Friday, January 13, 2012
Sunday, July 10, 2011
State Bank of India – Fixed Deposit Interest Rates - on 11th July 2011
| Type | Tenor | Interest Rate | As on |
| Public | 7 day to 90 days | 7.00% | 11/07/2011 |
| Public | 91 days to 179 days | 7.25% | 11/07/2011 |
| Public | 180 days to 240 days | 6.50% | 11/07/2011 |
| Public | 214 days to less than 1 year | 7.75% | 11/07/2011 |
| Public | 1 year less than 2 years | 9.25% | 11/07/2011 |
| Public | 2 years to less than 3 years | 9.25% | 11/07/2011 |
| Public | 3 years to less than 5 years | 9.25% | 11/07/2011 |
| Public | 5 years to 10 years | 9.25% | 11/07/2011 |
| Senior Citizens | 91 days to 179 days | 7.25% | 11/07/2011 |
| Senior Citizens | 180 days to 240 days | 6.50% | 11/07/2011 |
| Senior Citizens | 214 days to less than 1 year | 7.75% | 11/07/2011 |
| Senior Citizens | 1 year less than 2 years | 9.75% | 11/07/2011 |
| Senior Citizens | 2 years to less than 3 years | 9.75% | 11/07/2011 |
| Senior Citizens | 3 years to less than 10 years | 9.75% | 11/07/2011 |
Saturday, March 12, 2011
Delhi Auto Rickshaw and Delhi Taxi Fare Chart
CURRENT FARES CHARGEABLE W.E.F - 23/6/2010 BY THE AUTO-RICKSHAWS & TAXIS IN DELHI
| Taxi (Black &Yellow Top) | Auto Rickshaw | |||
| Fare |
| Fare | Rs 19/- for first fall of 2 Kilometer (upon downing the meter) and thereafter Rs. 6.50/- per Kilometer for every additional Kilometer | |
| Night Charges | 25% of the fare (11:00 PM to 5:00 AM) | Night Charges | 25% of the fare (11:00 PM to 5:00 AM) | |
| Waiting Charges | Rs 30/- per hour or part thereof (Subject to a minimum of 15 minutes stay) | Waiting Charges | Rs 30/- per hour or part thereof (Subject to a minimum of 15 minutes stay) | |
| Luggage | Rs. 10/- shall be charged as extra luggage charges whereas the driver/ operator shall not charge and money for a shopping bag or a small suitcase | Luggage | Rs. 7.50/- shall be charged as extra luggage charges whereas the driver/ operator shall not charge and money for a shopping bag or a small suitcase | |
http://www.delhitrafficpolice.nic.in/auto-taxi-fare.htm
Friday, August 20, 2010
Dengue in india
Labels:
Dengue in india
Impact of Dengue
During the 19th century, dengue was considered a sporadic disease that caused epidemics at long intervals, a reflection of the slow pace of transport and limited travel at that time. Today, dengue ranks as the most important mosquito-borne viral disease in the world. In the last 50 years, incidence has increased 30-fold. An estimated 2.5 billion people live in over 100 endemic countries and areas where dengue viruses can be transmitted. Up to 50 million infections occur annually with 500 000 cases of dengue haemorrhagic fever and 22,000 deaths mainly among children. Prior to 1970, only 9 countries had experienced cases of dengue haemorrhagic fever (DHF); since then the number has increased more than 4-fold and continues to rise.
Dengue fever
The clinical features of DF frequently depend on the age of the patient. Infants
and young children may have an undifferentiated febrile disease, often with a
maculopapular rash. Older children and adults may have either a mild febrile
syndrome or the classic incapacitating disease with high fever of abrupt onset,
sometimes with 2 peaks (saddle-backed), severe headache, pain behind the
eyes, muscle and bone or joint pains, nausea and vomiting, and rash. Skin
haemorrhages (petechiae) are not uncommon. Leukopenia is usually seen and
thrombocytopenia may be observed. Recovery may be associated with pro-
longed fatigue and depression, especially in adults.
Case definition for dengue haemorrhagic fever
The following must all be present:
Fever, or history of acute fever, lasting 2–7 days, occasionally biphasic.
Haemorrhagic tendencies, evidenced by at least one of the following:
— a positive tourniquet test1
— petechiae, ecchymoses or purpura
— bleeding from the mucosa, gastrointestinal tract, injection sites or other
locations
— haematemesis or melaena.
