Current Opinion in Infectious Diseases | volume = 23 | issue = 5 | pages = 438–444 | date = October 2010 | pmid = 20581669 | doi = 10.1097/QCO.0b013e32833c1d16 | s2cid = 2452280 }}</ref> There may also be nausea, vomiting, a rash, and pains in the muscle and joints.<ref name="WHO-Dengue-2023" />

Most people recover within a week or so. In about 5% of cases, symptoms worsen and can become life-threatening. This is called '''severe dengue''' (formerly called ''dengue hemorrhagic fever'' or ''dengue shock syndrome'').<ref name="Simmons-2012"/><ref name="Ranjit-2011">{{cite journal | vauthors = Ranjit S, Kissoon N | title = Dengue hemorrhagic fever and shock syndromes | journal = Pediatric Critical Care Medicine | volume = 12 | issue = 1 | pages = 90–100 | date = January 2011 | pmid = 20639791 | doi = 10.1097/PCC.0b013e3181e911a7 | s2cid = 10135251 }}</ref> Severe dengue can lead to shock, internal bleeding, organ failure and even death. Warning signs include severe stomach pain, vomiting, difficulty breathing, and blood in the nose, gums, vomit or stools.<ref name="Mayo-Symptoms-2024">{{Cite web |title=Dengue fever - Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/dengue-fever/symptoms-causes/syc-20353078 |access-date=25 February 2024 |website=Mayo Clinic |language=en |archive-date=26 February 2024 |archive-url=https://web.archive.org/web/20240226011216/https://www.mayoclinic.org/diseases-conditions/dengue-fever/symptoms-causes/syc-20353078 |url-status=live }}</ref>

During this period, there is leakage of plasma from the blood vessels, together with a reduction in [[platelet]]s.<ref name="Mayo-Symptoms-2024" /> This may result in fluid accumulation in the [[thoracic cavity|chest]] and [[abdominal cavity]] as well as [[hypovolemia|depletion of fluid from the circulation]] and [[hypoperfusion|decreased blood supply to vital organs]].<ref name="Ranjit-2011" />

The recovery phase usually lasts two to three days.<ref name="Ranjit-2011" /> The improvement is often striking, and can be accompanied with severe [[itch]]ing and a [[Bradycardia|slow heart rate]].<ref name="Ranjit-2011" />

{{multiple image
| align             = center
| direction         = horizontal
| total_width       = 600
| image1            = Early Dengue Fever Rash 2014.jpg
| alt1              =
| caption1          = The rash of dengue fever in the acute stage of the infection [[Blanch (medical)|blanches]] when pressed.
| image2            = Dengue recovery rash (White islands in red sea).jpg
| alt2              =
| caption2          = The rash that commonly forms during the recovery from dengue fever with its classic islands of white in a sea of red
}}

=== Complications===
[[Sequela|Complications]] following severe dengue include fatigue, somnolence, headache, concentration impairment and memory impairment.<ref name="Simmons-2012" /><ref>{{cite journal | vauthors = Kalimuddin S, Teh YE, Wee LE, Paintal S, Sasisekharan R, Low JG, Sheth SK, Ooi EE | title = Chronic sequelae complicate convalescence from both dengue and acute viral respiratory illness | journal = PLOS Neglected Tropical Diseases | volume = 16 | issue = 8 | article-number = e0010724 | date = August 2022 | pmid = 35981059 | pmc = 9426910 | doi = 10.1371/journal.pntd.0010724 | doi-access = free }}</ref> A pregnant woman who develops dengue is at higher risk of [[miscarriage]], [[low birth weight]], and [[Preterm birth|premature birth]].<ref>{{cite journal | vauthors = Paixão ES, Teixeira MG, Costa MD, Rodrigues LC | title = Dengue during pregnancy and adverse fetal outcomes: a systematic review and meta-analysis | journal = The Lancet. Infectious Diseases | volume = 16 | issue = 7 | pages = 857–865 | date = July 2016 | pmid = 26949028 | doi = 10.1016/S1473-3099(16)00088-8 | url = https://researchonline.lshtm.ac.uk/2537331/1/Systematic%20Literature%20Review%2020.11.docx | access-date = 5 December 2019 | url-status = live | archive-url = https://web.archive.org/web/20210828054827/https://researchonline.lshtm.ac.uk/id/eprint/2537331/1/Systematic | archive-date = 28 August 2021 }}</ref>

Children and older individuals are at a risk of developing complications from dengue fever compared to other age groups; young children typically suffer from more intense symptoms. Concurrent infections with [[tropical disease]]s<ref>{{cite journal | vauthors = Rothman AL | title = Immunity to dengue virus: a tale of original antigenic sin and tropical cytokine storms | journal = Nature Reviews. Immunology | volume = 11 | issue = 8 | pages = 532–543 | date = July 2011 | pmid = 21760609 | doi = 10.1038/nri3014 }}</ref> like the [[Zika virus]] can worsen symptoms and make recovery more challenging.<ref>Zanluca, C., & Duarte dos Santos, C. N. (2016). ''Zika virus – an overview. Microbes and Infection'', 18(5), 295-301. ''Retrieved 27 September 2024''</ref>

== Cause ==

=== Virology ===
{{Main|Dengue virus}}
[[File:Dengue.jpg|thumb|alt=A transmission electron microscopy image showing dengue virus|A [[Transmission electron microscopy|TEM]] [[micrograph]] showing dengue virus [[virion]]s (the cluster of dark dots near the center)]]

Dengue virus (DENV) is an [[RNA virus]] of the family ''[[Flaviviridae]]''; genus ''[[Flavivirus]]''. Other members of the same genus include [[yellow fever|yellow fever virus]], [[West Nile virus]], and [[Zika|Zika virus]].
Dengue virus [[genome]] (genetic material) contains about 11,000 [[nucleotide base]]s, which [[Genetic code|code]] for the three [[structural protein]] molecules (C, prM and E) that form the [[Virion|virus particle]] and seven other protein molecules that are required for replication of the virus.<ref>{{cite journal | vauthors = Rodenhuis-Zybert IA, Wilschut J, Smit JM | title = Dengue virus life cycle: viral and host factors modulating infectivity | journal = Cellular and Molecular Life Sciences | volume = 67 | issue = 16 | pages = 2773–2786 | date = August 2010 | pmid = 20372965 | pmc = 11115823 | doi = 10.1007/s00018-010-0357-z | url = https://link.springer.com/content/pdf/10.1007/s00018-010-0357-z.pdf | url-status = live | s2cid = 4232236 | archive-url = https://ghostarchive.org/archive/20221009/https://link.springer.com/content/pdf/10.1007/s00018-010-0357-z.pdf | archive-date = 9 October 2022 }}</ref><ref name="Guzman-2010">{{cite journal | vauthors = Guzman MG, Halstead SB, Artsob H, Buchy P, Farrar J, Gubler DJ, Hunsperger E, Kroeger A, Margolis HS, Martínez E, Nathan MB, Pelegrino JL, Simmons C, Yoksan S, Peeling RW | title = Dengue: a continuing global threat | journal = Nature Reviews. Microbiology | volume = 8 | issue = 12 Suppl | pages = S7-16 | date = December 2010 | pmid = 21079655 | pmc = 4333201 | doi = 10.1038/nrmicro2460 }}</ref> There are four confirmed strains of the virus, called [[serovar|serotype]]s, referred to as DENV-1, DENV-2, DENV-3 and DENV-4. The distinctions between the serotypes are based on their [[antigenicity]].<ref>{{cite book| vauthors = Solomonides T|title=Healthgrid applications and core technologies : proceedings of HealthGrid 2010|year=2010|publisher=IOS Press|location=Amsterdam|isbn=978-1-60750-582-2|page=235|url=https://books.google.com/books?id=nf-Q0TYTS-0C&pg=PA235|edition=[Online-Ausg.]|url-status=live|archive-url=https://web.archive.org/web/20160501063614/https://books.google.com/books?id=nf-Q0TYTS-0C&pg=PA235|archive-date=1 May 2016}}</ref>

