Talk:Dengue fever/Archive 1

Global Warming

In the subsection regarding Global Warming, it is written, "It has been hypothesized that this and other diseases primarily spread by Aedes mosquitoes, are expanding their range due to climate change or global warming. [38][39][40][41][42] However, there are others who posit that climate change has not yet, and may never, affect the range of mosquito-borne diseases.[43]" I propose that the last statement is removed. I understand the need to promote both sides of an argument. However, given that there are five sides promoting one side, and only one promoting the other (and that being from the pro-business, non-scientific American Enterprise Institute), that the last sentence be removed. This way, truth is held important, not the need to promote a false idea for the sake of balance. VarunRajendran (talk) 17:28, 28 July 2010 (UTC)

I propose that the last statement be restored. Comparative citation volume alone does not merit the removal of an argument. The five pro-global-warming citations are to freelance internet articles, and not to peer-reviewed scientific journals; they each carry an equivalent amount of scientific "weight" and scrutiny as the AEI article. If I dig up and post 20 citations for the counter-argument, then shall we remove the pro-global-warming argument, due to its relatively small citation volume? 71.183.230.203 (talk) 01:22, 3 August 2010 (UTC)

None of those sources actually is peer reviewed and I opt for removing all of them and base the paragraph (is it even necessary?) solely on articles like these: http://www.nature.com/nature/journal/v438/n7066/full/nature04188.html The IP is right, the mere mass of citations does not prove any side right.

I believe that this is a topic that is not really placed well here and should either be treated in Climate Change or Infectious Disease but not in each article where it could potentially be relevant. If we were to list all possible mechanisms on how Dengue might become a threat in the future, we would not know where to start. It would be different if there were a study showing that climate change in the past has been a major factor in Dengue spreading but actually other factors might have been much more important (such as mosquito eradication and global travel)...Well the nature article actually cites such studies:

Dengue fever and the more serious form of this disease, dengue haemorrhagic fever (DHF), are caused by the world's most prevalent mosquito-borne virus. All strains of the dengue virus are carried principally by the Aedes aegypti mosquito. This mosquito is strongly affected by ecological and human drivers, particularly the density of water-bearing containers, but is also influenced by climate, including variability in temperature, moisture and solar radiation. For relatively small countries with presumably some climate uniformity, a climate-based dengue model has been developed that strongly correlates with the inter-annual variability in dengue cases reported at the national level (Fig. 1)32.

Also, el nino has been found to have an influence on Dengue cases. In conclusion, I think we should only cite peer reviewed articles and not internet news-sites with an agenda (business or otherwise). Greetings --hroest 08:00, 3 August 2010 (UTC)

Português

There are two links to Português wiki. If somebody know which one is better, remove the other. —Preceding unsigned comment added by 77.252.177.87 (talk) 08:01, 14 January 2009 (UTC)

East Anglia

Is Dengue Fever really a problem in East Anglia? —Preceding unsigned comment added by 86.134.185.128 (talk) 02:24, 23 December 2007 (UTC) It was for a time, but with the help of Super Sid, Laird of Clenchwarton, it was eradicated with the help of his band of elves and a bucket of love piss

Confusing undefined terms

I'm not a doctor but I do read medical stuff. However not being an immunologist I am confused by many terms in this article, for instance:

enhancement of DHF incidence

DHF is the Dengue virus ("Dengue hemmorhogic fever"). What does "enhancement" mean in this context? Jaysbro 14:53, 17 November 2005 (UTC)

Response: ADE stands for "Antibody Dependent Enhancement" It that, in a case of infection by a second serotype, the dengue virus gets more virulent the more the immune system tries to fight it.

"Band" redirection

I redirected Dengue Fever to here from a band article. Someone added a redirect to the band. I don't think this "band" is well known, and needs a redirect from the main page. Tokakeke 22:37, 9 December 2005 (UTC)

Case Numbers Chart

I updated the information for Indonesia, which had a large number of cases in 2005. I wasn't sure what to put on the "date of information." I settled with "Jan. 2006" but perhaps simply "EOY" (End of Year) would be better. 24.124.61.165 23:28, 19 January 2006 (UTC)

Malaria

dengue was the most important mosquito-borne viral disease affecting humans after malaria

I remove the viral from this as malaria is not a viral disease. Nil Einne 11:20, 31 July 2006 (UTC)

Dengue Epidemic in Cuba

I'm surprised that Cuba doesn't appear in the list of recent outbreaks. There clearly is one, and in the German wikipedia they mention that possibly up to 600,000 people are infected... other sources (medical institutes) guess that the number might be some 10.000, but state that no official data is available. [6 October 2006]

I've added some info about it. --Steven Fruitsmaak (Reply) 13:56, 7 October 2006 (UTC)

Another country that needs attention is Mexico. There are outbreaks every year and we are currently in the middle of one with frequent spraying and the health officials running a door to door campaign. Several people I know have been affected and I believe the figures may be higher than for some of the countries quoted. --189.165.113.234 04:07, 2 March 2007 (UTC)

Herbal cures

The 'Rumoured Herbal Cure' section is poorly written and should be fixed prior to considering this a "good article". [2006 Oct 11]

There is a Dengue Cure Protocol at www.denguecure.com —Preceding unsigned comment added by 125.60.243.79 (talk) 07:44, 14 January 2008 (UTC)

GA Review

GA review (see here for criteria)

1. It is reasonably well written.

   a (prose): b (MoS):

2. It is factually accurate and verifiable.

   a (references): b (citations to reliable sources): c (OR):

3. It is broad in its coverage.

   a (major aspects): b (focused):

4. It follows the neutral point of view policy.

   a (fair representation): b (all significant views):

5. It is stable.

   

6. It contains images, where possible, to illustrate the topic.

   a (tagged and captioned): b lack of images (does not in itself exclude GA): c (non-free images have fair use rationales):

7. Overall:

   a Pass/Fail:

• Some sections, especially "Diagnosis" and "Treatement" needs a rewrite to be comprehensive (1a)
• Section "Recent outbreaks" needs to adhere the list guideline (1c)
• Some jargon is not defined, and some words are defined in it's second part.

As it's bothe 1a and 1d, I fail this nomination, better luck when these points have been adhered. Otherwise it's a good article, the section "Signs and Symptoms" was promising. _→AzaToth 14:31, 14 October 2006 (UTC)

No factual evidences for the herbal treatment

In the Treatment section, the herbal treatment for Dengue through the consumption of juice made of papaya leaf seems to be an urban legend and do not provide any factual evidences. This could be wrong information. —The preceding unsigned comment was added by Niranjansm (talk • contribs) 09:52, 16 Oct 2006 (UTC)

I have reverted the addition of "Papaya Juice - Cure for Dengue" section, and it seems like it was reverted once before.--DO11.10 18:02, 16 November 2006 (UTC)

I suggest word 'possible' should have been added in the now removed, treatment of papaya leaves. This is because, we as yet do not know that it is falls either. Unless some authority cancels it by giving an evidence against it, removal might not be justified. Some body with sincere effort to inform readers might have put it on the main page. Pathare Prabhu (talk) 05:53, 30 August 2010 (UTC)

If I just make something up, can I put it on the page of an encyclopedia? Of course not! How do we confirm that something isn't just imagined? The burden, especially for an article like this one, is to support with reliable sources. If there is a reliable source, then (anybody) please provide one. It would fantastic if something as inexpensive and available as papaya were an effective treatment. -- Scray (talk) 15:09, 30 August 2010 (UTC)

Can we define "high"?

The article currently states: "Cases of DHF also show higher fever, haemorrhagic phenomena, thrombocytopenia and haemoconcentration. A small proportion of cases lead to dengue shock syndrome (DSS) which has a high mortality rate." "High" is a relative term. Does it mean 1 in 50 will die? 1 in 8? 1 in 1,000? Can we define it more presicely? Also, that sentence could use a source. Johntex\^talk 03:00, 6 March 2007 (UTC)

"May also cause yeast infections to the genital area": Cite please

"It may also cause yeast infections to the genital area if left untreated for a long period of time." -- Could we have a cite for this? The connection doesn't seem obvious. -- 201.51.222.169 22:33, 8 May 2007 (UTC)

I had just been looking into this statement as you wrote your query. I've been unable to find a source for the statement, so I've removed it pending a reference. -- MarcoTolo 22:37, 8 May 2007 (UTC)

Etymology Section

The etymology section seems strangely placed. I think it should move to later in the article, in the history section, and have edited to do this, but I think it's worth discussing. OcciMoron 20:16, 15 August 2007 (UTC)

Nations such as Rio?

quoting: "often found in urban areas of developed tropical nations, including Singapore, Taiwan or Rio". Is it my understanding of the sentence or does it actually say that Rio is a nation? I'm changing it to Brazil, if anyone thinks I misinterpreted it feel free to reply. —Preceding unsigned comment added by PrestoK (talk • contribs) 13:17, 25 October 2007 (UTC)

Taiwan is a tropical nation, Rio is an urban area of a tropical nation. Mixing the two is incorrect, yes. --Chriswaterguy talk 06:50, 13 November 2007 (UTC)

quoting " One major difference, however, is that malaria is often eradicated in major cities, whereas dengue is often found in urban areas of developed tropical nations, including Singapore, Taiwan, Brazil & East Anglia."

