today I'm going to answer nine frequently asked questions about dengue and why I'm making this video about dengue because today, February 21, 2024, we are reaching the mark of 688,000 probable cases of dengue in Brazil's health system and we have already we have confirmed 122 cases of deaths due to dengue in today's video so I will explain number one What the cause of dengue is it a virus is it a bacteria how is dengue transmitted can it pass from person to person who is more at risk of getting serious with dengue what are the symptoms what are the signs of severity what is the famous hemorrhagic dengue how do we diagnose how do we protect ourselves and also talk a little about vaccines and immunity I am DrMozar Suzigan cardiologist And why is a cardiologist is talking about dengue because dengue affects many patients that the cardiologist treats in the ICU that he treats in the office are heart patients, elderly patients and even young patients that we unfortunately receive in the ICU with severe dengue but after all, what is the cause of dengue? dengue is a disease caused by a virus that has four types, denv 1, 2, 3 and 4, they are all types of dengue. So if a patient can be infected by type, another patient can be infected by type two and we have a reference dengue epidemic since 1916, it was a case registered in São Paulo and in 1923, a case that drew attention in Niterói, Rio de Janeiro, but anyway, how is dengue transmitted first?
There is no direct transmission between people, like Covid, for example, it is transmitted by bites from infected female mosquitoes are called aedes egipt aedes egipt means nasty hateful from Egypt, why is this because aedes egypt appeared in Africa, probably there in the Northeast region of Africa and from Africa it was spreading to Asia to the Americas and mainly through ships arrived in countries in Brazil, it is estimated that Egypt arrived around 1500 1600 and it turns out that these animals were transported by boats and also Another important point is that mosquito eggs can resist without being in contact with water, for example, on top of the wood for up to a year in 1955, Brazil ended up wiping out eg, but unfortunately we had the return of these mosquitoes in Brazil, but Mozer has a way for us to recognize this mosquito from Ed, Egypt, folks, it's not easy, but One way is to evaluate the legs, the trunk and the head are all black and white striped. This mosquito feeds on the sap of plants and will bite humans or even animals looking for blood to mature the eggs it has. managing there, on average, each mosquito can live for around 30 to 40 days and the female lays within this period around 150 to 200 eggs in a period of about a week, the larva already gives rise to the new mosquito, so it is very quickly, any dengue epidemic will be directly related to the amount of insects we have there, which is greater in the hottest months of the year, especially from October to May, in the hottest temperatures, focused there in March, April and May, especially the eggs, they don't they are placed directly in clean water, it is not that the mosquito will deposit the egg in the water closer to the water on surfaces such as cans, bottles, tires, gutters, water boxes, plates of plant pots, and then what happens when it rains, the rain takes these eggs to in the water and in the water it will hatch, it will give rise to these larvae, as I told you, they will turn into mosquitoes in a very short time and did you know that other diseases are also transmitted by the AIDS mosquito in Egypt, in addition to dengue, such as chikungunya, fever Yellow and Zica, although it is extremely rare, transmission can also occur through organ transplantation, blood transfusion and even passing from the mother to the fetus, although this is very, very rare, another interesting fact is that dogs can also be bitten by the Aed des Egypt mosquito and be infected by the heartworm Guys, this one is Chico So you have to be careful because the mosquito is from Egypt remember what I said PR You can transmit the disease to your dogs Chico let me record it now So guys when we talk about containment In addition to protecting humans, we are protecting our animals, our dogs, third question.
Who is most at risk of getting dengue, the most vulnerable, of getting really sick with dengue? severe dengue is small children pregnant women women who are growing elderly people with high blood pressure diabetes asthma previous heart attack cancer that has a problem with the immune system So as a cardiologist We are very afraid of patients with heart disease acquiring dengue for several reasons the patient who has it heart problems are generally more fragile, older patients have other health problems, diabetes, high blood pressure, mosquitoes are more likely to cause complications, second point, patients with heart problems generally use as, as cannot be used in the case of dengue fever because it can increase the risk of bleeding due to dengue In addition, patients with heart problems use anticoagulants sometimes, this will also increase the risk of bleeding, so when I have a patient with a heart problem who uses anticoagulants or anticoagulants and I have dengue fever, I need to think very carefully. calm down, what am I going to do with these two medications Because from the moment I take these medications off I am putting the patient at risk of having a new heart attack or having a new stroke, for example.