=== Transmission ===
[[File:Aedes aegypti feeding.jpg|left|alt=Close-up photograph of an ''Aedes aegypti'' mosquito biting human skin|thumb|The mosquito ''Aedes aegypti'' feeding on a human host]]
Dengue virus is most frequently transmitted by the bite of mosquitos in the ''[[Aedes]]'' genus, particularly ''[[Aedes aegypti|A.&nbsp;aegypti]]''.<ref>{{Cite web |date=9 June 2017 |title=Aedes aegypti – Factsheet for experts |url=https://www.ecdc.europa.eu/en/disease-vectors/facts/mosquito-factsheets/aedes-aegypti |access-date=25 February 2024 |website=www.ecdc.europa.eu |language=en |archive-date=10 July 2017 |archive-url=https://web.archive.org/web/20170710145706/https://ecdc.europa.eu/en/healthtopics/vectors/mosquitoes/Pages/aedes-aegypti.aspx |url-status=live }}</ref> They prefer to feed at dusk and dawn,<ref>{{cite book |url=http://apps.who.int/iris/bitstream/10665/75303/1/9789241504034_eng.pdf |title=Global Strategy For Dengue Prevention And Control |publisher=World Health Organization |year=2012 |isbn=978-92-4-150403-4 |pages=16–17 |archive-url=https://web.archive.org/web/20121030141619/http://apps.who.int/iris/bitstream/10665/75303/1/9789241504034_eng.pdf |archive-date=30 October 2012 |url-status=live}}</ref> but they may bite and thus spread infection at any time of day.<ref>{{cite web |url=http://wwwnc.cdc.gov/travel/content/outbreak-notice/dengue-tropical-sub-tropical.aspx |title=Travelers' Health Outbreak Notice |publisher=Centers for Disease Control and Prevention |date=2 June 2010 |access-date=27 August 2010 |archive-url=https://web.archive.org/web/20100826005756/http://wwwnc.cdc.gov/travel/content/outbreak-notice/dengue-tropical-sub-tropical.aspx |archive-date=26 August 2010 |url-status=dead }}</ref> Other ''Aedes'' species that may transmit the disease include ''[[Aedes albopictus|A.&nbsp;albopictus]]'', ''[[Aedes polynesiensis|A.&nbsp;polynesiensis]]'' and ''[[Aedes scutellaris|A.&nbsp;scutellaris]]''. Humans are the primary [[Host (biology)|host]] of the virus,<ref>{{cite journal | vauthors = Gould EA, Solomon T | title = Pathogenic flaviviruses | journal = Lancet | volume = 371 | issue = 9611 | pages = 500–509 | date = February 2008 | pmid = 18262042 | doi = 10.1016/S0140-6736(08)60238-X | url = https://www.thelancet.com/action/showPdf?pii=S0140-6736%2808%2960238-X | access-date = 6 June 2020 | url-status = live | s2cid = 205949828 | doi-access = free | archive-url = https://web.archive.org/web/20210828054828/https://www.thelancet.com/action/showPdf?pii=S0140-6736%2808%2960238-X | archive-date = 28 August 2021 | url-access = subscription }}</ref> but it also circulates in nonhuman [[primate]]s, and can infect other mammals.<ref>{{cite journal | vauthors = Gwee SX, St John AL, Gray GC, Pang J | title = Animals as potential reservoirs for dengue transmission: A systematic review | journal = One Health | volume = 12 | article-number = 100216 | date = June 2021 | pmid = 33598525 | pmc = 7868715 | doi = 10.1016/j.onehlt.2021.100216 }}</ref><ref>{{cite web|title=Vector-borne viral infections|url=https://www.who.int/vaccine_research/diseases/vector/en/index1.html|publisher=World Health Organization|access-date=17 January 2011|url-status=dead|archive-url=https://web.archive.org/web/20110203162048/http://www.who.int/vaccine_research/diseases/vector/en/index1.html|archive-date=3 February 2011}}</ref> An infection can be acquired via a single bite.<ref name="CDC-Yellow-2010">{{cite web|url=http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx|title=Chapter 5 – dengue fever (DF) and dengue hemorrhagic fever (DHF)|work=2010 Yellow Book|author=Center for Disease Control and Prevention|access-date=23 December 2010|url-status=live|archive-url=https://web.archive.org/web/20101229212025/http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx|archive-date=29 December 2010}}</ref>

For 2 to 10 days after becoming newly infected, a person's bloodstream will contain a high level of virus particles (the [[Viremia|viremic]] period). A female mosquito that takes a blood meal from the infected host then propagates the virus in the cells lining its gut.<ref>{{cite book| vauthors = St Georgiev V |title=National Institute of Allergy and Infectious Diseases, NIH.|year=2009|publisher=Humana|location=Totowa, N.J.|isbn=978-1-60327-297-1|page=268|url=https://books.google.com/books?id=pymSBkVU-FsC&pg=PA268|edition=1|url-status=live|archive-url=https://web.archive.org/web/20160501133441/https://books.google.com/books?id=pymSBkVU-FsC&pg=PA268|archive-date=1 May 2016}}</ref> Over the next few days, the virus spreads to other tissues including the mosquito's [[salivary gland]]s and is released into its saliva. Next time the mosquito feeds, the infectious saliva will be injected into the bloodstream of its victim, thus spreading the disease.<ref>{{Cite web |title=Dengue Transmission {{!}} Learn Science at Scitable |url=https://www.nature.com/scitable/topicpage/dengue-transmission-22399758/ |access-date=28 February 2024 |website=© 2014 Nature Education |language=en |archive-date=28 February 2024 |archive-url=https://web.archive.org/web/20240228211633/https://www.nature.com/scitable/topicpage/dengue-transmission-22399758/ |url-status=live }}</ref> The virus seems to have no detrimental effect on the mosquito, which remains infected for life.<ref name="Gubler-2010" />

Dengue can also be transmitted via infected [[blood products]] and through [[organ donation]].<ref name="WHO-Dengue-2023" /> [[Vertical transmission]] (from mother to child) during pregnancy or at birth has been reported.<ref>{{cite journal | vauthors = Wiwanitkit V | title = Unusual mode of transmission of dengue | journal = Journal of Infection in Developing Countries | volume = 4 | issue = 1 | pages = 51–54 | date = November 2009 | pmid = 20130380 | doi = 10.3855/jidc.145 | doi-access = free }}</ref>

=== Risk factors ===

The principal risk for infection with dengue is the bite of an infected mosquito.<ref name="Bisen-2013">{{Cite book | vauthors = Bisen PS, Raghuvanshi R |url=https://onlinelibrary.wiley.com/doi/book/10.1002/9781118393277 |title=Emerging Epidemics: Management and Control |date=22 July 2013 |publisher=Wiley |isbn=978-1-118-39323-9 |edition=1 |language=en |doi=10.1002/9781118393277.ch8 |access-date=23 February 2024 |archive-date=23 February 2024 |archive-url=https://web.archive.org/web/20240223222706/https://onlinelibrary.wiley.com/doi/book/10.1002/9781118393277 |url-status=live }}</ref> This is more probable in areas where the disease is endemic, especially where there is high population density, poor sanitation, and standing water where mosquitoes can breed.<ref name="Bisen-2013" /> It can be mitigated by taking steps to avoid bites such as by wearing clothing that fully covers the skin, using [[mosquito net]]ting while resting, and/or the application of [[insect repellent]] ([[DEET]] being the most effective).<ref name="CDC-Yellow-2010" />