East Anglia is a region of the UK and is certainly not tropical or urban —Preceding unsigned comment added by 81.157.197.221 (talk) 13:41, 21 December 2007 (UTC)

"Dengue fever (IPA: /ˈdɛŋgeɪ/) and dengue hemorrhagic fever (DHF) are acute febrile diseases, found in the tropics and Africa, and caused..." Gee, and I had that weird misconception that Africa was in the tropics...200.244.240.42 (talk) 17:52, 14 April 2008 (UTC)

That's why they call it a misconception. It's a fancy word that means YOU ARE WRONG. There's a new invention. It's called an atlas. Perhaps you've heard of it. —Preceding unsigned comment added by 216.49.77.67 (talk) 22:02, 11 July 2008 (UTC)

relationship between dengue, DHF and DSS

The article does not make connections between dengue fever, DHF and DSS. I find in another source that DHF may occur when the patient has already had an earlier case of the milder dengue fever. Is Dengue Shock Syndrome a development of DHF? Or does it also emerge by itself? As a consequence of earlier infection with dengue fever? It would be helpful if all this were laid out methodically. Thanks. NaySay (talk) 18:56, 13 December 2007 (UTC)

Pediatric Dengue Vaccine Initiative. Adspam or not?

"... one of the many ongoing vaccine development programs is the Pediatric Dengue Vaccine Initiative which was set up in 2003 with the aim of accelerating the development and introduction of dengue vaccine(s) that are affordable and accessible to poor children in endemic countries."
This somewhat resembles adspam to me. Is it? -- Writtenonsand (talk) 16:59, 21 March 2008 (UTC)

Total number of cases figures are confusing.

The Total at the bottom is not the sum of the numbers above... and the footnote only confuses things more since it says the totals are only for the listed countries (but that doesn't work out mathematically). Unless I'm missing something in which case it should be rewritten to be more clear. —Preceding unsigned comment added by 198.239.151.48 (talk) 20:39, 15 April 2008 (UTC)

Superinfection

Superinfection is infection with a different strain of the same organism when there is already one strain of that organism present.

"Through an immunological phenomenon, known as original antigenic sin, the immune system is not able to adequately respond to the stronger infection, and the secondary infection becomes far more serious.[10] This process is also known as superinfection.[11][12]"

That statement doesn't describe superinfection; it describes a second infection later in life with a different strain to the first, once the first infection has been cleared. Original antigenic sin means that the body will produce antibodies to the first strain instead of the second. The second infection becomes more serious because of the Halstead effect (aka ADE) described just before this statement - i.e. antibodies against the first strain do not neutralise the second strain, and instead enhance uptake of the viruses into the monocytes / macrophages, where they replicate.

Also, the second infection is not necessarily stronger, only poorly addressed because of original antigenic sin.

Comma removal x1. Add "humoral"

I would replace with:

"Through an immunological phenomenon known as original antigenic sin, the humoral immune system is not able to adequately respond to the second infection, resulting in antibody-dependent enhancement, and the infection becomes far more serious.[10]"

References 11+12 would therefore fall away, as they have no relevance to the topic. KosherPork (talk) 18:43, 27 November 2008 (UTC)

I'm deleting the superinfection references as it is not relevant to dengue ADE. Superinfection has not been well studied in dengue.Cavorting 01 June 2010 —Preceding unsigned comment added by 203.127.72.10 (talk) 09:03, 1 June 2010 (UTC)

Bolivian dengue

Note: There is now an article on dengue in Bolivia. --Candlewicke _S^T _# :) 16:18, 27 February 2009 (UTC)

Order of sections

The order of sections seems a bit odd. As of 2 Nov 09 it is

  * 1 Signs and symptoms
   * 2 Diagnosis
   * 3 Etiology
   * 4 Treatment
         o 4.1 Traditional and emerging treatments
   * 5 Epidemiology
   * 6 Prevention
         o 6.1 Vaccine development
         o 6.2 Mosquito control
         o 6.3 Potential antiviral approaches
   * 7 Etymology
   * 8 History
   * 9 Use as a biological weapon
   * 10 External links
   * 11 See also
   * 12 References

In particular Prevention should go before Treatment. Perhaps it should be (I've left the original numbers)

   * 3 Etiology
       * 9 Use as a biological weapon
   * 8 History
   * 5 Epidemiology
   * 6 Prevention
         o 6.1 Vaccine development
         o 6.2 Mosquito control
         o 6.3 Potential antiviral approaches
   *   Diagnosis (section containing 2 subsections with no preceding text)
        * 1 Signs and symptoms
        * 2 Criteria for diagnosis (was top-level diagnosis section)
   * 4 Treatment
         o 4.1 Traditional and emerging treatments
   * 7 Etymology
   * 10 External links
   * 11 See also
   * 12 References

I haven't thought this through carefully, so it needs to be discussed before anything is actually changed. Pol098 (talk) 14:58, 2 November 2009 (UTC)

see WP:MED which suggests the following order:

   * Classification
   * Signs and symptoms or Characteristics
   * Causes (e.g. Risk factors, Triggers, Genetics/Genome, Virology (e.g., structure/Morphology, replication ))
   * Pathophysiology or Mechanism
   * Diagnosis (including Characteristic biopsy findings and differential diagnosis)
   * Prevention or Screening
   * Treatment or Management. This might include diet, exercise, medication, palliative care, physical therapy, psychotherapy, self care, surgery, watchful waiting, and many other possibilities. It can help to discuss treatments in a plausible order in which they might be tried, or to discuss the most common treatments first.
   * Prognosis
   * Epidemiology
   * History (not patient history)
   * Society and culture (e.g., stigma, economics, religious aspects, awareness, legal issues)
   * Research directions (if addressed by significant sources; see Trivia, and avoid useless statements like "More research is needed")
   * In other animals
   * See also (avoid if possible, use wikilinks in the main article)
   * Notes
   * References
   * Further reading or Bibliography (paper resources such as books, not web sites)
   * External links (avoid if possible)

I implemented this, by moving cause before diagnosis. Greetings --hroest 11:44, 27 March 2010 (UTC)

Small ambiguity

In the article lead there is the following sentence: Dengue is transmitted to humans by the Aedes aegypti or more rarely the Aedes albopictus mosquito, which feed during the day. It is ambiguous as to whether both or just the latter mosquito feed during the day. Perhaps it would be clearer if it mentioned ... both of which feed exclusively during daylight hours. (If that is indeed the case). Samcol1492 (talk) 05:55, 27 March 2010 (UTC)

please go ahead and correct it :-) --hroest 11:36, 27 March 2010 (UTC)

New WHO dengue classification

In late 2009, the WHO came up with a new classification for dengue disease in which DHF and DSS are no longer used. Dengue infection is divided into dengue fever and severe dengue with subgroups of the latter.

The article probably needs to be revamped. I'll try to get round to it. Cavorting (talk) 09:33, 1 June 2010 (UTC)

Prevention

I'd like to see more on this topic since a vaccine seems not to be in the offing. 63.138.70.132 (talk) 16:43, 26 June 2010 (UTC)

So, nothing about mosquito control? Pesticides? I find that passing strange.RFabian (talk) 22:05, 24 July 2010 (UTC)

Good suggestion. Any of us, including you, can improve the article. -- Scray (talk) 00:01, 25 July 2010 (UTC)

Outbreak table is confusing

What exactly do the entries in the "Outbreak Table" mean? I couldn't come up with an interpretation consistent with the WHO figures from the page http://www.who.int/mediacentre/factsheets/fs117/en/, which puts the global number of infections at 50 million per year. The current figure in the "outbreak table" is 1,260,009. This is much too low, so is it perhaps treating "outbreaks" as a separate case, distinct from endemic infections? Or is it only referring to DHF, or ...?

Also, the column heading "Compared with previous year" is unclear. Is it referring to cases or deaths? 92.7.230.149 (talk) 01:30, 24 September 2010 (UTC)

Animal Hosts?

The article says how Dengue is transmitted to humans but does not mention whether it can originate in animals. Can domestic animals carry Dengue? Can it be carried by non-human primates? I have a Dengue outbreak amongst the workers on my farm in Thailand. It would be of practical value to me, and I think other non-medical wikipedia readers, to know if animals can play a part in the spread of this disease. Logicalgregory (talk) 05:23, 24 September 2010 (UTC)

How long till onset of symptoms?

