2001 Revised National Consensus on the Case Management of Dengue Fever & Dengue Hemorrhagic Fever

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Summary

This document is intended to provide general guidelines to health care providers on the treatment of dengue fever (DF) and dengue hemorrhagic fever (DHF) in the out-patient and in-patient settings. The cornerstone of treatment in dengue illness is fluid management and judicious use of blood or blood products. The aim is to reduce mortality rates, prevent complications, minimize cost and limit untoward reactions from these treatment options.

Background

Dengue is endemic in the Philippines and is one of the leading causes of hospitalizations. During peak months, hospitals become overcrowded because of over-diagnosis and unnecessary confinements. Heightened awareness among the public aggravates the situation wherein hospitalization is considered life safe, if not the only option available. Health care providers likewise respond differently, sometimes worried of legal entanglements especially when the illness or its complications are not immediately recognized and there are preventable causes.

Because dengue infections have a wide array of manifestations ranging from asymptomatic to fatal shock syndromes, not too many agree on a single course of action when a particular patient is seen for the first time. The pathologic mechanisms underlying the dengue hemorrhagic fever (increased vascular permeability and abnormal hemostasis) are likewise not always consistent to explain every abnormality found on patients. Nevertheless, there is general agreement that effective fluid management remains to be the cornerstone of the treatment, aided by judicious use of blood and blood products. The WHO has recently provided general treatment guidelines for dengue hemorrhagic fever using algorithms to facilitate decision-making.

The Department of Health through San Lazaro Hospital convened a Working Group of experts to establish and finalize a new set of guidelines in September 1998. Treatment recommendations have been formulated and adapted by both public and private sectors in previous years. With sufficient data and experiences, the group deemed it necessary to review and update existing guidelines to come up with a modified and perhaps unified consensus guideline to prevent unnecessary hospitalizations and deaths. Thus, on April 5-6, 2001 a workshop was conducted for this activity. Treatment recommendations provided in this document are based on published and unpublished data on dengue infection and treatment and when no definitive data were available, on the consensus of the Working Group. It is recommended that the guidelines be regarded as flexible and not supplant the clinical judgment of experienced health care providers. It is recognized that these guidelines will need to be modified as new information and experience become available.

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