Chronic diseases – such as asthma, sickle cell anemia, and diabetes mellitus – increase the risk of developing a severe form of the disease.<ref>{{Cite web |title=Host Response to the Dengue Virus {{!}} Learn Science at Scitable |url=https://www.nature.com/scitable/topicpage/host-response-to-the-dengue-virus-22402106/ |access-date=23 February 2024 |website=www.nature.com |language=en |archive-date=23 February 2024 |archive-url=https://web.archive.org/web/20240223222706/https://www.nature.com/scitable/topicpage/host-response-to-the-dengue-virus-22402106/ |url-status=live }}</ref> Other risk factors for severe disease include female sex and high [[body mass index]].<ref name="Simmons-2012" /><ref name="Guzman-2010" /> Infection with one serotype is thought to produce lifelong immunity to that type, but only short-term protection against the other three.<ref name="Chen-2010" /> Subsequent re-infection with a different serotype increases the risk of severe complications due to a phenomenon known as [[antibody-dependent enhancement]] (ADE).<ref name="CDC-YellowBook-2024" /><ref name="Teo-2023">{{cite journal | vauthors = Teo A, Tan HD, Loy T, Chia PY, Chua CL | title = Understanding antibody-dependent enhancement in dengue: Are afucosylated IgG1s a concern? | journal = PLOS Pathogens | volume = 19 | issue = 3 | article-number = e1011223 | date = March 2023 | pmid = 36996026 | pmc = 10062565 | doi = 10.1371/journal.ppat.1011223 | doi-access = free }}</ref>

[[File:antibody dependent enhancement.svg|thumb|In antibody-dependent enhancement (ADE), antibodies bind to both viral particles and Fc gamma receptors expressed on immune cells, increasing the likelihood that the viruses will infect those cells.]]

The exact mechanism of ADE is not fully understood.<ref name="Teo-2023" /> It appears that ADE occurs when the antibodies generated during an immune response recognize and bind to a pathogen, but they fail to neutralize it. Instead, the antibody-virus complex has an enhanced ability to bind to the [[Fc receptor|Fcγ]] receptors of the target immune cells, enabling the virus to infect the cell and reproduce itself.<ref name="Teo-2023" /><ref>{{Cite web |date=7 December 2020 |title=Antibody-dependent Enhancement (ADE) and Vaccines |url=https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-safety/antibody-dependent-enhancement-and-vaccines |access-date=29 February 2024 |website=The Children's Hospital of Philadelphia |archive-date=29 February 2024 |archive-url=https://web.archive.org/web/20240229214549/https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-safety/antibody-dependent-enhancement-and-vaccines |url-status=live }}</ref>

=== Mechanism of infection ===
When a dengue virus carrying mosquito bites a person, the virus enters the skin together with the mosquito's saliva. The virus infects nearby skin cells called [[keratinocyte]]s, as well as specialized immune cells located in the skin, called [[Langerhans cell]]s.<ref>{{Cite web |title=Host Response to the Dengue Virus {{!}} Learn Science at Scitable |url=https://www.nature.com/scitable/topicpage/host-response-to-the-dengue-virus-22402106/ |access-date=28 February 2024 |website=© 2014 Nature Education |language=en |archive-date=23 February 2024 |archive-url=https://web.archive.org/web/20240223222706/https://www.nature.com/scitable/topicpage/host-response-to-the-dengue-virus-22402106/ |url-status=live }}</ref> The Langerhans cells migrate to the [[lymph node]]s, where the infection spreads to [[white blood cell]]s, and reproduces inside the cells while they move throughout the body.<ref name="Martina-2009" />

The white blood cells respond by producing several signaling proteins, such as [[cytokines]] and [[interferons]], which are responsible for many of the symptoms, such as the fever, the flu-like symptoms, and the severe pains. In severe infection, the virus production inside the body is greatly increased, and many more organs (such as the [[liver]] and the [[bone marrow]]) can be affected. Fluid from the bloodstream leaks through the wall of small blood vessels into body cavities due to increased [[capillary permeability]]. As a result, [[blood volume]] decreases, and the blood pressure becomes so low that it cannot supply sufficient blood to vital organs. The spread of the virus to the bone marrow leads to reduced numbers of platelets, which are necessary for effective blood clotting; this increases the risk of bleeding, the other major complication of dengue fever.<ref name="Martina-2009">{{cite journal | vauthors = Martina BE, Koraka P, Osterhaus AD | title = Dengue virus pathogenesis: an integrated view | journal = Clinical Microbiology Reviews | volume = 22 | issue = 4 | pages = 564–581 | date = October 2009 | pmid = 19822889 | pmc = 2772360 | doi = 10.1128/CMR.00035-09 }}</ref>

== Diagnosis ==
[[File:Dengue testing.png|thumb|upright=1.5|Graph of when laboratory tests for dengue fever become positive. Day zero refers to the start of symptoms, 1st refers to in those with a primary infection, and 2nd refers to in those with a secondary infection.<ref name="Simmons-2012" />]]
Mild cases of dengue fever can easily be confused with several common diseases including [[Influenza]], [[measles]], [[chikungunya]], and [[Zika fever|zika]].<ref name="WHO-Guidelines-2009">{{Cite book |date=21 April 2009 |title=Dengue guidelines, for diagnosis, treatment, prevention and control |url=https://www.who.int/publications-detail-redirect/9789241547871 |access-date=7 March 2024 |page=46 |language=en |isbn=978-92-4-154787-1 |quote=Textbox B and Textbox C. |publisher=World Health Organization |vauthors=Organization WH |archive-date=16 March 2024 |archive-url=https://web.archive.org/web/20240316010639/https://www.who.int/publications/i/item/9789241547871 |url-status=live }}</ref><ref name="MSD Manual Professional Edition">{{Cite web |title=Dengue - Infectious Diseases |url=https://www.msdmanuals.com/en-gb/professional/infectious-diseases/arboviruses,-arenaviridae,-and-filoviridae/dengue |access-date=4 March 2024 |website=MSD Manual Professional Edition |language=en-GB |archive-date=4 March 2024 |archive-url=https://web.archive.org/web/20240304203003/https://www.msdmanuals.com/en-gb/professional/infectious-diseases/arboviruses,-arenaviridae,-and-filoviridae/dengue |url-status=live }}</ref> Dengue, chikungunya and zika share the same mode of transmission (''Aedes'' mosquitoes) and are often endemic in the same regions, so that it is possible to be [[Coinfection|infected simultaneously]] by more than one disease.<ref name="Beltran-Silva-2018" /> For travellers, dengue fever diagnosis should be considered in anyone who develops a fever within two weeks of being in the [[tropics]] or [[subtropics]].<ref name="Simmons-2012" />

Warning symptoms of severe dengue include abdominal pain, persistent vomiting, odema, bleeding, lethargy, and liver enlargement. Once again, these symptoms can be confused with other diseases such as malaria, gastroenteritis, leptospirosis, and typhus.<ref name="WHO-Guidelines-2009"/>