How long between getting bitten and getting the first symptoms? That would be very useful information (e.g. in helping diagnosis, by considering where one has traveled - if it takes at least a week and you've only been in a Dengue area for 3 days, then probably those symptoms aren't Dengue.) --Chriswaterguy talk 06:50, 13 November 2007 (UTC)

This is very important, please add something to this effect, thanks. —Preceding unsigned comment added by 189.62.207.114 (talk) 01:25, 1 October 2009 (UTC)

Yes very important, the incubation period is one of the most important facts for the general reader. I do not understand why it has been left out. One of the workers on my farm in Thailand has just got Dengue fever. I'd like to know where he got it from, so I can stop other people getting. But before I can find out where I need to know when. Logicalgregory (talk) 06:38, 25 September 2010 (UTC)

Supportive Therapy

The link for supportive therapy in the Treatment section may refer to the wrong type of therapy (mental health). 220.244.43.129 (talk) 22:14, 23 October 2010 (UTC)

Are there relapses for dengue fever?

I know that malaria comes back. My elderly father seems to have a relapse from an infection in WWII. There is no mention of this on the page. Is it possible? 144.134.129.216 22:59, 2 June 2007 (UTC)

Dengue Fever does not have relapses, as far as I know. Any relapsed condition is either due to new infection or a different disease. There is no in-body reservoir for Dengue as there is for Malaria. OcciMoron 20:08, 15 August 2007 (UTC)

I didn't see anything in the article about no relapses. Can this be put into the article with references? Andy Irons just died of possibly dengue fever and there is an article online where his friend says that Andy has had relapses of dengue fever before. If you cannot get relapses, then I would like to see it in the article before the world believes that it is possible. —Preceding unsigned comment added by 71.154.232.44 (talk) 18:58, 3 November 2010 (UTC)

This page could use a really good rewrite ...

After the Andy Irons died, I decided to read through this article. The writing in it is extremely confusing, run-on sentences everywhere, and the information is horribly outlined. I don't have time to sit and correct this entire article, but wow ... Paravis (talk) 00:53, 3 November 2010 (UTC)

I did find a very small error where it lists 'paracetamol, acetaminophen' as if they were two different drugs. I would probably list it as 'paracetamol (acetaminophen/Tylenol)' as I believe that states that they are all the same drug. —Preceding unsigned comment added by 71.154.232.44 (talk) 19:02, 3 November 2010 (UTC)

Pronunciation in the United States

The U.S. pronunciation of "dengue" has been questioned. I don't know what the requirements for reliable sources are for pronunciation, but Merriam-Webster seems appropriate and agrees with the current version. I'll remove the "cn" template and see whether others weigh in or if someone wants to add the M-W citation. No doubt pronunciation is not uniform in a country as large and heterogeneous as the U.S., so I'm not sure there would be a case for dogmatism. Our own experiences don't count, so it is sources we need. -- Scray (talk) 10:09, 3 November 2010 (UTC)

Minor comment for image

For the Vector Control.jpg when you click in the source leads you to an invalid search page.--Garrondo (talk) 10:05, 21 December 2010 (UTC)

It is strange. The ID number for the image is 7383 but you cannot link directly too it. Doc James (talk · contribs · email) 10:54, 21 December 2010 (UTC)

While not influencing the GAN it would be great to upload the image at high resolution both as tiff as a jpg to commons. It is a great image. Similar comment goes for the mosquito image. There are great images of mosquitos in the CDC site that could be uploaded to commons.--Garrondo (talk) 21:57, 21 December 2010 (UTC)

GA Review

This review is transcluded from Talk:Dengue fever/GA1. The edit link for this section can be used to add comments to the review.

I will be reviewing this article. Comments will follow below. Reviewer: JFW | T@lk 20:02, 22 December 2010 (UTC)

Many thanks. Doc James (talk · contribs · email) 23:39, 22 December 2010 (UTC)

• General
  •  Done Some of the references are not templated, particularly those to web-based resources
  •  Done This page also covers dengue virus (redirects here), so perhaps better to bold the first instance and increase the amount of information about the virus in the intro
    •  Done Have moved the virus content to its own page.
  • There are several links to disambiguation pages in the article (see tool)
    •  Done Fixed
  •  Done I'm not sure why dengue shock syndrome has its own page, while dengue virus is discussed in this article. Would a merge enhance the content?
    •  Done Agree and have merged (all content was basically covered here ).
• Intro
  • Optional: would you consider adding sources (broad strokes only) to the introduction?
    •  Done It is all reffed in the body. The WHO 2009 paper does cover it all.Doc James (talk · contribs · email) 04:20, 23 December 2010 (UTC)
  • Perhaps more emphasis on the virus, as above
• Classification
  • Is this the place to mention the four serotypes of the virus (DEN1-4)

Will continue after doing some background reading. JFW | T@lk 23:59, 22 December 2010 (UTC)

• Signs and symptoms
  •  Done Given that dengue hemorrhagic fever now redirects here, perhaps we need a bit more information on the nature of the bleeding in DHF. We also provide relatively little information on the sites of fluid accumulation, e.g. ascites and pleural effusions. Do we need to discuss abdominal compartment syndrome and myocardial dysfunction as mentioned by Peads10?
    • Discuss the bleeding to some extent right now. We do mention shock wrt myocardial dysfunction.Doc James (talk · contribs · email) 04:54, 14 January 2011 (UTC)
  •  Done Do we need to mention dengue encephalitis and other end-organ problems? (WHO pg 35 lists them.)

Done Doc James (talk · contribs · email) 04:54, 14 January 2011 (UTC)

• •  Done Do we need to mention whether the virus is transmissible between people or not?

We do discussion that it is transmissible via blood transfusion.Doc James (talk · contribs · email) 04:54, 14 January 2011 (UTC)

• Mechanism
  •  Done Currently we have no section on how dengue virus causes the symptoms. The CMLS source that we already quote, as well as the CMR 2009 reference I supplied above, may be useful. (COI: both papers are from Dutch groups.)
  •  Done We could also use this area to discuss the finer details of end-organ dysfunction and DIC.

Would that not be best on the DIC page? Doc James (talk · contribs · email) 04:54, 14 January 2011 (UTC)

• Diagnosis
  •  Done Peads10 places a degree of evidence on the use of ultrasound in identify capillary leak (gallbladder wall oedema and fluid in body cavities) - should we mention this?
  •  Done The warning signs are currently listed, but we don't discuss their relevance beyond diagnosis. I seem to recall that a decision to admit for observation may be based on the presence of warning signs.

Added that warning signs typically occur before severe dengue. Yes as per discussed in management section.Doc James (talk · contribs · email) 04:54, 14 January 2011 (UTC)

• •  Done WHO has a fairly elaborate section on the diagnostic modalities. Should we at least mention which modality is most useful at which stage of the disease? Serology is apparently pretty useless in the initial stages of the disease.

• Prevention
  • Are there any specific international efforts we need to discuss here, e.g. surveillance? WHO has some interesting recommendations (e.g. using the Poecilia reticulata fish to eat mosquito larvae, pg 71). Various advocacy models are discussed in that chapter also - not sure how immediately relevant they are.
  •  Done Worth mentioning that dengue is regarded a "neglected tropical disease" (one of 17) by WHO?

• Management
  • Do we need to specify the types of fluids recommended by various sources (saline, Ringer's, hydroxyethyl starch)? Do we need to explain that diuretics are usually of no benefit?

The WHO says isotonic and I have added that.Doc James (talk · contribs · email) 05:02, 14 January 2011 (UTC)

• • We are currently not covering triggers for transfusion and the relative uselessness of platelet transfusions and plasma

Added Doc James (talk · contribs · email) 05:16, 14 January 2011 (UTC)

• • We could still discuss organ support modalities mentioned in Peads10
  • WHO has a lot of content on preparedness for epidemics. This seems somewhat relevant.

• Prognosis
  • A very short section. Worth merging or expanding?

Will see if I can expand it. Doc James (talk · contribs · email) 04:55, 24 December 2010 (UTC)

• Epidemiology
  • Do we need to mention the estimated annual number of people dying from dengue? Can't immediately find the figure in WHO, but I'm sure it can be retrieved. - none of the sources mentions actual death rate

Found a 2009 WHO source that gives it at 2.5% of 500,000 or doing the math 12,500.Doc James (talk · contribs · email) 17:00, 27 December 2010 (UTC) Also see "Bacteria could help control dengue fever : Nature News".

• History
  •  Done In "etymology", does the IPA pronunciation guide not really belong in the introduction?
  •  Done In "literature", is there any better source for the term "dandy fever"?

• Research
  • Some of the modalities discussed here are already in use. Should we move them to "prevention"?
  • There is an inherent risk of NOR and WP:NOTCRYSTAL with these sections, as we don't know which modalities will eventually be applied widely. Is there a secondary source we could use to scaffold this section? WHO discusses antivirals, something we ought to mention.

I will continue to help with the above issues. JFW | T@lk 04:01, 24 December 2010 (UTC)

May need a few days to get through these... Doc James (talk · contribs · email) 04:55, 24 December 2010 (UTC)

I might have a read of the "Dutch reviews" and start work on the "mechanism" section. JFW | T@lk 05:42, 24 December 2010 (UTC)

Further comments

I still have the following comments:

• Signs and symptoms:
  •  Done It currently sounds like all dengue infections have a "critical phase", but only 5% get DHF or DSS. Unsure how we could make this better.