Thrombocytopenia (100 000 cells per mm3 or less).2
Evidence of plasma leakage due to increased vascular permeability, mani-
fested by at least one of the following:
— a rise in the haematocrit equal to or greater than 20% above average for
age, sex and population;
Indications for hospitalization
Hospitalization for bolus intravenous fluid therapy may be necessary where
significant dehydration (Ͼ10% of normal body weight) has occurred and rapid
volume expansion is needed. Signs of signficant dehydration include:
- Tachychardia
- Increased capillary refill time (Ͼ2 s)
- Cool, mottled or pale skin
- Diminished peripheral pulses
- Changes in mental status
- Oliguria
- Sudden rise in haematocrit or continuously elevated haematocrit despite
- administration of fluids
- Narrowing of pulse pressure (Ͻ20 mmHg (2.7 kPa) )
- Hypotension (a late finding representing uncorrected shock).
Essential laboratory tests
In assessing a patient’s condition, the following tests are recommended:
- Haematocrit
- Serum electrolytes and blood gas studies
- Platelet count, prothrombin time, partial thromboplastin time and thrombin time
- Liver function tests—serum aspartate aminotransferase, serum alanine ami-
- notransferase and serum proteins.
Criteria for discharging inpatients
The following criteria should be met before patients recovering from DHF/
DSS are discharged:
- Absence of fever for at least 24 hours without the use of antifever therapy (cryotherapy or antipyretics)
- Return of appetite
- Visible clinical improvement
- Good urine output
- Stable haematocrit
- Passing of at least 2 days after recovery from shock
- No respiratory distress from pleural effusion or ascites
- Platelet count of more than 50 000 per mm3.
http://www.who.int/csr/resources/publications/dengue/Denguepublication/en/
Frequently Asked Questions
Q. What is dengue?
A. Dengue (pronounced den' gee) is a disease caused by any one of four closely related dengue viruses (DENV 1, DENV 2, DENV 3, or DENV 4). The viruses are transmitted to humans by the bite of an infected mosquito. In the Western Hemisphere, the Aedes aegypti mosquito is the most important transmitter or vector of dengue viruses, although a 2001 outbreak in Hawaii was transmitted by Aedes albopictus. It is estimated that there are over 100 million cases of dengue worldwide each year.
Q.What is dengue hemorrhagic fever (DHF)?
A.DHF is a more severe form of dengue infection. It can be fatal if unrecognized and not properly treated in a timely manner. DHF is caused by infection with the same viruses that cause dengue fever. With good medical management, mortality due to DHF can be less than 1%.
Q.How are dengue and dengue hemorrhagic fever (DHF) spread?
A. Dengue is transmitted to people by the bite of an Aedes mosquito that is infected with a dengue virus. The mosquito becomes infected with dengue virus when it bites a person who has dengue virus in their blood. The person can either have symptoms of dengue fever or DHF, or they may have no symptoms. After about one week, the mosquito can then transmit the virus while biting a healthy person. Dengue cannot be spread directly from person to person.
Q.What are the symptoms of the disease?
A. The principal symptoms of dengue fever are high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash, and mild bleeding (e.g., nose or gums bleed, easy bruising). Generally, younger children and those with their first dengue infection have a milder illness than older children and adults.
Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms consistent with dengue fever. When the fever declines, symptoms including persistent vomiting, severe abdominal pain, and difficulty breathing, may develop. This marks the beginning of a 24- to 48-hour period when the smallest blood vessels (capillaries) become excessively permeable (“leaky”), allowing the fluid component to escape from the blood vessels into the peritoneum (causing ascites) and pleural cavity (leading to pleural effusions). This may lead to failure of the circulatory system and shock, followed by death, if circulatory failure is not corrected. In addition, the patient with DHF has a low platelet count and hemorrhagic manifestations, tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding.
Q.What is the treatment for dengue?
A. There is no specific medication for treatment of a dengue infection. Persons who think they have dengue should use analgesics (pain relievers) with acetaminophen and avoid those containing aspirin. They should also rest, drink plenty of fluids, and consult a physician. If they feel worse (e.g., develop vomiting and severe abdominal pain) in the first 24 hours after the fever declines, they should go immediately to the hospital for evaluation.
Q.Is there an effective treatment for dengue hemorrhagic fever (DHF)?
A. As with dengue fever, there is no specific medication for DHF. It can however be effectively treated by fluid replacement therapy if an early clinical diagnosis is made. DHF management frequently requires hospitalization. Physicians who suspect that a patient has DHF may want to consult the Dengue Branch at CDC, for more information.