Blood tests can be used to confirm a diagnosis of dengue. During the first few days of infection, enzyme-linked immunosorbent assay ([[ELISA]]) can be used to detect the [[NS1 antigen test|NS1 antigen]]; however this antigen is produced by all flaviviruses.<ref name="Beltran-Silva-2018">{{Cite journal | vauthors = Beltrán-Silva SL, Chacón-Hernández SS, Moreno-Palacios E, Pereyra-Molina JÁ |date=1 July 2018 |title=Clinical and differential diagnosis: Dengue, chikungunya and Zika |url=https://www.elsevier.es/en-revista-revista-medica-del-hospital-general-325-articulo-clinical-differential-diagnosis-dengue-chikungunya-S0185106316301135 |journal=Revista Médica del Hospital General de México |language=en |volume=81 |issue=3 |pages=146–153 |doi=10.1016/j.hgmx.2016.09.011 |issn=0185-1063 |access-date=7 March 2024 |archive-date=4 March 2024 |archive-url=https://web.archive.org/web/20240304213207/https://www.elsevier.es/en-revista-revista-medica-del-hospital-general-325-articulo-clinical-differential-diagnosis-dengue-chikungunya-S0185106316301135 |url-status=live |doi-access=free }}</ref><ref name="CDC-Diagnosis-2019"/> Four or five days into the infection, it is possible to reliably detect anti-dengue [[IgM]] antibodies, but this does not determine the serotype.<ref name="Beltran-Silva-2018"/> [[Nucleic acid test|Nucleic acid amplification tests]] provide the most reliable method of diagnosis.<ref name="CDC-Diagnosis-2019" />

=== Types ===
The [[World Health Organization]]'s [[International Classification of Diseases]] divides dengue fever into two classes: uncomplicated and severe.<ref name="Whitehorn-2010" /> '''Severe dengue''' is defined as that associated with severe bleeding, severe organ dysfunction, or severe plasma leakage.<ref>{{Cite web |date=1 January 2022 |title=International Classification of Diseases (ICD-11) |url=https://www.who.int/standards/classifications/classification-of-diseases |access-date=28 February 2024 |website=World Health Organization |language=en |archive-date=20 September 2023 |archive-url=https://web.archive.org/web/20230920045132/https://www.who.int/standards/classifications/classification-of-diseases |url-status=live }}</ref> Risk factors of getting severe dengue include prior exposure to the disease, young children, older adults and those with medical comorbidities.{{Citation needed|date=August 2025}}

Severe dengue can develop suddenly, sometimes after a few days as the fever subsides.<ref name="Mayo-Symptoms-2024" /> Leakage of plasma from the capillaries results in extreme [[Hypotension|low blood pressure]] and [[hypovolemic shock]]; Patients with severe plasma leakage may have fluid accumulation in the [[Pleural effusion|lungs]] or [[Ascites|abdomen]], [[Hypoproteinemia|insufficient protein in the blood]], or [[Hematocrit|thickening of the blood]]. Severe dengue is a medical emergency which can cause damage to organs, leading to multiple organ failure and death.<ref>{{Cite web |last=CDC |date=13 April 2023 |title=Dengue Clinical Presentation {{!}} CDC |url=https://www.cdc.gov/dengue/healthcare-providers/clinical-presentation.html |access-date=29 February 2024 |website=Centers for Disease Control and Prevention |language=en-us |archive-date=29 February 2024 |archive-url=https://web.archive.org/web/20240229211732/https://www.cdc.gov/dengue/healthcare-providers/clinical-presentation.html |url-status=live }}</ref>

== Prevention ==
=== Mosquito control ===
[[File:Vector Control.jpg|alt=A black and white photograph of people filling in a ditch with standing water|thumb|A 1920s photograph of efforts to disperse standing water and thus decrease mosquito populations]]{{Main|Mosquito control}}
The principal risk for infection with dengue is the bite of an infected mosquito.<ref name="WHO-Dengue-2023" /> This is more probable in areas where the disease is endemic, especially where there is high population density, poor sanitation, and standing water where mosquitoes can breed.<ref name="Bisen-2013" /> It can be mitigated by taking steps to avoid bites such as by wearing clothing that fully covers the skin, using mosquito netting while resting, and/or the application of insect repellent (DEET being the most effective);<ref name="CDC-Yellow-2010" /> it is also advisable to treat clothing, nets and tents with 0.5% [[permethrin]].<ref name="CDC-2023">{{Cite web |last=CDC |date=20 October 2023 |title=Traveling? Avoid Dengue |url=http://www.cdc.gov/ncezid/dvbd/media/avoid-dengue.html |access-date=8 March 2024 |website=Centers for Disease Control and Prevention |language=en-us |archive-date=8 March 2024 |archive-url=https://web.archive.org/web/20240308160645/https://www.cdc.gov/ncezid/dvbd/media/avoid-dengue.html |url-status=live }}</ref>

Protection of the home can be achieved with door and window screens, by using air conditioning, and by regularly emptying and cleaning all receptacles both indoors and outdoors which may accumulate water (such as buckets, planters, pools or trashcans).<ref name="CDC-2023" />

[[File:Church of the Immaculate Conception, JB (2025) - img 10.jpg|thumb|left|A [[holy water font]] at the [[Church of the Immaculate Conception (Johor)|Church of the Immaculate Conception]] in [[Johor Bahru]], [[Malaysia]] was closed as a part of open water sources elimination in retaliation to the dengue outbreak in the area.]]

The primary method of controlling ''A. aegypti'' is by eliminating its [[habitat]]s. This is done by eliminating open sources of water, or if this is not possible, by adding [[insecticide]]s or [[Biological pest control|biological control agents]] to these areas. Generalized spraying with [[organophosphate]] or [[pyrethroid]] insecticides, while sometimes done, is not thought to be effective.<ref name="Reiter-2010"/> Reducing open collections of water through environmental modification is the preferred method of control, given the concerns of negative health effects from insecticides and greater logistical difficulties with control agents. Ideally, mosquito control would be a community activity, e.g. when all members of a community clear blocked gutters and street drains and keep their yards free of containers with standing water.<ref name="Scitable-Control-2024">{{Cite web |title=Controlling Dengue Outbreaks {{!}} Learn Science at Scitable |url=https://www.nature.com/scitable/topicpage/controlling-dengue-outbreaks-22403714/ |access-date=8 March 2024 |website=www.nature.com |language=en |archive-date=8 March 2024 |archive-url=https://web.archive.org/web/20240308160444/https://www.nature.com/scitable/topicpage/controlling-dengue-outbreaks-22403714/ |url-status=live }}</ref> If residences have direct water connections this eliminates the need for wells or street pumps and water-carrying containers.<ref name="Scitable-Control-2024" />