Changed to "the critical phase, if it occurs"

• •  Done I slightly rephrased what we quote from "Neurol India", as I don't think the author specifically attributed the encephalopathy to liver dysfunction.
    • The India ref states "Encephalopathy in dengue infection is well recognized, however, to-date it remains unclear whether the virus is neurotropic; it is unclear whether encephalopathy is mediated by direct infection of the nervous system, or indirectly via other mechanisms. In particular, hepatic encephalopathy is well reported in dengue." Thus they specifically mention the liver.
      • I agree. Rephrased now. JFW | T@lk 10:15, 16 January 2011 (UTC)
• Prevention
  •  Done We could say more about international efforts as suggested above.

You mean a discussion of integrated vector management as a method of mosquito control? I have added the sentence "A number of novel methods have been used to reduce mosquito numbers including the placement of the fish Poecilia reticulata or copepods in standing water to eat the mosquito larva."

• Prognosis
  •  Done Worth merging with "epidemiology", as very short?

Sure until it is bigger... Doc James (talk · contribs · email) 01:08, 16 January 2011 (UTC)

Good luck with the final steps. JFW | T@lk 00:11, 16 January 2011 (UTC)

Looks great. I've done some final micromanaging and perfectionist i-dotting and t-crossing. Ready for GA by all accounts. JFW | T@lk 14:47, 16 January 2011 (UTC)

Dengue hemorrhagic fever and dengue shock syndrome.

These two terms where combined into the severe classification in 2009 in an effort de emphasize these two aspects of potentially fatal dengue fever. We touch on them in the classification section. Maybe we should just have the redirect go to that section to explain that they have been replaced and no longer recommended? --Doc James (talk · contribs · email) 06:54, 23 December 2010 (UTC)

Sounds reasonable. JFW | T@lk 06:17, 24 December 2010 (UTC)

Reviews

• Whitehorn J, Farrar J (2010). "Dengue". Br. Med. Bull. 95: 161–73. doi:10.1093/bmb/ldq019. PMID 20616106.
• Chen LH, Wilson ME (2010). "Dengue and chikungunya infections in travelers". Curr. Opin. Infect. Dis. 23 (5): 438–44. doi:10.1097/QCO.0b013e32833c1d16. PMID 20581669. {{cite journal}}: Unknown parameter |month= ignored (help)
• Lambrechts L, Scott TW, Gubler DJ (2010). "Consequences of the expanding global distribution of Aedes albopictus for dengue virus transmission". PLoS Negl Trop Dis. 4 (5): e646. doi:10.1371/journal.pntd.0000646. PMC 2876112. PMID 20520794.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
• Webster DP, Farrar J, Rowland-Jones S (2009). "Progress towards a dengue vaccine". Lancet Infect Dis. 9 (11): 678–87. doi:10.1016/S1473-3099(09)70254-3. PMID 19850226. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Ross TM (2010). "Dengue virus". Clin. Lab. Med. 30 (1): 149–60. doi:10.1016/j.cll.2009.10.007. PMID 20513545. {{cite journal}}: Unknown parameter |month= ignored (help)
• Hemungkorn M, Thisyakorn U, Thisyakorn C (2007). "Dengue infection: a growing global health threat". Biosci Trends. 1 (2): 90–6. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

Doc James (talk · contribs · email) 12:55, 18 December 2010 (UTC)

Martina BE, Koraka P, Osterhaus AD (2009). "Dengue virus pathogenesis: an integrated view". Clin. Microbiol. Rev. 22 (4): 564–81. doi:10.1128/CMR.00035-09. PMC 2772360. PMID 19822889. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) - looks useful. JFW | T@lk 05:59, 23 December 2010 (UTC)

Halstead SB (2007). "Dengue". Lancet. 370 (9599): 1644–52. doi:10.1016/S0140-6736(07)61687-0. PMID 17993365. {{cite journal}}: Unknown parameter |month= ignored (help) JFW | T@lk 06:17, 23 December 2010 (UTC)

Guzman MG, Halstead SB, Artsob H; et al. (2010). "Dengue: a continuing global threat". Nat. Rev. Microbiol. 8 (12 Suppl): S7–S16. doi:10.1038/nrmicro2460. PMID 21079655. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) JFW | T@lk 06:15, 24 December 2010 (UTC)

I can't seem to get access to the Ross article. Unless it contains novel points, I submit that we stick to the sources that we are using currently. JFW | T@lk 15:03, 27 December 2010 (UTC)

Moved

I have moved the "research" section here, because it lacks WP:MEDRS. Even a review by arguably the world's experts on dengue (Nat Rev Immunol 2010) does not cover any of the modalities discussed here. JFW | T@lk 18:38, 25 December 2010 (UTC)

Research

Singapore has managed to reduce the cases of not only dengue, but chikungunya and malaria by introducing an integrated vector management system.

In 2009, scientists from the School of Integrative Biology at The University of Queensland revealed that by infecting Aedes mosquitos with the bacterium Wolbachia, the adult lifespan was reduced by half. In the study, super-fine needles were used to inject 10,000 mosquito embryos with the bacterium. Once an insect was infected, the bacterium would spread via its eggs to the next generation. A pilot release of infected mosquitoes could begin in Vietnam within three years. If no problems are discovered, a full-scale biological attack against the insects could be launched within five years.

The sterile insect technique, a form of biological control, has long proved difficult with mosquitos because of the fragility of the males. However, a transgenic strain of Aedes aegypti was announced in 2010 which might alleviate this problem: the strain produces females that are flightless due to a mis-development of their wings, and so can neither mate nor bite. The genetic defect only causes effects in females, so that males can act as silent carriers.

Saddleback fever

Some sources (of dubious strength) suggest that the fever in dengue may be "saddleback" or "camelback" in character. I am unsure if it is worthy of mention. JFW | T@lk 15:12, 16 January 2011 (UTC)

Never heard of it. If not in a review article, just leave it out. Casliber (talk · contribs) 15:38, 16 January 2011 (UTC)

feedback

• The Classification section looks weird without any mention of criteria for subdivision at all. Casliber (talk · contribs) 15:42, 16 January 2011 (UTC)

I agree, but at the same time we've just said that they're not that useful... I will add them, in the briefest possible form. Thanks for the copyediting. JFW | T@lk 15:50, 16 January 2011 (UTC)

just that little bit extra helps alot. The other thing I thought was slotting this as a subsection of Signs and symptoms, either before or after clinical course as by then there is some discussion of the symptoms which then would segue into classification nicely. Anyway, not a huge deal. Casliber (talk · contribs) 23:29, 16 January 2011 (UTC)

• I think I'd rejig the content - make Dengue fever outbreaks a List-class article, and move much of the discussion and a summary to the main Dengue fever article. The parent article is short enough to allow further discussion of things like geographical boundaries and outbreaks. I recall it being a pretty big deal when dengue fever resurfaced in northern Australia (cairns etc.). Anyway, your view may vary. Casliber (talk · contribs) 23:29, 16 January 2011 (UTC)

• Maybe a brief line on other illnesses caused by related viruses. Does this occur in any non-human animals? Any parallel conditions? Casliber (talk · contribs) 23:29, 16 January 2011 (UTC)

Otherwise, not lookin' too bad...Casliber (talk · contribs) 23:29, 16 January 2011 (UTC)

I think the list of outbreaks was pared off in December. I'm not entirely sure how much of it should be brought back to this article without falling prey to recentism and what have you. I can imagine Australia was less than pleased to have dengue around!

Adding content on related viruses might be useful, but the major sources spend very little time on the subject. We could spend some time discussing the flaviviruses and the various viruses that cause VHF. At the same time, we have subarticles on all these issues, and the article already discusses the various conditions that could mimic dengue, such as meningococcal disease. I will await James' response to this, and we could ask GrahamColm, who apparently does this stuff for a living.

I think we are already alluding to the fact that humans are the main host of the virus, and I recall the fact that there is no other reservoir. Will need to dip into the sources to clarify this. JFW | T@lk 23:49, 16 January 2011 (UTC)

It is nearly impossible to get good refs on outbreak stats. Also they become quickly outdated. Prefer to give overall yearly numbers.

We could add more to the differential section to discuss flavivirueses if refs can be found.

We already state "Humans are the primary host of the virus" Doc James (talk · contribs · email) 23:58, 16 January 2011 (UTC)

There dose appear to be other dengue strains that affect other animals per the WHO "Sylvatic dengue strains in some parts of Africa and Asia may also lead to human infection, causing mild illness" Pg16 Added that it may also occur in non human primates. Doc James (talk · contribs · email) 00:10, 17 January 2011 (UTC)

More sources, vicar?