So, if you have a heart problem and you have with dengue fever, please talk to your cardiologist and the fourth question is what are the symptoms? death we say that a patient is a suspected case of dengue when he has a fever and at least two of the following manifestations that I will tell you about here headache pain behind the eyes redness in the skin weakness muscle pain and joint pain so all cases who has a fever and two of these symptoms are suspected cases of dengue fever the symptoms usually start 4 to 10 days after the patient was bitten guys I wanted to interrupt a little to ask you to kindly subscribe here to my channel leave a like leave a comment about This video is for those who need to learn about this, protect themselves against dengue fever and also help me here on the channel, this video will reach more and more people, you can leave a like here, subscribe to the channel, activate the bells, as well as receive new updates quickly videos that I post about health about cardiology will help me a lot here so continuing and the disease has an average duration of 5 to 10 days after this critical phase of dengue fever the patient will enter a recovery phase But this period can be quick but it it can also take a while Sometimes the patient takes a while to get better, he becomes very weak for several weeks, it depends on the degree of dengue and it depends on the severity of the patient, most patients will recover quickly, they will be fine, but some cases in which dengue acquires a second phase and symptoms worsen, which is generally between the third and seventh day of the onset of the disease and with this worsening we can have a more serious disease that can greatly increase the risk of these patients having serious bleeding and even death, but this fortunately happens in a small proportion of patients, so regarding these serious cases, question number five, what are the signs of severity, are several pains in the belly, a pain that is intense, continuous, constant vomiting, an increase in the size of the liver that we put our hand on, the patient feels pain, episodes of falling of pressure episodes of feeling faint, a significant weakness, children can become very irritated, a drop in temperature, which we call hypothermia, drowsiness or a lot of irritability, which we see in elderly patients, a decrease in the amount of urine, mucosal bleeding, such as the nose, mouth, an increase in weeds and a drop in platelets, which is something that the doctor observes in the blood count shortness of breath bleeding in the stool also draws attention peruna number six What is hemorrhagic dengue fever, folks, the term hemorrhagic dengue or hemorrhagic fever is becoming increasingly common less being used because that just means a worse evolution and this worse evolution does not necessarily have hemorrhage hemorrhage is excessive bleeding and that's why we are using more the fear of severe dengue the initial symptoms of hemorrhagic dengue of severe dengue are similar to more dengue light that I told you just now, but there is a worsening of these symptoms between the third and seventh day with the appearance of these serious symptoms that I mentioned in the last question here and the patient can develop severe bleeding with a drop in pressure, convulsions and cases in which he can no longer have adequate blood circulation and unfortunately this patient may die, an important fact is that if someone is infected for the first time, the chance of this patient having severe dengue fever is lower, but if he is infected for the second time, the chance of this condition If they get worse they end up being a little bigger but it doesn't mean that every second infection will be more serious it depends on each patient It depends on the diseases that this patient already has it depends on the medicines that this patient already uses It depends on how the patient's body will react question number seven How the diagnosis is made So, as dengue is a very common and very frequent disease, so we don't leave any case without a diagnosis, we will call the cases probable cases, which are initially suspected cases when the person will have those symptoms that I I spoke to you earlier about fever and at least two of the following manifestations I will repeat because it is so important that it is fever plus headache pain behind the eyes redness of the skin weakness muscle pain and joint pain if you have two of these symptoms plus fever it is one case considered suspicious to make a personal diagnosis, in addition to this clinical history, we understand where the patient came from, if they are having a lot of cases of dengue there, if those symptoms could be from other diseases, we will do a complete blood count of this patient, this complete blood count will show us, we will look mainly at the hematocrit and the platelets, these are two little technical details that the doctor, looking at, if the hematox increases and the platelets drop, can be an additional indication, in addition to the history, that this patient may have D. Furthermore, in addition to this history and blood count, we will do other blood tests, obviously this will exclude other differential diagnoses, this patient may have meningitis, this patient may have a urine infection, this patient may just have an intestinal infection, he may just have covid, but We do have tests that we can do up until the fifth day, which is PCR to assess the presence of the virus or after the fifth day, a serology exam, I remember that these two tests are not available in most places, they have a high cost, so the We don't need these tests to make us suspicious of a patient or to guide this patient, so these tests can be used, they confirm that the patient has dengue but they are not mandatory, so a patient completing all these tests, clinical evaluation will understand if this patient has a probable case of dengue has a confirmed case of dengue if he is more likely to have another disease than dengue and will guide this patient he needs to be hospitalized to receive a serum in the internal vein to undergo continuous tests to receive a transfusion of platelet blood or he can receive something so this will be there at the time of the assessment so the eighth question is how are we going to protect ourselves from getting infected with dengue although we already have a vaccine against dengue the control of the AES mosquito in Egypt is the main method for us to be able to prevent both dengue, chungu and zic and yellow fever, despite the fact that in the past, back in 1950, this mosquito was eradicated, that is, we got rid of it, today it is practically impossible for us to achieve this because with the Population growth, disorderly occupation of environments, the lack of basic sanitation infrastructure in large cities makes it very difficult for us to put an end to all these outbreaks that help mosquitoes proliferate, and in this personal sense, the most effective way for us to combat it is with awareness.