Q. Where can outbreaks of dengue occur?
A.Outbreaks of dengue occur primarily in areas where Ae. aegypti (sometimes also Ae. albopictus) mosquitoes live. This includes most tropical urban areas of the world. Dengue viruses may be introduced into areas by travelers who become infected while visiting other areas of the tropics where dengue commonly exists.
Q.What can be done to reduce the risk of acquiring dengue?
A.There is no vaccine for preventing dengue. The best preventive measure for residents living in areas infested with Ae. aegypti is to eliminate the places where the mosquito lays her eggs, primarily artificial containers that hold water.
Items that collect rainwater or to store water (for example, plastic containers, 55-gallon drums, buckets, or used automobile tires) should be covered or properly discarded. Pet and animal watering containers and vases with fresh flowers should be emptied and cleaned (to remove eggs) at least once a week. This will eliminate the mosquito eggs and larvae and reduce the number of mosquitoes present in these areas.
Using air conditioning or window and door screens reduces the risk of mosquitoes coming indoors. Proper application of mosquito repellents containing 20% to 30% DEET as the active ingredient on exposed skin and clothing decreases the risk of being bitten by mosquitoes. The risk of dengue infection for international travelers appears to be small. There is increased risk if an epidemic is in progress or visitors are in housing without air conditioning or screened windows and doors.
Q.How can we prevent epidemics of dengue hemorrhagic fever (DHF)?
A.The emphasis for dengue prevention is on sustainable, community-based, integrated mosquito control, with limited reliance on insecticides (chemical larvicides, and adulticides). Preventing epidemic disease requires a coordinated community effort to increase awareness about dengue fever/DHF, how to recognize it, and how to control the mosquito that transmits it. Residents are responsible for keeping their yards and patios free of standing water where mosquitoes can be produced.
http://www.cdc.gov/dengue/fAQFacts/index.html
http://www.cdc.gov/dengue/prevention/index.html
http://www.healthmap.org/dengue/index.php
Methods for environmental management
Environmental management methods to control Ae. aegypti and Ae. albopictus
and reduce human–vector contact include the improvement of water supply
and storage, solid waste management and the modification of man-made larval
habitats. Table 5.2 summarizes the primary methods of environmental manip-
ulation used to control Aedes larval habitats.
Environmental management should focus on the destruction, alteration,
disposal or recycling of containers and natural larval habitats that produce the
greatest number of adult Aedes mosquitos in each community. These pro-
grammes should be conducted concurrently with health education programmes
and communications that encourage community participation in the planning,
execution and evaluation of container-management programmes (e.g. regular
household sanitation or clean-up campaigns).
Improvement of water supply and storage
One method for controlling urban Aedes vectors, particularly Ae. aegypti, is to
improve domestic water supplies. The mere delivery of potable water to neigh
bourhoods or individual homes is not, however, sufficient to reduce the use of
the water storage containers that play a dominant role in Ae. aegypti breeding
in many urban areas. For example, after piped water had been supplied to
households in one municipality in Thailand, approximately eight water storage
jars were still kept by each household. Similar situations have been reported
elsewhere in Asia and the Caribbean. Households typically continue to store
water because water supplies are not reliable. With such water storage comes
the concomitant problem of Ae. aegypti breeding and the increased risk of
dengue infection. Therefore, potable water must be delivered in sufficient
quantity, quality and consistency to reduce the use of water storage containers
that serve as larval habitats, such as drums, overhead tanks, and jars. Water
piped to households is preferable to wells, communal standpipes, rooftop
catchments and other delivery systems. If storage tanks, drums and jars are
required for water storage, they should be covered with tight lids or screens.
Many people fail to cover water containers because lids and screens are not
designed in such a way that they will seal containers while nevertheless enabling
users to withdraw water easily. Water storage systems, however, can be de-
signed to prevent Ae. aegypti oviposition or adult emergence. In Sarawak,
Malaysia, for example, mosquito-proof rainwater collection and storage con-
tainers made of high-density polyethylene have fibreglass screens in the lids that
allow rainwater to enter but prevent adult mosquitos from emerging. Covered
containers should be routinely inspected because even the best-designed lids
and screens can tear or deteriorate in harsh climates and with age.