 Done PMID 20060421 - how one could develop dengue virus inhibitors (and also PMID 18796313 and PMID 19428601)

 Done PMID 20581669 - specifically about dengue in travellers (and chikungunya)

✗ Not done PMID 20384534 - another paper about vaccine development - we've got enough

✗ Not done PMID 20402771 - dengue in infants - a fairly inaccessible paper that introduces numerous concepts not seen in other sources (e.g. ADE due to same-serotype antibodies)

✗ Not done PMID 19081488 - history and evolution of dengue emergence - probably more suitable for dengue virus

On scanning PubMed, there's a lot of reviews with similar coverage to what we are already saying. JFW | T@lk 06:00, 23 January 2011 (UTC)

Depression

Gould & Solomon observe that depression after recovery from dengue is common. There is no source for this claim in the paper, and no other source seems to discuss this. I hesitate to include it without support from other sources. JFW | T@lk 06:27, 23 January 2011 (UTC)

Classification

Should the classification section on DHF make it more obvious that infected persons are febrile? It currently reads, "Grade I is the presence only of easy bruising or a positive "tourniquet test". But, should this be .. the presence of fever and... Graham Colm (talk) 17:43, 25 January 2011 (UTC)

I agree. It presumes that fever is present, but it could be made more specific. JFW | T@lk 20:15, 25 January 2011 (UTC)

Strategic distance

I think it might be very useful at this stage to ask Colin to comment on the article. I am concerned that it is not that lay-friendly and reads, in parts, a little like lecture notes. Graham Colm (talk) 23:14, 26 January 2011 (UTC)

Agree. JFW | T@lk 23:35, 26 January 2011 (UTC)

Can we please move "classification"?

During the GA review I was prepared to leave the "classification" section in its rightful place as required by MEDMOS, but I'm having misgivings. Colin's views have augmented this further. I think the section tries to discuss clinical features before we have actually had the opportunity to discuss the clinical features of dengue to any level of detail. I am breaking my lance here for some consensus on moving the section down to just above "diagnosis", or basically anywhere below "signs and symptoms". JFW | T@lk 22:01, 5 February 2011 (UTC)

How about as a subsection of diagnosis? Classification often fits in nicely here... Doc James (talk · contribs · email) 22:16, 5 February 2011 (UTC)

I can live with that. JFW | T@lk 22:42, 5 February 2011 (UTC)

Severe disease

From the numerous sources, it is not entirely clear if severe dengue is always the result of secondary infection. I suspect that in most clinical cases it not possible to establish this, because the inital infection may have been paucisymptomatic, unless one started doing elaborate viral titer studies. Epidemiological evidence for the phenomenon abounds (e.g. clusters of severe dengue whenever a new DENV serotype enters a particular population that was previously exposed only to another serotype).

PMID 20402771 seems to state that low titers of same serotype DENV antibodies can also precipitate severe dengue, and that this explains why infants are at risk: maternal antibodies cross the placenta, but gradually disappear over the first few months of life. If DENV infection (with the same serotype) occurs at this point, the residual antibodies are inadequate for viral clearance but instead participate in ADE! I found the paper slightly obtuse and terribly inaccessible, and this has dissuaded me from trying harder to incorporate its hypotheses into the article. I might ask GrahamColm to enlighten us again. JFW | T@lk 22:49, 5 February 2011 (UTC)

Etymology

PMC 2220391 seems to indicate that Dandy and Dengue are related terms. No other sources more recent that 1877 seem to back this up though... JFW | T@lk 22:48, 25 December 2010 (UTC)

Found a books that discusses the historical terms. Doc James (talk · contribs · email) 00:12, 26 December 2010 (UTC)

Also, I could not find evidence that the term "breakbone fever" was coined by Benjamin Rush, but this could be reintroduced when a source is found. JFW | T@lk 23:51, 25 December 2010 (UTC)

 Done Found it. JFW | T@lk 10:58, 27 December 2010 (UTC)

...and it's also here: Chakraborty, T (2008). Dengue Fever and Other Hemorrhagic Viruses (Deadly Diseases and Epidemics). Chelsea House Publications. p. 16. ISBN 0-7910-8506-6. Graham Colm (talk) 00:35, 2 January 2011 (UTC)

Please forgive the Wall of Text: I recently heard the word Dengue being attributed to Swahili on a Jeopardy clue, which surprised me in that I didn't recognize it as a Swahili word, so I headed here and found trouble. Right off the bat, I can tell you that "Ka-dinga pepo" is wrong, it's not even what is written in the source! The cited source writes "ki denga pepo", which is still somewhat wrong: "Ki" or "Ka" are never separate words in Swahili. Dengue Fever in Swahili is "kidingapopo".

Grammatically, the explanation of "ki denga pepo" as "cramplike seizure caused by an evil spirit" makes superficial sense. Structurally, "kidingapopo" is a noun of the sort that are sometimes formed out of "Ki" + verb/noun, so there is a possibility it was formed this way and shifted in spelling, but it doesn't sit well with me. "Dinga" or "denga" would need to be a noun or verb associated with illness, with the addition of "pepo" (evil spirit or wind) indicating the causative agent, yet I am not aware of any meaning for dinga or denga on their own. My Swahili is imperfect, and I'd love native speakers to weigh in, but I checked four dictionaries for variations of (ki/ka/_)dinga/denga and came up with only kidinga as a shortened form of kidingapopo. Perhaps the word is simply too archaic, being that this traces back to the 1800s.

Additionally, this etymology would require a spelling shift from "pepo" to "popo". This is troubling in that Swahili words compounded in the manner suggested are highly stable because the meaning is dependent on the constituent parts. If this etymology is correct, this spelling shift changes the modern word into something like "cramp caused by a bat" or "bat seizure"...

I'm new to Wikipedia editing, I didn't want to edit first and defend my changes later, especially since this is all fairly opaque to people who don't speak Swahili. Anyhow, my point is that the Swahili etymology theory, as presented, has serious flaws and the sources are weak to boot. One is an anonymous shot-in-the-dark guess and the other is a grammatically-incorrect factoid from what appears to be a CDC journal.

Now that I've explained my reasoning, I'd like to scrap and rewrite the first paragraph of this section using better sources. Please have mercy on a newbie. MJaywalker (talk) 05:21, 2 March 2011 (UTC)

Thank you for your input. Finding useful etymology sources has been difficult, as you can see in our exchange above. If you have a more reliable source I would only be too happy to scrap the current ones. I can assist if necessary. JFW | T@lk 07:26, 2 March 2011 (UTC)

Diagnostic test

New test [4] Doc James (talk · contribs · email) 21:59, 11 April 2011 (UTC)

An IgM-based ELISA that may be false negative in the early stages of the disease... JFW | T@lk 22:38, 11 April 2011 (UTC)

Review notes

I'm reading through this article as requested. So far I've just read to Mechanism and haven't looked at the sources. There are some problems with inaccessible jargon that could be improved. The prose is in need of a good copyedit, though that can perhaps wait till it has finished being worked on. The biggest structural problem I've identified so far is the "secondary infection" issue is mentioned before it is explained. I'm a little concerned that the article lacks the depth needed for an FA but won't be able to judge for sure till I read to the end and poke around the sources and other resources a bit. The main medical facts are perhaps all there in terse form but it may need a bit more richness and colour to be an engaging read and leave the reader satisfied. Here are some notes that I'm afraid are in a bit of "notes to self" form. If they are useful then great, but if not then I'll expand on them.

There are several ways of dealing with the jargon. Where I've said "explain" below, that isn't necessarily what is required. All I'm pointing out is that as a lay reader I don't understand those terms and they are presented in such a way that I'm expected to understand them so I feel ignorant and want to skip the section or read another article. So you need to either help me understand roughly what they are about (even just telling me they are proteins helps, say, because I may have absolutely no clue if they are nouns, adjectives or verbs) or guide me past them so I know I don't really need to understand them. The level of understanding needed will vary.

Lead

•  Done Jargon: "petechial rash", "serotypes"
•  Done Semicolon in 2nd sentence doesn't seem appropriate.
•  Done "reducing the habitat and number of mosquitoes". Should be "reducing the habitat and the number of mosquitoes". Possibly "prevented" is too strong?
•  Done "rates of infection have increased" should perhaps be "The rate of infection has increased".
• "A global disease". Arguably not, unlike say measles. It requires certain mosquitoes so it is surely tropical?.
  • • It is global in the sense that it affects returning travellers. JFW | T@lk 22:01, 5 February 2011 (UTC)
•  Done "dengeue is currently endemic... where it is prevalent". What is the difference between the two? Can we simplify or reword this?
  • • It is an overstatement - not all these people are at risk, only potentially so

Classification

• What is the threshold between uncomplicated and severe? Why is the new classification given so little time but the old one covered in detail. Would it help to re-order and give the old (widely used) classification first and then conclude with the new and reasons for change (more reasons surely than just "too restrictive").
  • • The problem is the placement of the section. The severity of dengue is determined by clinical parameters, and we cannot go into too much detail without having a discussion about blood pressure, plasma leak and bleeding. I will attempt consensus about moving the section once more. JFW | T@lk 22:01, 5 February 2011 (UTC)

Signs

•  Done The range "from" should have just one "to". Can this be worded a different way?
•  Done "In travellers returning from" doesn't work. Try "Travellers...probably do not have dengue if their symptoms start..".