and constant monitoring of possible outbreaks in homes by the entire population then everyone can help with this And furthermore, it is important that the population, in addition to understanding the importance of this, cooperates with the city hall so that vacant lots of abandoned houses and any other place that could serve as a breeding ground for mosquitoes are monitored . These are still waters All stagnant water can be the focus of mosquito development, so there's no point in waiting until the summer for the rainy season so we can start chasing it throughout the year. We have to take preventive actions to stop the development of this mosquito .
If there is someone confirmed in the region, for example, it is necessary to investigate the outbreaks of larvae and the presence of mosquitoes in the neighborhood and in addition to the government, as I told you, we can use window screens and repellents in areas of known transmission, removing mosquitoes. containers in homes where we can accumulate water that are mosquito breeders, seal off places where mosquitoes can lay their eggs, such as a water tank, a water reservoir, unblock drains on slabs that accumulate liquid there too, and help with government supervision, do not let accumulate water in plant dishes or other places in our backyard. Swimming pools are important that they are cleaned regularly and covered with a tarp and for individual prevention, obviously repellents do help .
the ninth question about vaccine and immunity talking about immunity the first infection with dengue will not guarantee that you are immune to those four types So if the patient caught type one he will be protected against type one he can become infected with two or three and the four for example, so when she is infected by one type she is immune only to it and is open to infection from others and if she gets dengue again, so for another type this time this other type can be a little more aggressive but not necessarily The Second Time It is the most serious case but in most cases of severe dengue hemorrhagic dengue will occur in patients who have already been infected It was clear if you have already been infected not necessarily a second time will be more serious but the majority of cases that has the most serious cases are of second infection and about the Ked denga vaccine on December 21, 2023 the vaccine against dengue was incorporated into the Unified Health System which is Ked denga produced by the pharmaceutical company taeda is a vaccine produced from the weakened viruses So we have a very small part of the virus there, when it enters our body, our body will induce a response from the immune system, functioning similar to the body's defense when we are infected. So put a small piece of the virus there in our body will produce antibodies a vaccine against denga it needs to act against these four types at the same time and Ked denga does this according to its leaflet patients aged 4 to 60 could receive the vaccine but initially in the Unified Health System it will be aimed at children and adolescents aged 10 to 14, which is an age group that presents a higher risk of serious cases, especially in regions where we see more cases of the disease, the laboratory does not have a large quantity available for the entire population and this vaccination schedule will be consisting of two doses with an interval of 3 months between them, then you received one dose, now you wait 3 months to receive the next one and pay attention, those who have already had dengue should also get vaccinated to avoid new infections or, in case of contagion, have milder symptoms, remember similar to covid, in addition, these people are expected to have a better immunological response to the vaccine because the body will accept this vaccine better, so the recommendation for those who have recently had dengue is to wait months to take the vaccine and the contraindications of Ked denga are the same for vaccines made to from a Live virus which is an attenuated Live virus and these patients that we do not advise to take the vaccine are pregnant women who are increasing and people with serious immunological problems so when in doubt Ask your doctor if you can and should take the vaccine there is another vaccine that is from Butantã, a recent study that came out had a very satisfactory response and we are keeping Anvisa's approval, it is a single dose and will also offer protection against the four types of viruses, to conclude, I think it is very important to comment on the difference between dengue and covid, folks, covid can also cause pain in the body, covid can also giving you shortness of breath, covid can also cause a drop in blood pressure, covid can also cause fever, but dengue fever is usually accompanied by more important muscle pain, covid is accompanied by more important pain behind the eyes, more important weakness and obviously There in the Clinical history we go beyond those tests that I told you about, you know, blood counts.