=== Vaccine ===
{{main|Dengue vaccine}}
As of March 2024, there are two vaccines to protect against dengue infection; Dengvaxia and Qdenga.<ref name="ECDC-Factsheet-2023">{{Cite web |date=7 August 2023 |title=Factsheet about dengue |url=https://www.ecdc.europa.eu/en/dengue-fever/facts |access-date=8 March 2024 |website=www.ecdc.europa.eu |language=en |archive-date=25 February 2024 |archive-url=https://web.archive.org/web/20240225174109/https://www.ecdc.europa.eu/en/dengue-fever/facts |url-status=live }}</ref>
[[File:Intradermal injection.jpg|alt=Subcutaneous injection|thumb|Illustration of a subcutaneous injection]]
Dengvaxia (formerly CYD-TDV) became available in 2015, and is approved for use in the US, EU and in some Asian and Latin American countries.<ref>{{Cite web |title=Information on Dengvaxia® |url=https://www.sanofi.com/en/our-company/social-impact/responsible-business-values/information-on-dengvaxia |access-date=8 March 2024 |website=www.sanofi.com |language=en |archive-date=8 March 2024 |archive-url=https://web.archive.org/web/20240308212800/https://www.sanofi.com/en/our-company/social-impact/responsible-business-values/information-on-dengvaxia |url-status=live }}</ref> It is an attenuated virus, is suitable for individuals aged 6–45 years and protects against all four serotypes of dengue.<ref>{{Cite web |title=Dengvaxia : EPAR - Medicine overview |url=https://www.ema.europa.eu/en/documents/product-information/dengvaxia-epar-product-information_en.pdf |access-date=9 March 2024 |website=European Medicines Agency |archive-date=9 March 2024 |archive-url=https://web.archive.org/web/20240309191332/https://www.ema.europa.eu/en/documents/product-information/dengvaxia-epar-product-information_en.pdf |url-status=live }}</ref> Due to safety concerns about [[antibody-dependent enhancement]] (ADE), it should only be given to individuals who have previously been infected with dengue, in order to protect them from reinfection.<ref>{{Cite web |date=1 December 2017 |title=Sanofi restricts dengue vaccine but downplays antibody enhancement {{!}} CIDRAP |url=https://www.cidrap.umn.edu/dengue/sanofi-restricts-dengue-vaccine-downplays-antibody-enhancement |access-date=9 March 2024 |website=Center for Infectious Disease Research & Policy |language=en |archive-date=9 March 2024 |archive-url=https://web.archive.org/web/20240309191331/https://www.cidrap.umn.edu/dengue/sanofi-restricts-dengue-vaccine-downplays-antibody-enhancement |url-status=live }}</ref> It is given subcutaneously as three doses at six month intervals.<ref>{{Cite web |date=26 April 2023 |title=Administering the Dengue Vaccine |url=https://www.cdc.gov/vaccines/vpd/dengue/hcp/administration.html |access-date=8 March 2024 |website=www.cdc.gov |language=en-us |archive-date=8 March 2024 |archive-url=https://web.archive.org/web/20240308212735/https://www.cdc.gov/vaccines/vpd/dengue/hcp/administration.html |url-status=live }}</ref>

Qdenga (formerly TAK-003) completed clinical trials in 2022 and was approved for use in the European Union in December 2022;<ref name="ECDC-Factsheet-2023" /> it has been approved by a number of other countries including Indonesia and Brazil, and has been recommended by the [[Strategic Advisory Group of Experts|SAGE committee]] of the World Health Organization.<ref>{{Cite web |title=Message by the Director of the Department of Immunization, Vaccines and Biologicals at WHO - September 2023 |url=https://www.who.int/news/item/05-10-2023-message-by-the-director-of-the-department-of-immunization--vaccines-and-biologicals-at-who---september-2023 |access-date=8 March 2024 |website=[[World Health Organization]] |language=en |archive-date=16 March 2024 |archive-url=https://web.archive.org/web/20240316010658/https://www.who.int/news/item/05-10-2023-message-by-the-director-of-the-department-of-immunization--vaccines-and-biologicals-at-who---september-2023 |url-status=live }}</ref> It is indicated for the prevention of dengue disease in individuals four years of age and older, and can be administered to people who have not been previously infected with dengue. It is a live [[Attenuated vaccine|attenuated]] vaccine containing the four serotypes of dengue virus, administered subcutaneously as two doses three months apart.<ref name="ECDC-Factsheet-2023" />

== Treatment ==

As of July 2024, there is no specific antiviral treatment available for dengue fever.<ref name="Mayo-Diagnosis-2022">{{Cite web |date=5 October 2022 |title=Dengue fever - Diagnosis and treatment |url=https://www.mayoclinic.org/diseases-conditions/dengue-fever/diagnosis-treatment/drc-20353084 |access-date=10 March 2024 |website=Mayo Clinic |language=en |archive-date=10 March 2024 |archive-url=https://web.archive.org/web/20240310191537/https://www.mayoclinic.org/diseases-conditions/dengue-fever/diagnosis-treatment/drc-20353084 |url-status=live }}</ref>

Most cases of dengue fever have mild symptoms, and recovery takes place in a few days.<ref name="WHO-Dengue-2023" /> No treatment is required for these cases. [[Paracetamol|Acetaminophen]] (Paracetamol, [[Tylenol]]) may be used to relieve mild fever or pain. Other common pain relievers, including [[aspirin]], [[ibuprofen]] (Advil, Motrin IB, others) and [[Naproxen|naproxen sodium]] (Aleve) should be avoided as they can increase the risk of bleeding complications.<ref name="Mayo-Diagnosis-2022" />

For moderate illness, those who can drink, are passing urine, have no warning signs and are otherwise reasonably healthy can be monitored carefully at home. [[Symptomatic treatment|Supportive care]] with analgesics, fluid replacement, and bed rest are recommended.<ref name="Smith-2022">{{Cite journal | vauthors = Smith DS, Mariano DJ, Trautwein ML | veditors = Bronze MS |date=16 November 2022 |title=Dengue Treatment & Management |url=https://emedicine.medscape.com/article/215840-treatment |access-date=10 March 2024 |website=Medscape |archive-date=10 March 2024 |archive-url=https://web.archive.org/web/20240310191537/https://emedicine.medscape.com/article/215840-treatment |url-status=live }}</ref><ref name="Ranjit-2011" />

Severe dengue is a life-threatening emergency, requiring hospitalization and potentially intensive care.<ref name="Mayo-Symptoms-2024" /> Warning signs include [[dehydration]], decreasing platelets and increasing [[hematocrit]].<ref name="CDC-Case-Management">{{Cite web |title=Dengue Case Management |url=https://www.cdc.gov/dengue/resources/dengue-clinician-guide_508.pdf |access-date=10 March 2024 |website=Centers for Disease Control and Prevention |archive-date=10 March 2024 |archive-url=https://web.archive.org/web/20240310191537/https://www.cdc.gov/dengue/resources/dengue-clinician-guide_508.pdf |url-status=live }}</ref> Treatment modes include intravenous fluids, and transfusion with platelets or plasma.<ref name="Smith-2022" />

== Prognosis ==
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Most people with dengue recover without any ongoing problems. The risk of death among those with severe dengue is 0.8–2.5%,<ref name="Kularatne-2015"/> and with adequate treatment this is less than 1%. However, those who develop significantly low blood pressure may have a fatality rate of up to 26%.<ref name="Ranjit-2011"/> The risk of death among children less than five years old is four times greater than among those over the age of 10.<ref name="Kularatne-2015"/> Elderly people are also at higher risk of a poor outcome.<ref name="Kularatne-2015"/>