Solid waste management
Vector control efforts should encourage effective and environmentally sound
waste management by promoting the basic rule of “reduce, reuse, recycle”. In
some parts of Africa, plastic containers that may serve as potential larval
habitats are effectively recycled. Used tyres are another form of solid waste that
is of critical importance to urban Aedes control; they should be recycled or
disposed of by proper incineration in waste transformation facilities (e.g. incin-
erators, energy-production plants, lime kilns). If cut into halves, shredded, or
chipped, tyres can be mixed with other wastes and buried in landfills, as local
sanitary regulations allow. Whole tyres should be buried in a separate area of a
landfill, to avoid their rising upwards under compaction and disrupting soil
cover.
Modification of man-made larval habitats
Common-sense approaches should be employed to reduce the potential for Ae.
aegypti mosquitos to breed in and around human habitats. For example, fences
and fence posts made from hollow stems, such as bamboo, should be cut to the
node; tyres and containers stored outside should be covered or placed in a shed,
and buckets and other small containers should be inverted if stored outdoors.
Ant traps used to protect food storage cabinets can be filled with oil or salty
water instead of fresh water; condensate-collection pans under refrigerators
and air-conditioning units should be drained and cleaned regularly. Floor
drains should be cleaned and kept covered. Roof gutters, outdoor sinks, laun-
dry basins and similar items that can retain water and serve as larval habitats
should be drained and kept free of debris. Ornamental pools and fountains can
be either chlorinated or populated with larvivorous fish. Where possible, hous-
ing should be designed or modified to reduce opportunities for mosquitos to
enter, i.e. without open eaves and with screened doors and windows. These
measures and others will help reduce or prevent the breeding of vector mosqui-
tos near humans, and thereby diminish the risk of dengue viral disease.
Chemical control
Chemicals have been used to control Ae. aegypti since the turn of the century.
In the first campaigns against yellow fever in Cuba and Panama, in conjunction
with widespread clean-up campaigns, Aedes larval habitats were treated with oil
and houses were dusted with pyrethrins. When the insecticidal properties of
DDT were discovered in the 1940s, this compound became the principal
method for Ae. aegypti eradication programmes in the Americas. When resist-
ance to DDT emerged in the early 1960s, organophosphate insecticides, in-
cluding fenthion, malathion, fenitrothion and temephos, were used for Ae.
aegypti control. Current methods for applying insecticides include larvicide
application, perifocal treatment and space spraying.
Application methods
Larvicidal or “focal” control of Ae. aegypti is usually limited to containers
maintained for domestic use that cannot be eliminated. Three larvicides can be
used to treat containers that hold drinking-water: 1% temephos sand granules,
the insect growth regulator methoprene in the form of briquettes, and BTI
(Bacillus thuringiensis H-14), which is considered below in the section on bio-
logical control. All these larvicides have extremely low mammalian toxicity, and
properly treated drinking-water is safe for human consumption.
Perifocal treatment involves the use of hand or power sprayers to apply
wettable powder or emulsifiable-concentrate formulations of insecticide as a
spray to larval habitats and peripheral areas. This will destroy existing and
subsequent larval infestations in containers of non-potable water, as well as kill
the adult mosquitos that frequent these sites. This method can be used to treat
containers that are preferred by Ae. aegypti, whether or not they hold water.
The internal and external walls of containers are sprayed until they are covered
by a film of insecticide; spraying is also extended to cover any wall within 60 cm
of the container. The surface of non-potable water in containers is also treated.
Selected insecticides and dosages for cold-spray control of Aedes aegypti a Dosage (grams of active ingredient per ha)
Organophosphates
Malathion
Fenitrothion
Naled
Pirimiphos-methyl
Pyrethroids
Deltamethrin
Resmethrin
Bioresmethrin
Permethrin
Cypermethrin
Lamda-cyhalothrin
CDC health tips and Malari and Dengue prevention tips
Areas of India with Malaria: All areas throughout country except no malaria in areas >2,000 m (>6,561 ft) in Himachal Pradesh, Jammu, Kashmir, and Sikkim. Present in cities of Delhi and Bombay (Mumbai).
If you will be visiting an area of India with malaria, you will need to discuss with your doctor the best ways for you to avoid getting sick with malaria. Ways to prevent malaria include the following:
Note: Chloroquine is NOT an effective antimalarial drug in India and should not be taken to prevent malaria in this region.
To find out more information on malaria throughout the world, you can use the interactive CDC malaria map. You can search or browse countries, cities, and place names for more specific malaria risk information and the recommended prevention medicines for that area.