Virology

•  Done What is a "positive-stranded RNA virus"?
  • • Seems to have been removed somewhere along the way. JFW | T@lk 22:36, 5 February 2011 (UTC)
•  Done "is about 11000 bases" should that be "contains" or "consists of"?
•  Done Explain structural and non-structural proteins; "non-coding region"; "5' and 3' ends"; "serotype".
•  Done "The severe complications on secondary infection" This hasn't been mentioned yet in the article. The Signs and symptoms section makes no mention of secondary infection having a different set of complications.
  • • The information was there, but the key term "secondary infection" was glaringly absent; fixed now JFW | T@lk 22:36, 5 February 2011 (UTC)

Predisposition

•  Done The impression I got from the lead of Signs and symptoms is that children got a cold or an upset tummy from the disease. Then I read in Predisposition that they are more likely to get the severe disease.
•  Done "The genes coding for..." You need to give the lay reader some help here. He probably isn't interested in these names but may have no idea what they are. Just adding "coding for the proteins known as ..." helps.
• "particular alleles of human leukocyte antigen" not following what this means. Just give me an idea of what on earth it is.
  • • This is a person's tissue type, which people know best because of its relevance in transplant compatibility. Different HLAs predispose to particular illnesses, and apparently some HLAs make one more susceptible to dengue. I have had difficulty explaining the concept of HLA before, so your recommendations are most welcome! JFW | T@lk 22:36, 5 February 2011 (UTC)
•  Done "Glucose-6-phosphate dehydrogenase deficiency, a common genetic abnormality in Africans, appears to increase the risk". Just turning this round makes it friendlier: "A common genetic abnormality in Africans, known as glucose-6-phosphate dehydrogenase deficiency, appears to increase the risk."
• "Polymorphisms in the genes" What are "polymorphisms".
  • • A variation in a gene is only called a "mutation" if it leads to a definite abnormality or illness. There are many small person-to-person variations in genes that don't usually lead to illness, or only when combined with other risk factors (see e.g. the recent glut in studies into SNPs). These small variations are referred to as "Polymorphism".

Mechanism

•  Done Can you explain the mechanism without losing the reader? I'm sure it is possible to explain what kind of cells the virus infects, how it travels round the body, where it ends up and causes harm. There are some really advanced words in this section and unless the reader is extremely persistent, they will just give up. We need to find a way to either avoid them or mention them in such a way that the reader either learns something or is assured he doesn't need to learn that bit in order to understand the section.
  • • I have summarised the section in a single paragraph, followed by the present content in an improved form. I hope that this hierarchy will provide sufficient levels of detail while still allowing the reader to survive reading it! JFW | T@lk 23:15, 5 February 2011 (UTC)

Colin°^Talk 20:39, 30 January 2011 (UTC)

Transmission

I'm bothered by the phrase "A mosquito that takes a blood meal from a person infected with dengue fever becomes itself infected...." This implies that the mosquito receives sustenance from the blood. Mosquitoes eat plant juices. The blood is used in the reproductive process by the female. The current wording further spreads the myth that the mosquito uses blood as food. Although the current wording is "colorful" it is misleading and unnecessary. — Preceding unsigned comment added by NatureBag (talk • contribs) 07:16, 23 April 2011 (UTC)

It may bother you, and some people may find it confusing for the reason you give, but the mosquito uses its mouth parts to ingest blood that enters its gut, and it is able to use that "meal" for necessary biological functions. Much more importantly, it's common usage in reliable sources - this search currently returns over 800 mosquito-related sources with these terms, 98 of which have "blood meal" in the title. Our own feelings about it don't matter - we depend on sources, and I'm not aware of any scientific consensus for eliminating the term "blood meal" for mosquitos. -- Scray (talk) 14:13, 23 April 2011 (UTC)

Maintenance cycle etc.

Following my comments at this article's FA nomination, here is a suggestion for a paragraph on the maintenance cycle:

Like most arboviruses, dengue virus is maintained in nature in cycles that involve preferred blood-sucking vectors and vertebrate hosts. The viruses are maintained in the forests of Southeast Asia and Africa by transmission from the female aedes mosquitoes – of species other than Aedes aegypti – to her offspring and to lower primates. In rural settings the virus is transmitted to humans by Aedes aegypti and other species of Aedes such as Aedes albopictus. In towns and cities, the virus is primarily transmitted to humans by Aedes aegypti, which is highly domesticated. In all settings the infected lower primates or humans greatly increase the number of circulating dengue viruses. This is called amplification.<ref>[[#refGubler2010|Gubler (2010)]], pp. 376</ref> The urban cycle is the most important to infections of humans and dengue infections are primarily confined to towns and cities.<ref>[[#refGubler2010|Gubler (2010)]], pp. 377</ref> In recent decades, the expansion of villages, towns and cities in endemic areas, and the increased mobility of humans has increased the number of epidemics and circulating viruses. Dengue fever, which was once confined to Southeast Asia, has now spread to China, countries in the Pacific Ocean and America,<ref>[[#refGubler2010|Gubler (2010)]], pp. 377</ref> and might pose a threat to Europe.<ref name=Euro10> Graham Colm (talk) 15:50, 20 June 2011 (UTC)

Yes looks excellent. Add away... Doc James (talk · contribs · email) 17:05, 20 June 2011 (UTC)

OK, after a couple of hiccups I have done that. There might be a little duplication with regard to the last sentence or two, but I will wait until JFW reads it - he usually turns-up around midnight. Graham Colm (talk) 18:49, 20 June 2011 (UTC)

Heh, am I that predictable? I really like the paragraph, and agree that it needed to be added. One quick query: are we trying to say that "amplification" happens during the disease process. Is it known whether the primate hosts become symptomatic when infected? JFW | T@lk 19:47, 20 June 2011 (UTC)

The viruses are much more productive in primates, including humans, so the answer is yes. I don't know, and my books don't help, about the percentage of asymptomatic infections in the lower primates. I suspect the research has not been done. Of course, I have my theories, but they don't belong here. Graham. Graham Colm (talk) 20:04, 20 June 2011 (UTC)

Image for the lead

The current image is not the greatest. We have some other options here which are not much better. [5] Doc James (talk · contribs · email) 20:10, 15 June 2011 (UTC)

The current one is the best of a bad bunch. This is a difficult disease to illustrate: the rash is usually benign looking as far as viral infections go. There are nice pictures of the vector, but this is a medical article, not a virus one. Graham Colm (talk) 20:31, 15 June 2011 (UTC)

Brasil is in the middle of an outbreak. Will email friends to see if they can get some better pictures. --Doc James (talk · contribs · email) 06:13, 16 June 2011 (UTC)

An image of the rash is very relevant. JFW | T@lk 15:52, 16 June 2011 (UTC)

Yes agree just wish one that is of higher quality than the current one. --Doc James (talk · contribs · email) 16:43, 16 June 2011 (UTC)

For better or worse, the "standard", most instantly recognizable image of dengue—used in materials for the lay public and everything—is Aedes aegypti. Any reason why one of our skeeter pics isn't the lead image? Was it a deliberate decision? Fvasconcellos (t·c) 19:30, 19 June 2011 (UTC)

I would prefer a mozzie as the lead image, but I'm a virologist. Graham Colm (talk) 19:51, 19 June 2011 (UTC)

As a clinician I would prefer a clinically relevant image. An image of the rash is not a bad idea. JFW | T@lk 22:39, 19 June 2011 (UTC)

Yes I agree the rash is best. I think the subject of the image we have now is good just need a similar image but of higher quality. Doc James (talk · contribs · email) 17:06, 20 June 2011 (UTC)

Hmm. Marginally related question, by the way—just how common is the rash? I haven't found any mention of symptom/sign frequency in the article, nor in a smattering of external sources. I imagine the "classical" rash (maculopapular, sparing islands of skin) is not that common, and that less dramatic presentations are possible. Fvasconcellos (t·c) 17:36, 21 June 2011 (UTC)

Not sure if we should use this but:

Constitutional symptoms including fever (90 percent) and headache, eye pain, body pain, and joint pain (63 to 78 percent)

Rash (slightly more than 50 percent) Gastrointestinal symptoms including nausea or vomiting (more than 50 percent) and diarrhea (30 percent)

Respiratory tract symptoms including cough, sore throat, and nasal congestion (each observed in approximately one-third of patients).

Per Uptodate from PMID 7485067 Have also found a recent text which supports. Doc James (talk · contribs · email) 17:17, 24 June 2011 (UTC)

Fitzpatrick says "Rash estimated to occur in 50–80% of cases." Doc James (talk · contribs · email) 17:26, 24 June 2011 (UTC)

Space-spraying and chemical vector control

The article currently makes no major mention of space-spraying and other insecticide-based vector control methods, which are still a mainstay of control efforts during outbreaks and are somewhat controversial due to insufficient evidence and resistence concerns. Perhaps more space should be devoted to this issue? What do the current sources say? Fvasconcellos (t·c) 19:24, 21 June 2011 (UTC)

The sources I cited in the changes are made today are peer-reviewed scientific publications, with the exception of the unpublished manuscript. There's plenty more to add, and I'd be happy to expand it in fuller detail. In Mexico, for instance, the government undertook a policy of dropping or spraying Temephos in any open water source they found, without having to discuss it with homeowners or gain their consent. The problem with these pesticides is not only that they have not been proved to be harmless (so far it's been the opposite), but also that the authorities that enforce their use can't regulate how much water people ingest in proportion to their weight and health.