== Epidemiology ==
{{See also|Dengue fever outbreaks}}
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As of March 2023, dengue is [[Endemic (epidemiology)|endemic]] in more than 100 countries with cases reported in every continent with the exception of Antarctica.<ref name="WHO-Dengue-2023" /><ref>{{Cite web |last=CDC |date=21 September 2023 |title=Dengue Areas of Risk Around the World {{!}} CDC |url=https://www.cdc.gov/dengue/areaswithrisk/around-the-world.html |access-date=17 March 2024 |website=Centers for Disease Control and Prevention |language=en-us}}</ref> The Americas, Southeast Asia and the Western Pacific regions are the most seriously affected.<ref name="WHO-Dengue-2023" /><ref name="Tidy-2022">{{Cite web | vauthors = Tidy C | veditors = Vakharia K |date=22 June 2022 |title=Dengue (Causes, Symptoms, and Treatment) |url=https://patient.info/doctor/dengue-2 |access-date=14 March 2024 |website=patient.info |language=en}}</ref> It is difficult to estimate the full extent of the disease, as many cases are mild and not correctly diagnosed. WHO currently estimates that 3.9&nbsp;billion people are at risk of dengue infection.<ref name="WHO-Dengue-2023" /><ref name="Tidy-2022" /> In 2013, it was estimated that 390&nbsp;million dengue infections occur every year, with 500,000 of these developing severe symptoms and 25,000 deaths.<ref>{{cite journal | vauthors = Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL, Drake JM, Brownstein JS, Hoen AG, Sankoh O, Myers MF, George DB, Jaenisch T, Wint GR, Simmons CP, Scott TW, Farrar JJ, Hay SI | title = The global distribution and burden of dengue | journal = Nature | volume = 496 | issue = 7446 | pages = 504–507 | date = April 2013 | pmid = 23563266 | pmc = 3651993 | doi = 10.1038/nature12060 | bibcode = 2013Natur.496..504B }}</ref><ref name = "Jing_2019">{{Cite journal | vauthors = Jing Q, Wang M |date=June 2019 |title=Dengue epidemiology |journal=Global Health Journal |volume=3 |issue=2 |pages=37–45 |doi=10.1016/j.glohj.2019.06.002 |issn=2414-6447|doi-access=free }}</ref>

Generally, areas where dengue is endemic have only one serotype of the virus in circulation. The disease is said to be [[hyperendemic]] in areas where more than one serotype is circulating; this increases the risk of severe disease on a second or subsequent infection.<ref>{{Cite web | vauthors = Smith DS |title=What is characteristic of hyperendemic dengue? |url=https://www.medscape.com/answers/215840-43445/what-is-characteristic-of-hyperendemic-dengue |access-date=23 June 2021 |publisher=Medscape}}</ref>

Infections are most commonly acquired in urban environments where the virus is primarily transmitted by the mosquito species ''[[Aedes aegypti]]''.<ref name="Gubler-2010" /> This species has adapted to the urban environment, is generally found close to human habitation, prefers humans as its host, and takes advantage of small bodies of standing water (such as [[Water tank|tanks]] and buckets) in which to breed. In rural settings the virus is transmitted to humans by ''A. aegypti'' and other related mosquitoes such as ''[[Aedes albopictus]]''.<ref name="Gubler-2010" /> Both these species have expanding ranges.<ref name="Simmons-2012" /> There are two subspecies of ''[[Aedes aegypti]]'', where ''Aedes aegypti formosus'' can be found in natural habitats such as forests and ''Aedes aegypti aegypti'' has adapted to urban domestic habitats.<ref>{{Cite web |date=9 June 2017 |title=Aedes aegypti - Factsheet for experts |url=https://www.ecdc.europa.eu/en/disease-vectors/facts/mosquito-factsheets/aedes-aegypti |access-date=18 October 2024 |website=www.ecdc.europa.eu |language=en}}</ref>

Dengue has increased in incidence in recent decades, with WHO recording a ten fold increase between 2010 and 2019 (from 500,000 to 5 million recorded cases).<ref name="WHO-Dengue-2023" /> This increase is tied closely to the increasing range of Aedes mosquitoes, which is attributed to a combination of [[urbanization]], population growth, and [[Global warming|an increasingly warm climate]].<ref name="Whitehorn-2010"/><ref>{{Cite web |date=5 March 2019 |title=Climate Change Will Expose Half of World's Population to Disease-Spreading Mosquitoes By 2050 |url=https://e360.yale.edu/digest/climate-change-will-expose-half-of-worlds-population-to-disease-spreading-mosquitoes-by-2050 |access-date=17 March 2024 |website=Yale Environment 360 |language=en-US}}</ref> In endemic areas, dengue infections peak when rainfall is optimal for mosquito breeding.<ref>{{Cite web |title=Dengue increase likely during rainy season: WHO warns |url=https://www.who.int/westernpacific/news/item/11-06-2019-dengue-increase-likely-during-rainy-season-who-warns |access-date=17 March 2024 |website=World Health Organization |language=en}}</ref> In October 2023, the first confirmed symptomatic case of locally acquired dengue (i.e. not while travelling) in the US was identified in California.<ref>{{cite journal | vauthors = Feaster M, Patrick R, Oshiro M, Kuan M, Goh YY, Carmona M, Tartof SY, Farned J, Hallum T, Lund AJ, Preas C, Messenger S, Kramer V, Danforth M, Sheridan C | title = Notes from the Field: First Locally Acquired Dengue Virus Infections - Pasadena, California, October-December 2023 | language = en-us | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 73 | issue = 42 | pages = 955–956 | date = October 2024 | pmid = 39446691 | pmc = 11500840 | doi = 10.15585/mmw.mm7342a4 }}</ref>

The disease infects all races, sexes, and ages equally. In endemic areas, the infection is most commonly seen in children who then acquire a lifelong partial immunity.<ref name = "Jing_2019" />

===Climate change ===
Rising temperatures and altered rainfall patterns are expanding the season and habitats of Aedes mosquitoes, the primary vectors of the disease.<ref>{{Cite web |last=Nature |first=Research Communities by Springer |date=6 January 2025 |title=Rising Temperatures, Rising Dengue |url=https://communities.springernature.com/posts/rising-temperatures-rising-dengue |access-date=17 February 2025 |website=Research Communities by Springer Nature |language=en}}</ref> In India, a study has developed an early warning system that analyzes regional climate factors—such as temperature, rainfall, and humidity—to predict potential dengue outbreaks two months in advance, enhancing preparedness and response strategies.<ref name="Sophia-2025">{{Cite journal |last1=Sophia |first1=Yacob |last2=Roxy |first2=Mathew Koll |last3=Murtugudde |first3=Raghu |last4=Karipot |first4=Anand |last5=Sapkota |first5=Amir |last6=Dasgupta |first6=Panini |last7=Baliwant |first7=Kalpana |last8=Saunik |first8=Sujata |last9=Tiwari |first9=Abhiyant |last10=Chattopadhyay |first10=Rajib |last11=Phalkey |first11=Revati K. |date=21 January 2025 |title=Dengue dynamics, predictions, and future increase under changing monsoon climate in India |journal=Scientific Reports |language=en |volume=15 |issue=1 |page=1637 |doi=10.1038/s41598-025-85437-w |pmid=39837878 |pmc=11750985 |bibcode=2025NatSR..15.1637S |issn=2045-2322}}</ref><ref>{{Cite web |date=21 January 2025 |title=Scientists create early warning system to curb dengue outbreaks |url=https://www.mid-day.com/mumbai/mumbai-news/article/climate-change-fuels-dengue-surge-new-system-predicts-outbreaks-23469177 |access-date=17 February 2025 |website=Mid-day |language=en}}</ref> Future projections indicate that dengue transmission risk will continue to rise with the rise in temperatures.<ref name="Sophia-2025" />

== History ==

The first historical record of a case of probable dengue fever is in a Chinese medical encyclopedia from the [[Jin dynasty (266–420)]] which referred to a "water poison" associated with flying insects.<ref name="Gubler-1998">{{cite journal | vauthors = Gubler DJ | title = Dengue and dengue hemorrhagic fever | journal = Clinical Microbiology Reviews | volume = 11 | issue = 3 | pages = 480–496 | date = July 1998 | pmid = 9665979 | pmc = 88892 | doi = 10.1128/cmr.11.3.480 }}</ref><ref>{{cite journal |author=Anonymous |year=2006 |title=Etymologia: dengue |url=http://wwwnc.cdc.gov/eid/article/12/6/pdfs/et-1206.pdf |url-status=live |journal=Emerg. Infect. Dis. |volume=12 |issue=6 |page=893 |doi=10.3201/eid1206.ET1206 |pmc=3373045 |s2cid=29398958 |archive-url=https://web.archive.org/web/20131203085913/http://wwwnc.cdc.gov/eid/article/12/6/pdfs/et-1206.pdf |archive-date=3 December 2013 |doi-access=free}}</ref>

