By: Gredia M. Huerta-Montañez, MD, FAAP, and Joshua M. Wong, MD
About half of the world's population lives where
dengue virus spreads. In the United States, dengue is common (endemic) in some U.S. territories and freely associated states (American Samoa, Puerto Rico, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of Marshall Islands and the Republic of Palau).
Many times, dengue is mild. But those at risk of severe dengue may need hospital care. If your family is at risk for dengue, consult your pediatrician for
information about the dengue vaccine for children and adolescents.
What is dengue?
Dengue is a disease caused by one of the four related viruses: dengue 1, 2,3, and 4. There are four types of dengue viruses, therefore, people can get infected four times throughout their lives. Dengue viruses are spread to people through the bite of an infected
Aedes species of mosquito
(Aedes aegypti or Aedes albopictus).
Dengue outbreak in Puerto Rico
On March 25, 2024, the Puerto Rico Department of Health declared dengue as a
public health emergency. The
Centers for Disease Control and Prevention recommends the dengue vaccine for children ages 9 through 16 years who live in Puerto Rico. To be eligible for the dengue vaccine, your child or teen must first have a test to confirm that they had a previous dengue infection. Testing is available in Puerto Rico. Contact your child's health care provider for details.
Here is what families need to know about symptoms of dengue, when to get medical care and tips to
prevent bites from mosquitos that spread dengue.
Is dengue dangerous?
For many who get sick, dengue is mild. Some who get sick with dengue have sudden onset of fever with other symptoms including nausea, vomiting, aches and pain (muscle, joint, or bone pain, pain behind the eyes), or a rash.
Warning signs of severe dengue: About 1 in 20 people who get sick will have severe dengue—a medical emergency that requires immediate medical care at a hospital. Severe dengue can have serious effects on the liver, heart, central nervous system, kidneys, eyes, muscles, or bone marrow. Severe dengue can also lead to death.
These warning signs usually begin around the time fever starts to go away and include stomach pain and tenderness, vomiting (3 times or more in 24 hours), bleeding from the nose or gums, blood in vomit or stool, and extreme tiredness, restlessness, or irritability.
Some people are at higher risk of serious illness: People who have been infected with a dengue virus in the past are more likely to develop severe dengue illness the next time they get infected. Infants and pregnant women are at higher risk for severe dengue. Hospitalization with dengue is also common in older children and adolescents.
How is dengue treated?
Currently, no medication is available to effectively treat a dengue infection or shorten your child's length of illness. Mild symptoms can be treated at home by resting as much as possible, controlling fever, and preventing dehydration. Watch for warning signs as fever goes away.
If your child has a fever, their doctor may suggest acetaminophen and physical cooling methods. Non-steroidal anti-inflammatory (NSAID) medication and aspirin are not recommended because of the risk of bleeding and other problems. Some patients at high risk for severe dengue may need to be monitored in the hospital.
For
babies and children who develop symptoms of dengue, illness can become serious quickly.
The sooner their serious symptoms are recognized, the better. Severe dengue infections may require intravenous (IV) treatment and hospital care.
Can dengue spread to my baby if I get infected while pregnant or breastfeeding?
A pregnant woman who is infected with dengue can pass the virus to her fetus during
pregnancy or around the time of birth. Dengue can have harmful effects, including death of the fetus, low birth weight and premature birth.
To date, there has been one report of dengue spread through breast milk. Because of the benefits of breastfeeding, mothers are encouraged to continue breastfeeding even with a dengue infection.
How can I help protect my children and my family from dengue?
There are two ways to prevent dengue: preventing mosquito bites and, for some children, a vaccine.
Prevention: It is essential to control the mosquitoes inside and outside the home, prevent mosquito bites by using an U.S. Environmental Protection Agency (EPA)-registered insect repellent, and use other methods, such as wearing long-sleeved shirts and long pants.
Vaccination: In 2021, a dengue vaccine, Dengvaxia, was approved and recommended to prevent dengue illness, hospitalization, and severe dengue in children ages 9 through 16 years who have laboratory evidence of a previous dengue infection and live in dengue-endemic areas.
Consult with your child's pediatrician to learn more about your family's risk for dengue infection and severe dengue, and how this vaccine can help protect your children from dengue.
Is the dengue vaccine for all kids?
No. The Dengvaxia dengue vaccine is recommended specifically for children:
9 through 16 years of age,
who have laboratory evidence of previous dengue infection,
who currently live in areas where dengue is common.
Kids with no evidence of previous dengue infection cannot get the dengue vaccine as it may increase their risk of hospitalization and severe illness if they get infected with dengue in the future. The dengue vaccine is not recommended for people traveling to endemic areas.
How effective is the dengue vaccine?
The dengue vaccine is more than 80% effective at preventing dengue illness, hospitalization, and severe dengue in children who have had dengue in the past.
How is the dengue vaccine administered?
The dengue vaccine is injected in the arm muscle. A total of three doses are given six months apart for full protection. Clinical studies indicate that the dengue vaccine can protect children against dengue for at least six years.
Before kids can get the dengue vaccine, a laboratory
test
is required to confirm that they have previously had a dengue infection.
The blood test will check to see if your child has had a previous dengue infection.
If the lab test results are positive, they can receive the dengue vaccine.
If the lab test results are negative, they won't be able to be vaccinated. Your child or teen should be tested again in one or two years.
Remember
Even though most people infected with dengue have mild symptoms, it can be a life-threatening disease.
If you live in an area where dengue is common, prevent mosquito bites and talk to your pediatrician about the dengue vaccine for children.
More information
About Dr. Huerta-Montañez
 Gredia Huerta-Montañez, MD, FAAP, works on environmental health and climate change solutions for children. She is past president of the AAP Puerto Rico Chapter. She is a pediatrician and a scientist with Northeastern University and teaches courses at the University of Puerto Rico School of Medicine.
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About Dr. Wong
 Joshua Wong, MD, is an Epidemic Intelligence Service officer with the Centers for Disease Control and Prevention Dengue Branch in the Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases in San Juan, Puerto Rico. Dr. Wong has worked with the Puerto Rico Department of Health to provide education about the dengue vaccine. |
This article was written in collaboration with the Centers for Disease Control and Prevention, Dengue Branch, San Juan, Puerto Rico.