I'm drafting an addition regarding a controlled trial in Acapulco and other communities of Guerrero, where dengue was on the rise between 2003-2007 due to the government's switch to a pesticide-based policy and a slackening of campaigns to promote community education about dengue and sealing of water containers. The purpose of the trial was to keep both the larvae and the pesticides out of the water. — Preceding unsigned comment added by Flaucirica (talk • contribs) 20:31, 21 June 2011 (UTC)

You really need to read WP:MEDRS. You seem to have a fine grasp of the subject matter, but we have rather specific criteria about using primary sources and unpublished work. As Fvasconcellos has said, a brief discussion about space-spraying would be valuable. Casting aspersions probably is not. JFW | T@lk 21:20, 21 June 2011 (UTC)

(Edit conflict) The use of ultralow volume application of insecticides has been regarded as the mainstay method of control for over twenty five years but have proved to be ineffective. The cited, free article from Euro surveillance has a useful paragraph that covers this, which is headed "Vector Control". There is also mention of this in Gruber on page 381. I am not sure how much detail is needed on this, at least in this article. I reverted Flaucirica's recent addition mainly because of the use of an unpublished source and concerns about neutrality. Graham Colm (talk) 21:23, 21 June 2011 (UTC)

We are already saying "[vector control] may be done by emptying containers of water or by adding insecticides or biological control agents to these areas." Do we need to go into details? I have no access to "Gubler10", but will look at Euro Surveillance. JFW | T@lk 11:14, 23 June 2011 (UTC)

I have both sources and I'll compose something and post it here for discussion, if I think more needs to said. Graham Colm (talk) 17:03, 23 June 2011 (UTC)

Female mosquitoes?

The article doesn't seem to mention that only females take blood meals and, therefore, are capable of spreading the virus. I don't think the article should take this for granted just because it is true for all mosquito-borne diseases. Fvasconcellos (t·c) 14:25, 24 June 2011 (UTC)

I have added this, suspecting that Gubler mentions this on pages 377-388. I imagine Graham will correct me if that is wrong. JFW | T@lk 16:07, 24 June 2011 (UTC)

Oddly, he doesn't but the WHO fact sheet says "Dengue viruses are transmitted to humans through the bites of infective female Aedes mosquitoes.[6] Graham Colm (talk) 18:05, 24 June 2011 (UTC)

Thanks! Fvasconcellos (t·c) 21:20, 24 June 2011 (UTC)

Problems with the prose in recent additions

At this stage of the FAC it is important to be careful that the prose does not give rise to opposes. This recent addition is a cause for concern, but I do not have time to fix it right now:

"A rash is estimated to occur in 50-80% of symptomatic cases. This may occur early (days 1—2 of the symptoms) as flushed skin or later (days 4—7) with a maculopapular or morbilliform appearance and / or petechia. The fever is classically biphasic in nature with this pattern occurs in 5—83% of people. It typically lasts two to seven days."

We have "occur" - "occur", a nasty "and / or ", the use of "cases", which is not lay-friendly, and odd "days 1—2 of the symptoms", and a grammatically incorrect "with this pattern occurs". I would hate to see an Oppose at this critical stage because of poor prose. Please be careful. Graham Graham Colm (talk) 20:43, 24 June 2011 (UTC)

Yes hopefully someone with greater grammatical skill will help fix it. I was address a concern regarding scope expressed on JFDs page. Doc James (talk · contribs · email) 20:46, 24 June 2011 (UTC)

I'm afraid my comments will have been the cause of that. Thank you for the additions, James—I'll integrate them into the existing paragraphs. We also have to be careful not to conflict with the previous content. Fvasconcellos (t·c) 21:05, 24 June 2011 (UTC)

Excellent this is exactly why I edit Wikipedia. Someone with greater linguistic skills than I comes along and fixes my mistakes. Thanks Fv :-) Doc James (talk · contribs · email) 21:59, 24 June 2011 (UTC)

Vertical transmission in humans

With regard to Colin's recent edit summary, there are numerous case reports of vertical transmission in humans in the literature. For a review article I suggest using Wiwanitkit V (2010). "Unusual mode of transmission of dengue". J Infect Dev Ctries. 4 (1): 51–4. PMID 20130380. {{cite journal}}: Unknown parameter |month= ignored (help) - because it is is licensed under Creative Commons Attribution 3.0. Graham Colm (talk) 20:51, 27 June 2011 (UTC)

Thanks for fixing this. A few points so far:

• Can someone review the use of "it is thought that", "seems to", "appears to" to ensure there really is doubt here and that the sources contain the doubt (rather than the editors, say). I think some of these have crept in through writing style rather than because there really is doubt.
• Similarly, review the frequent use of "may" to consider (a) if an alternative might avoid repetition and (b) where a reader could interepet it as "might" and would be mislead.
• Predisposition: Guzman et al does not correspond with the body text. There are many more factors listed (e.g. AB blood group) and the "protection" we mention is classed in the sources as "reduce the risk of severe disease during a second dengue infection", which is much more specific.

Colin°^Talk 21:12, 27 June 2011 (UTC)

• "Apart from serology, laboratory tests are only of diagnostic value during the acute phase of the illness." I think I follow what this is trying to say but it is confusing because (a) it refers to tests in a previous paragraph and (b) "serology" and "laboratory tests" don't seem compatible terms and (c) does the "only" refer to "diagnostic value" (rather than, epidemiological value, say) or "during the acute phase" (I'm guessing this one). Colin°^Talk 21:29, 27 June 2011 (UTC)
  • Serology and laboratory tests are compatible terms. In fact serology is a laboratory test. It means that the virus cannot be found during convalescence. So your guess is sort of right. Graham Colm (talk) 21:38, 27 June 2011 (UTC)
    • I'm just unfamiliar with the word and it sounds like other "ologies" (Maureen Lipman suddenly enters my brain). Colin°^Talk 21:56, 27 June 2011 (UTC)
      • It's the study of serum, the liquid left after blood has clotted.(yellow liquid) That's where antibodies are easier to test for in the lab. These days the term almost exclusively means the study of the antibodies and antigens in the blood. Graham Colm (talk) 22:08, 27 June 2011 (UTC)

Response

• I take responsibility for the guarded language in all the instances you have pointed out. These probably crept in when I found a fact in one article that was not discussed in other articles. I think it is reasonable to change them into more definitive statements.
• I will scan for remaining uses of "may"; it appears the The Lancet has a blanket ban on the word, and that "might" is used much more often
• Predisposition: when writing this section I have included the factors that are mentioned in more than one source to avoid overkill. Many of these claims are based in turn on fairly small studies, so I used this criterion as a marker for notability. I don't think other sources apart from Guzman10 mention the AB blood group as modifying risk. (I have also made it clear that these are examples rather than an exhaustive list.)

JFW | T@lk 21:46, 27 June 2011 (UTC)

I wouldn't necessarily remove all uses of "may" but agree it is a problematic word in precise writing. There were two problems with Predisposition, not just the incompleteness (for which I'm happy to accept your explanation). Colin°^Talk 21:56, 27 June 2011 (UTC)

Ah thanks I just spotted the second point about Guzman. It only mentions secondary infection in the context of protective factors, although I imagine that the same thing applies to predisposing factors (but they just say "severe disease"). JFW | T@lk 22:19, 27 June 2011 (UTC)

It's FA!

Great work by everyone! JFW | T@lk 04:23, 6 July 2011 (UTC)

Excellent article! Congratulations to all you guys who worked on this! As an ED doc doing a stint in travel medicine, I found this article to be highly informative and easy to read. Once again - Well done! Orinoco-w (talk) 06:11, 12 July 2011 (UTC)

Map from 2006?

How is the Dengue fever doing in East Germany and Czechoslovakia? Please update this map if you can :) also Pakistan is missing a line at the bottom. —Ynhockey ^(Talk) 11:10, 12 July 2011 (UTC)

Buenos Aires?

It would appear that someone copy/pasted the introductory section from the article on Buenos Aires, Argentina, into the introduction for this article. I'm not sure how to remedy that myself; would a more experienced Wiki-editor please rectify the problem? — Preceding unsigned comment added by 184.79.202.30 (talk) 17:38, 5 August 2011 (UTC)

No vaccine?

I thought there was a vaccine for this. Lambanog (talk) 13:26, 4 August 2011 (UTC)

The article clearly says that "there is no approved vaccine", which is correct and it gives a reliable source. This review article gives more details, which are beyond the scope of our article: Murrell S, Wu SC, Butler M (2011). "Review of dengue virus and the development of a vaccine". Biotechnology Advances. 29 (2): 239–47. doi:10.1016/j.biotechadv.2010.11.008. PMID 21146601.{{cite journal}}: CS1 maint: multiple names: authors list (link) Graham Colm (talk) 18:26, 4 August 2011 (UTC)

"rash" picture

At that resolution, it's hard to tell he has a rash at all. It looks like he might just have freckles. Is the picture really useful? --Trovatore (talk) 00:21, 5 August 2011 (UTC)

It's been difficult to find another one. Given that the rash is quite important to the diagnosis, we have retained this image until some kind soul is prepared to have their rash photographed for Wikipedia. JFW | T@lk 06:29, 5 August 2011 (UTC)

Recovery / 'cure'

Excuse my ignorance, but after reading the introduction, and looking through what seem to be relevant sections, I don't understand what I assume is a rather simple thing: is this fatal? For how many people? Is there a 'cure' (a vaccine is preventative, after all)? Is this something you live with for the rest of your life?