The principal mosquito vector of dengue, ''Aedes aegypti'', spread out of Africa in the 15th to 19th centuries due to the [[History of slavery|slave trade]] and consequent expansion of international trading.<ref name="Simmons-2012" /> There have been descriptions of epidemics of dengue-like illness in the 17th century, and it is likely that epidemics in [[Jakarta]], [[Cairo]], and [[Philadelphia]] during the 18th century were caused by dengue.<ref name="Gubler-1998"/><ref>{{cite journal | vauthors = Kuno G | title = A Re-Examination of the History of Etiologic Confusion between Dengue and Chikungunya | journal = PLOS Neglected Tropical Diseases | volume = 9 | issue = 11 | article-number = e0004101 | date = November 2015 | pmid = 26562299 | pmc = 4643049 | doi = 10.1371/journal.pntd.0004101 | quote = 1779–1780: 'Knokkel-koorts' in Batavia (now Jakarta, Indonesia) and 'break bone fever' in Philadelphia | doi-access = free }}</ref>

It is assumed that dengue was [[Endemic (epidemiology)|constantly present]] in many tropical urban centres throughout the 19th and early 20th centuries, even though significant outbreaks were infrequent.<ref name="Gubler-1998"/> The marked spread of dengue during and after the [[World War II|Second World War]] has been attributed partly to disruption caused by the war, and partly to subsequent urbanisation in south-east Asia.<ref name="Gubler-1998"/> As novel serotypes were introduced to regions already endemic with dengue, outbreaks of severe disease followed. The severe hemorrhagic form of the disease was first reported in the [[Philippines]] in 1953; by the 1970s, it had become recognised as a major cause of [[child mortality]] in Southeast Asia.<ref name="Gubler-1998"/>

In Central and South America, the Aedes mosquito had been eradicated in the 1950s; however the eradication program was discontinued in the 1970s and the disease re-established itself in the region during the 1980s, becoming hyperendemic and causing significant epidemics.<ref name="Gubler-1998"/>

Dengue has continued to increase in prevalence during the 21st century, as the mosquito vector continues to expand its range. This is attributed partly to continuing urbanisation, and partly to the impact of a warmer climate.<ref>{{Cite web |title=As Temperatures Rise, Dengue Fever Spreads and Cases Rise |url=https://e360.yale.edu/features/dengue-fever-climate-change |access-date=20 March 2024 |website=Yale E360 |language=en-US}}</ref>

=== Etymology ===

The name came into English in the early 19th century from [[Spanish West Indies|West Indian Spanish]], which borrowed it from the [[Kiswahili]] term ''dinga'' / ''denga'', meaning "cramp-like seizure" – the full term of the condition being ''ki-dinga pepo'': "a sort of cramp-like seizure (caused by) an evil spirit".<ref>Christie J. On Epidemics of Dengue Fever: Their Diffusion and Etiology. Glasgow Med J. 1881;16(3):161-176.</ref> The borrowed term changed to ''dengue'' in Spanish due to this word existing in Spanish with the meaning "fastidiousness" and this [[folk etymology]] referring to the dislike of movement by affected patients.<ref name="lexico-definition" /><ref>{{cite journal|author=Anonymous|title=Etymologia: dengue|journal=Emerg. Infect. Dis.|year=2006|volume=12|page=893|url=http://wwwnc.cdc.gov/eid/article/12/6/pdfs/et-1206.pdf|issue=6|pmc=3373045| doi=10.3201/eid1206.ET1206|s2cid=29398958|url-status=live|archive-url=https://web.archive.org/web/20131203085913/http://wwwnc.cdc.gov/eid/article/12/6/pdfs/et-1206.pdf|archive-date=3 December 2013|doi-access=free}}</ref> Slaves in the West Indies having contracted dengue were said to have the posture and gait of a [[dandy]], and the disease was known as "dandy fever".<ref>{{cite web|author=Anonymous|url=http://www.medterms.com/script/main/art.asp?articlekey=6620|title=Definition of Dandy fever|work=MedicineNet.com|date=15 June 1998|access-date=25 December 2010|url-status=live|archive-url=https://web.archive.org/web/20110605231418/http://www.medterms.com/script/main/art.asp?articlekey=6620|archive-date=5 June 2011}}</ref><ref name="Halstead-2008">{{cite book| vauthors = Halstead SB |title=Dengue (Tropical Medicine: Science and Practice)|publisher=Imperial College Press|location=River Edge, N.J|year=2008|pages=1–10|isbn=978-1-84816-228-0|url=https://books.google.com/books?id=6zLd9mFwxwsC&pg=PA1|url-status=live|archive-url=https://web.archive.org/web/20160521221422/https://books.google.com/books?id=6zLd9mFwxwsC&pg=PA1|archive-date=21 May 2016}}</ref>

The term ''break-bone fever'' was applied by physician and [[Founding Fathers of the United States|United States Founding Father]] [[Benjamin Rush]], in a 1789 report of the 1780 epidemic in [[Philadelphia]], due to the associated muscle and joint pains. In the report title he uses the more formal term "bilious remitting fever".<ref>{{cite book|vauthors=Barrett AD, Stanberry LR|title=Vaccines for biodefense and emerging and neglected diseases|publisher=Academic|location=San Diego|year=2009|pages=287–323|isbn=978-0-12-369408-9|url=https://books.google.com/books?id=6Nu058ZNa1MC&pg=PA289|url-status=live|archive-url=https://web.archive.org/web/20160512080958/https://books.google.com/books?id=6Nu058ZNa1MC&pg=PA289|archive-date=12 May 2016}}</ref> The term dengue fever came into general use only after 1828.<ref name="Halstead-2008"/> Other historical terms include "breakheart fever" and "la dengue".<ref name="Halstead-2008"/> Terms for severe disease include "infectious thrombocytopenic purpura" and "Philippine", "Thai", or "Singapore hemorrhagic fever".<ref name="Halstead-2008"/>

== Research ==
Research directions include dengue [[pathogenesis]] (the process by which the disease develops in humans), as well as the biology, ecology and behaviour of the mosquito vector. Improved [[Diagnosis|diagnostics]] would enable faster and more appropriate treatment.<ref>{{cite journal | vauthors = Laughlin CA, Morens DM, Cassetti MC, Costero-Saint Denis A, San Martin JL, Whitehead SS, Fauci AS | title = Dengue research opportunities in the Americas | journal = The Journal of Infectious Diseases | volume = 206 | issue = 7 | pages = 1121–1127 | date = October 2012 | pmid = 22782946 | pmc = 3499110 | doi = 10.1093/infdis/jis351 }}</ref> Attempts are ongoing to develop an [[Antiviral drug|antiviral]] medicine targeting the NS3 or NS5 proteins.<ref>{{cite journal | vauthors = Obi JO, Gutiérrez-Barbosa H, Chua JV, Deredge DJ | title = Current Trends and Limitations in Dengue Antiviral Research | journal = Tropical Medicine and Infectious Disease | volume = 6 | issue = 4 | page = 180 | date = September 2021 | pmid = 34698303 | pmc = 8544673 | doi = 10.3390/tropicalmed6040180 | doi-access = free }}</ref>