If you will be visiting an area of India with malaria, you will need to discuss with your doctor the best ways for you to avoid getting sick with malaria. Ways to prevent malaria include the following:
- Taking a prescription antimalarial drug
- Using insect repellent and wearing long pants and sleeves to prevent mosquito bites
- Sleeping in air-conditioned or well-screened rooms or using bednets
Note: Chloroquine is NOT an effective antimalarial drug in India and should not be taken to prevent malaria in this region.
To find out more information on malaria throughout the world, you can use the interactive CDC malaria map. You can search or browse countries, cities, and place names for more specific malaria risk information and the recommended prevention medicines for that area.
Malaria in Province:
Malaria in Country:| Province Name | Malaria in Province | Prophylaxis for this State/Province/District |
|---|---|---|
| West Bengal | All areas | Atovaquone/ proguanil, doxycycline, or mefloquine |
| Country Name | Malaria in Country | Drug Resistance | Malaria Type | Prophylaxis for Areas with Malaria |
|---|---|---|---|---|
| India | All areas throughout country except no malaria in areas >2,000m (>6,561ft) in Himachal Pradesh, Jammu, Kashmir, and Sikkim. Present in cities of Delhi and Bombay (Mumbai). | Chloroquine | P. vivax 40%, P. falciparum 20-40%, P. malariae and P. ovale 20-40% | Atovaquone/ proguanil, doxycycline, or mefloquine |
Malaria Contact for Health-Care Providers
For assistance with the diagnosis or management of suspected cases of malaria, call the CDC Malaria Hotline: 770-488-7788 (M-F, 9 am-5 pm, Eastern time). For emergency consultation after hours, call 770-488-7100 and ask to speak with a CDC Malaria Branch clinician.
A Special Note about Antimalarial Drugs
You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use.
Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available.
For detailed information about these antimalarial drugs, see Choosing a Drug to Prevent Malaria.
More Information About Malaria
Malaria is always a serious disease and may be a deadly illness. Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health-care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites (see below).Travelers to malaria risk-areas in India, including infants, children, and former residents of India, should take one of the antimalarial drugs listed in the box above.
Symptoms
Malaria symptoms may include- fever
- chills
- sweats
- headache
- body aches
- nausea and vomiting
- fatigue
Malaria may cause anemia and jaundice. Malaria infections with Plasmodium falciparum, if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel.
Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF)
Infectious Agent
- Four immunologically related, single positive-stranded RNA viruses known as dengue viruses (DENV-1 through DENV-4) of the genus Flavivirus, family Flaviviridae, are responsible for causing dengue fever (DF) and dengue hemorrhagic fever (DHF).
- Infection with one DENV produces lifelong immunity against reinfection with that one virus and short-term (≤9 months), partial cross-protection against the other three dengue viruses. An individual may be infected up to four times during his or her lifetime.
Mode of Transmission
- Transmission occurs from the bite of an infected Aedes aegypti (rarely Aedes albopictus) mosquito. Mosquitoes first become infected with DENV by feeding on the blood of a dengue-infected person. After the virus replicates for 8–12 days in the mosquito, the mosquito can transmit DENV to many other people.
- Direct person-to-person transmission has not been documented. A few case reports have been published of transmission of DENV through exposure to: dengue-infected blood, organs, or other tissues from blood transfusions; solid organ or bone marrow transplants; needlestick injuries; and mucous membrane contact with dengue-infected blood.
Occurrence
- Dengue infections have been reported in over 100 countries and are widespread in most tropical countries of the South Pacific, Asia, the Caribbean, the Americas, and Africa (Maps 5-1 and 5-2). The geographic spread of dengue infections is similar to that of malaria, but unlike malaria, dengue infections are often found in the urban areas of tropical nations, including Thailand, Singapore, Taiwan, Indonesia, Philippines, India, and Brazil. Because the main risk of exposure for the traveler is in populated urban and residential areas, travelers are advised to consult CDC (www.cdc.gov/ncidod/dvbid/dengue) and WHO www.who.int/topics/dengue/en websites for outbreak information.
- Recently, locally acquired dengue infections have been reported in Texas, Hawaii, and the Middle East.
Risk for Travelers
- Cases of DF and DHF are confirmed every year among travelers returning to the United States. Infection rates (based on antidengue serology) among febrile travelers returning from dengue-endemic areas in the tropics range from 2.9% to 8.0%.