In addition to the two vaccines which are already available, several vaccine candidates are in development.<ref>{{cite journal | vauthors = Kariyawasam R, Lachman M, Mansuri S, Chakrabarti S, Boggild AK | title = A dengue vaccine whirlwind update | journal = Therapeutic Advances in Infectious Disease | volume = 10 | article-number = 20499361231167274 | date = 20 April 2023 | pmid = 37114191 | pmc = 10126642 | doi = 10.1177/20499361231167274 }}</ref>

An area of active research is developing experimental models for Dengue, beyond experimental animal models. [[organ-on-a-chip|Organ Chips]] and Lab-on-Chips have been developed to model Dengue leak syndrome and [[mechanobiology|mechanopathology]].<ref>{{cite web |last1=LBSP |first1=Bilyana |title=Leiden scientists create first-ever dengue-on-a-chip to study this deadly virus |url=https://leidenbiosciencepark.nl/news/leiden-scientists-create-first-ever-dengue-on-a-chip-to-study-this-deadly-virus/ |website=Leiden Bio Science Park |date=11 April 2025}}</ref><ref>{{cite journal |last1=Tang |first1=Huaqi |last2=Evers |first2=Tom M. J. |last3=Babaei |first3=Mehrad |last4=Mashaghi |first4=Alireza |title=Revealing Mechanopathology Induced by Dengue NS1 Using Organ Chips and Single-Cell Force Spectroscopy |journal=ACS Biomaterials Science & Engineering |date=14 April 2025 |volume=11 |issue=4 |pages=2448–2455 |doi=10.1021/acsbiomaterials.4c02410|pmid=40131123 |pmc=12001184 }}</ref>

== Society and culture ==

=== Blood donation ===

Outbreaks of dengue fever increase the need for blood products while decreasing the number of potential [[blood donor]]s due to potential infection with the virus.<ref name="Teo-2009">{{cite journal | vauthors = Teo D, Ng LC, Lam S | title = Is dengue a threat to the blood supply? | journal = Transfusion Medicine | volume = 19 | issue = 2 | pages = 66–77 | date = April 2009 | pmid = 19392949 | pmc = 2713854 | doi = 10.1111/j.1365-3148.2009.00916.x }}</ref> Someone who has a dengue infection is typically not allowed to donate blood for at least the next six months.<ref name="Teo-2009"/>

=== Public awareness ===

[[File:Dengue alert post in Tampines, Singapore.jpg|thumb|upright=1.35|A poster in [[Tampines]], Singapore, notifying people that there are ten or more cases of dengue in the neighbourhood (November 2015)]]

International Anti-Dengue Day is observed every year on 15 June in a number of countries.<ref name=DayWHO2013>{{cite web|title=Marking ASEAN Dengue Day|url=http://www.wpro.who.int/emerging_diseases/meetings/ASEAN.dengue.day.2013/en/|access-date=16 June 2015|url-status=dead|archive-url=https://web.archive.org/web/20150617222405/http://www.wpro.who.int/emerging_diseases/meetings/ASEAN.dengue.day.2013/en/|archive-date=17 June 2015}}</ref> The idea was first agreed upon in 2010 with the first event held in [[Jakarta]], Indonesia, in 2011.<ref name=DayWHO2013/> Further events were held in 2012 in [[Yangon]], Myanmar, and in 2013 in [[Vietnam]].<ref name=DayWHO2013/> Goals are to increase public awareness about dengue, mobilize resources for its prevention and control and, to demonstrate the Southeast Asian region's commitment in tackling the disease.<ref>{{cite book|title=ACTION AGAINST DENGUE Dengue Day Campaigns Across Asia|date=2011|publisher=World Health Organization|isbn=978-92-9061-539-2}}</ref> Efforts are ongoing as of 2019 to make it a global event.<ref>{{cite web |title=Calling for a World Dengue Day |url=https://www.isntd.org/world-dengue-day-open-letter |website=The International Society for Neglected Tropical Diseases |access-date=7 January 2019 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107233032/https://www.isntd.org/world-dengue-day-open-letter |url-status=live }}</ref>

The Philippines has an awareness month in June since 1998.<ref>{{cite news |title=Dengue Awareness Month {{!}} GOVPH |url=https://www.officialgazette.gov.ph/2011/06/02/dengue-awareness-month/ |access-date=7 January 2019 |work=Official Gazette of the Republic of the Philippines |publisher=Official Gazette |date=2 June 2011 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107181057/https://www.officialgazette.gov.ph/2011/06/02/dengue-awareness-month/ |url-status=dead }}</ref><ref>{{cite news |title=Did you know: Dengue Awareness Month {{!}} Inquirer News |url=https://newsinfo.inquirer.net/696969/did-you-know-dengue-awareness-month-2 |access-date=7 January 2019 |work=newsinfo.inquirer.net |date=9 June 2015 |archive-date=7 January 2019 |archive-url=https://web.archive.org/web/20190107181201/https://newsinfo.inquirer.net/696969/did-you-know-dengue-awareness-month-2 |url-status=live }}</ref>

A National Dengue Day is held in India annually on 16 May.<ref>{{cite web |date=6 June 2018 |title=National Dengue Day |url=https://www.nhp.gov.in/national-dengue-day_pg |url-status=dead |archive-url=https://web.archive.org/web/20190107232919/https://www.nhp.gov.in/national-dengue-day_pg |archive-date=7 January 2019 |access-date=7 January 2019}}</ref>

=== Economic burden ===
Persistent symptoms negatively impact patients' quality of life, reduce productivity, and increase medical and economic costs beyond the acute phase.<ref>{{Cite journal |last1=Wilastonegoro |first1=Nandyan N. |last2=Andriani |first2=Sri |last3=Sebong |first3=Perigrinus H. |last4=Agarwal-Harding |first4=Priya |last5=Shepard |first5=Donald S. |date=2024 |title=Estimating dengue disease and economic burden to inform municipal-level policymakers: Method for a pragmatic city-level observational cohort study |journal=Gates Open Research |volume=8 |pages=3 |doi=10.12688/gatesopenres.15015.3 |doi-access=free |issn=2572-4754 |pmc=11362393 |pmid=39221028}}</ref> A study estimated that the global burden of dengue in 2013 amounted to US$8.9 billion.<ref>{{cite journal | vauthors = Shepard DS, Undurraga EA, Halasa YA, Stanaway JD | title = The global economic burden of dengue: a systematic analysis | journal = The Lancet. Infectious Diseases | volume = 16 | issue = 8 | pages = 935–941 | date = August 2016 | pmid = 27091092 | doi = 10.1016/s1473-3099(16)00146-8 }}</ref>

{{clear}}

== References ==
{{Reflist}}

== External links ==
{{Sister project links |wikt=no|commons=Category:Dengue |b=no |n= no|q=no |s=no |v=no |voy=Dengue|species=no |d=no |display=Dengue fever }}

{{Medical condition classification and resources
 | ICD11           = {{ICD11|1D20}}, {{ICD11|1D21}}, {{ICD11|1D22}}
 | ICD10           = {{ICD10|A|97||a|00}}
 | ICD9            = {{ICD9|061}}
 |OMIM=614371
 | DiseasesDB      = 3564
 | MedlinePlus     = 001374
 | eMedicineSubj   = med
 | eMedicineTopic  = 528
 | MeshName        = Dengue
 | MeshNumber      = C02.782.417.214
}}
{{Zoonotic viral diseases}}
{{Portalbar|Medicine|Viruses}}
{{Authority control}}

[[Category:Dengue fever| ]]
[[Category:Insect-borne diseases]]
[[Category:Tropical diseases]]
[[Category:Vaccine-preventable diseases]]
[[Category:Zoonotic viral diseases]]