- Dengue was the leading cause of systemic febrile illness among travelers returning from the Caribbean, South America, South Central Asia, and Southeast Asia in a recent study of 17,353 ill travelers seen at GeoSentinel surveillance network clinics. In some case studies, dengue is the second most common cause of hospitalization (malaria is the most common) among travelers returning from the tropics.
- The bite of one infected mosquito can result in infection. The risk of being bitten is highest during the early morning, several hours after daybreak, and in the late afternoon several hours before sunset, because the female mosquito typically feeds (bites) during these hours. However, mosquitoes may feed at any time during the day.
- Published data are limited on the health outcomes associated with dengue infection among pregnant women and the effects of maternal dengue infection on a developing fetus. However, if a pregnant woman has dengue at the time of delivery, the infant can be born with dengue infection or acquire dengue during labor and delivery and then develop the clinical manifestations of DF or DHF. Transplacental transfer of maternal antidengue antibodies (from a previous maternal infection) may place infants at greater risk for DHF with their first dengue infection.
Clinical Presentation
- Dengue should be considered in the differential diagnosis of febrile patients with a history of travel to the tropics in the 2 weeks prior to symptom onset. The incubation period is typically 4–7 days (range 3–14 days).
- Many travelers infected with DENV are asymptomatic, as are about half of people infected with DENV who live in areas where the virus is widespread.
- The clinical manifestations of symptomatic illness range from mild, undifferentiated febrile illness to classic DF or DHF. DF is defined clinically by an acute febrile illness with two or more of the following symptoms: headache, retro-orbital pain, muscle or joint pain, rash, hemorrhagic manifestation, or leucopenia. The rash usually appears as the fever subsides and lasts 2–4 days. The rash is either macular or maculopapular and generalized, often confluent with small patches of normal skin, and it may become scaly and itchy. Other signs and symptoms include flushed facies (usually during the first 24–48 hours), nausea, and vomiting. Approximately 1% of patients with DF develop DHF as the fever subsides (usually 3–7 days following the onset of fever).
- The hallmark of DHF is evidence of vascular leakage. DHF is defined by the presence of all the following symptoms:
- fever or recent history of fever lasting 2–7 days,
- any hemorrhagic manifestation,
- thrombocytopenia (i.e., platelet count <100,000/mm³), and
- evidence of increased vascular permeability (i.e., hemoconcentration, pleural or abdominal effusion, hypoalbuminemia, or hypoproteinemia).
- Thrombocytopenia can occur with classic DF and does not by itself indicate DHF.
- Dengue Shock Syndrome (DSS) is defined as a syndrome in any case patient who meets the criteria for DHF and has hypotension, narrow pulse pressure (≤20 mm Hg), or frank shock.
Treatment
- No specific therapeutic agents exist for dengue infections.
- Encourage bed rest and maintenance of fluids to prevent dehydration.
- Control fever with acetaminophen. Headache, back pain and muscle aching may be so severe as to require narcotics. Aspirin (acetylsalicylic acid), aspirin-containing drugs, and other nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) should be avoided because of their anticoagulant properties. Aspirin and other salicylates should be especially avoided in children due to the association with Reye syndrome.
- Ask patients to watch for warning signs of DHF or DSS as fever declines 3–7 days after onset of symptoms. Instruct patients to go to the hospital if they have any of the following warning signs: abrupt change from fever to hypothermia, severe abdominal pain, persistent vomiting, bleeding, difficulties breathing, or altered mental status (e.g., irritability, confusion, lethargy).
- Prompt and judicious administration of intravenous fluids in patients with DHF or DSS can improve outcomes. In patients with DHF or DSS, hospitalization with close monitoring of vital signs, fluid balance, and hematologic parameters (i.e., hematocrit, platelet count) is indicated, as well as additional supportive measures.
Preventive Measures for Travelers
- Neither vaccine nor drugs for preventing infection are available.
- Travelers should be advised to take measures to avoid being bitten by Aedes mosquitoes. These preventive measures include the following:
- Select accommodations with well-screened windows or air-conditioning when possible. Aedes mosquitoes typically live indoors and are often found in dark, cool places such as in closets, under beds, behind curtains, and in bathrooms. A traveler should be advised to use insecticides to get rid of mosquitoes in these areas.
- Wear clothing that adequately covers the arms and legs, especially during the early morning and late afternoon.
- Apply insect repellent to both skin and clothing (e.g., permethrin). The most effective repellents contain DEET (N,N-diethylmetatoluamide) (see the Protection Against Mosquitoes, Ticks, and Other Insects and Arthropods section in Chapter 2).
- For long-term travelers, empty and clean or cover any standing water that can be mosquito-breeding sites in your accommodation (e.g., water storage barrels).
Other items you may need:
- Iodine tablets and portable water filters to purify water if bottled water is not available. See A Guide to Water Filters, A Guide to Commercially-Bottled Water and Other Beverages, and Safe Food and Water for more detailed information.
- Sunblock and sunglasses for protection from harmful effects of UV sun rays. See Basic Information about Skin Cancer for more information.
- Antibacterial hand wipes or alcohol-based hand sanitizer containing at least 60% alcohol.
- To prevent insect/mosquito bites, bring:
- Lightweight long-sleeved shirts, long pants, and a hat to wear outside, whenever possible.
- Flying-insect spray to help clear rooms of mosquitoes. The product should contain a pyrethroid insecticide; these insecticides quickly kill flying insects, including mosquitoes.
- Bed nets treated with permethrin, if you will not be sleeping in an air-conditioned or well-screened room and will be in malaria-risk areas. For use and purchasing information, see Insecticide Treated Bed Nets on the CDC malaria site. Overseas, permethrin or another insecticide, deltamethrin, may be purchased to treat bed nets and clothes.
Note: Check the Air Travel section of the Transportation Security Administration website for the latest information about airport screening procedures and prohibited items.
Staying Healthy During Your Trip
Prevent Insect Bites
Many diseases, like malaria and dengue, are spread through insect bites. One of the best protections is to prevent insect bites by:- Using insect repellent (bug spray) with 30%-50% DEET. Picaridin, available in 7% and 15% concentrations, needs more frequent application. There is less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria.
- Wearing long-sleeved shirts, long pants, and a hat outdoors.
- Remaining indoors in a screened or air-conditioned area during the peak biting period for malaria (dusk and dawn).
- Sleeping in beds covered by nets treated with permethrin, if not sleeping in an air-conditioned or well-screened room.
- Spraying rooms with products effective against flying insects, such as those containing pyrethroid.
Prevent Animal Bites and Scratches
Direct contact with animals can spread diseases like rabies or cause serious injury or illness. It is important to prevent animal bites and scratches.- Be sure you are up to date with tetanus vaccination.
- Do not touch or feed any animals, including dogs and cats. Even animals that look like healthy pets can have rabies or other diseases.
- Help children stay safe by supervising them carefully around all animals.
- If you are bitten or scratched, wash the wound well with soap and water and go to a doctor right away.
- After your trip, be sure to tell your doctor or state health department if you were bitten or scratched during travel.
Be Careful about Food and Water
Diseases from food and water are the leading cause of illness in travelers. Follow these tips for safe eating and drinking:- Wash your hands often with soap and water, especially before eating. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol).
- Drink only bottled or boiled water, or carbonated (bubbly) drinks in cans or bottles. Avoid tap water, fountain drinks, and ice cubes. If this is not possible, learn how to make water safer to drink.
- Do not eat food purchased from street vendors.
- Make sure food is fully cooked.
- Avoid dairy products, unless you know they have been pasteurized.
Avoid Injuries
Car crashes are a leading cause of injury among travelers. Protect yourself from these injuries by:- Not drinking and driving.
- Wearing your seat belt and using car seats or booster seats in the backseat for children.
- Following local traffic laws.
- Wearing helmets when you ride bikes, motorcycles, and motor bikes.
- Not getting on an overloaded bus or mini-bus.
- Hiring a local driver, when possible.
- Avoiding night driving.
Prevent Altitude Illness and Sunburn
If you visit the Himalayan Mountains, ascend gradually to allow time for your body to adjust to the high altitude, which can cause insomnia, headaches, nausea, and altitude illness. If you experience these symptoms descend to a lower altitude and seek medical attention. Untreated altitude illness can be fatal.Use sunblock rated at least 15 SPF, especially at high altitudes, where the risk of sunburn is greater.
Other Health Tips
- To avoid infections such as HIV and viral hepatitis do not share needles for tattoos, body piercing, or injections.
- To reduce the risk of HIV and other sexually transmitted diseases always use latex condoms.
- To prevent fungal and parasitic infections, keep feet clean and dry, and do not go barefoot, especially on beaches where animals may have defecated.
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