The last paragraph of the introduction says treatment is "supportive" (what does that mean?), and the last paragraph of the 'Clinical Course' section says "The recovery phase ... lasts two or three days." but then goes on to list rather awful sounding complications.

Could someone with the relevant expertise update the article so it is more clear what recovery is like, and if there is any such thing when it comes to this disease? Thanks! Gijs Kruitbosch (talk) 09:32, 19 September 2011 (UTC)

see epidemiology section [7] Doc James (talk · contribs · email) 16:01, 19 September 2011 (UTC)

Blum/dengue as a biological weapon

Touseefliaqat (talk · contribs) added a section on dengue as a biological weapon, based on ISBN 1842773690 (Blum, "Killing Hope", 1995).[8] We already discuss the uselessness of dengue as a biological weapon elsewhere in the article. The experiments with dengue seem to have been a single event that is probably not individually noteworthy. Blum's book strikes me as controversial and clearly not an ideal source for a medical/scientific article. JFW | T@lk 19:41, 26 September 2011 (UTC)

Scientific American resource, regarding Genetically modified organism(s),

http://www.scientificamerican.com/article.cfm?id=the-wipeout-gene The Wipeout Gene] ... "A new breed of genetically modified mosquitoes carries a gene that cripples its own offspring. They could crush native mosquito populations and block the spread of disease. And they are already in the air—though that's been a secret" by Bijal P. Trivedi SciAm October 24, 2011 97.87.29.188 (talk) 22:26, 1 November 2011 (UTC)

Yes. The reason the article doesn't mention this is the lack of secondary sources. A news report in Scientific American is probably not sufficient. None of the reviews currently cited makes any mention of this approach. JFW | T@lk 22:57, 1 November 2011 (UTC)

What of this from Nature (journal) http://www.nature.com/scientificamerican/journal/v305/n5/full/scientificamerican1111-68.html referencing doi:10.1038/scientificamerican1111-68 305, 68 - 75 (2011) published online: 18 October 2011 99.181.138.228 (talk) 05:39, 2 November 2011 (UTC)

Please read WP:MEDRS. JFW | T@lk 07:10, 2 November 2011 (UTC)

I had temporary access to all seven webpage, then the subscription page kicked-in. Maybe free access will be soon ... until then, I got (author) Bijal P. Trivedi is an award-winning writer who focuses on biology, the environment and medicine. She studied molecular biology and biochemistry at Oberlin College and at the University of California, Los Angeles. on "page 7". 97.87.29.188 (talk) 00:21, 3 November 2011 (UTC)

You have clearly not read WP:MEDRS. JFW | T@lk 20:08, 7 November 2011 (UTC)

I've got access to the seven wepages. Here is an excerpt from page 2 ...

(Luke) Alphey founded Oxitec in 2002 to capitalize on the technology. In 2005 the Foundation for the National Institutes of Health, funded in large part by the Bill & Melinda Gates Foundation, granted James $20 million to test genetic strategies against dengue. (Anthony) James gave Oxitec $5 million to build the mosquitoes.

Page 5 ...

While all this slow scientific and community work was going on in Mexico, Alphey was quietly taking a dramatically different approach. Last November he arrived at the annual meeting of the American Society of Tropical Medicine and Hygiene with a surprising story to tell. Beginning in September 2009, Alphey said, Oxitec had been releasing genetically modified mosquitoes on Grand Cayman island in the Caribbean. (The mosquitoes are similar to the ones being tested in Tapachula, but not identical—in the Cayman strain, both male and female mosquitoes die as larvae.) Between May and October of 2010 Oxitec released more than three million male mosquitoes, he revealed, which cut the indigenous A. aegypti population by 80 percent. The data have been submitted for publication.

Also see Malaysia and Juazeiro (Bahia) 99.181.135.155 (talk) 05:55, 10 November 2011 (UTC)

Please provide a secondary source that considers this line of research to be promising. Once again, please show that this source satisfies WP:MEDRS. JFW | T@lk 20:36, 10 November 2011 (UTC)

Contradiction in epidemiology section?

The article says:

The mortality is 1–5% without treatment,[5] and less than 1% with adequate treatment;[23] however severe disease carries a mortality of 26%.[5] [...] It infects 50 to 100 million people worldwide a year, leading to [...] approximately 12,500–25,000 deaths.

Based on 50-100 million infections per year and 12,500–25,000 deaths, I would estimate a mortality of 0.01%-0.05%, yet the first sentence says "less than 1%". I suppose technically this is not a contradiction, but widely misleading; it's like saying the Eiffel Tower is taller than 15 meters. AxelBoldt (talk) 22:49, 11 December 2011 (UTC)

We are just going by what the best available evidence says.Doc James (talk · contribs · email) 05:01, 13 December 2011 (UTC)

Well, right now the paragraph is formulated as if it were a list of facts, with their respective references. But since those "facts" are contradictory, it would be better to alert the reader to this, e.g. "estimations of mortality differ widely among recent publications:..." It's also possible that the word "mortality" in the first sentence refers only to severe cases or hospitalized cases or infections resulting in symptoms, in which case it would be even more important to alert the reader. AxelBoldt (talk) 22:57, 18 December 2011 (UTC)

Edit request on 17 February 2012

Please change the section labeled "Viral Reproduction" to "Viral Replication" as viruses cannot reproduce and this title is misleading. Viruses cannot produce another copy of themselves; they can only bind to a host and have it produce copies for them.

Nxtfari (talk) 04:19, 17 February 2012 (UTC)

 Done --andy4789 ★ · (talk? contribs?) 13:07, 17 February 2012 (UTC)

Placement of History/Etymology

The History/Etymology section ought to be the first sub-section in the article, since that is generally how articles are organized. — Preceding unsigned comment added by Ciamoley (talk • contribs) 16:48, 7 June 2012 (UTC)

Nope, this is of less actual relevance than the other stuff, which is why on WP:MEDMOS it has been relegated to the lower sections. Refer to MEDMOS for other medicine-related Wikipedia conventions. JFW | T@lk 21:55, 7 June 2012 (UTC)

New review

• Simmons, CP (2012 Apr 12). "Dengue". The New England journal of medicine. 366 (15): 1423–32. PMID 22494122. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help) Doc James (talk · contribs · email) 20:20, 15 June 2012 (UTC)

We should certainly include points from that article. So far I've not had the time to sit down and do that. JFW | T@lk 22:32, 16 June 2012 (UTC)

New Historical Review

http://www.ncbi.nlm.nih.gov/pubmed/22469290

Dengue and US military operations from the Spanish-American War through today. Gibbons RV, Streitz M, Babina T, Fried JR.

could be an interesting addition to this article. --hroest 17:40, 19 August 2012 (UTC)

Jolly good! Thanks much. JFW | T@lk 20:06, 19 August 2012 (UTC)

Attempt to reduce prevalence by genetic modfication of male Aedes mosquitos

Reported in The New Yorker Magazine (7/9&16/2012); abstract at http://www.newyorker.com/reporting/2012/07/09/120709fa_fact_specter Jo3sampl (talk) 00:41, 5 July 2012 (UTC)

I put in a couple of sentences about a trial of these GM mosquitoes in the Cayman Islands.SylviaStanley (talk) 17:58, 27 July 2012 (UTC)

Per WP:MEDRS we typically use high quality secondary rather than primary sources. If there are secondary sources that support this feel free to add it back in. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 23:35, 27 July 2012 (UTC)

I haven't found any "high quality" secondary sources yet but will keep looking. I guess this area is relatively new. To my mind, this sub-section of the article is not about the medical details of Dengue fever, so does WP:MEDRS really apply? The WP:MEDRS guidelines apply to "...medical and health-related content in any type of article..." If it is not medical then WP:IRS applies. In which case, there a several articles in the relatively reliable sections of the popular press that could be included - like the one mentioned by Jo3sampl above.SylviaStanley (talk) 08:24, 28 July 2012 (UTC)

There are a number of references that talk about ongoing research. If you look at the WHO reference it has a good overview. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 17:18, 28 July 2012 (UTC)

Just happened by. I heard an interview, on I believe the BBC, today about this research. There may be some good info here. --  :- ) Don 00:27, 29 August 2012 (UTC)

Clinical course figure

This figure is excellent. I have some minor suggestions, which I've made on the Commons Talk page for this figure -- Scray (talk) 13:49, 7 October 2012 (UTC)

• Thanks Scray, I have made the changes that you suggested. Graham Colm (talk) 14:49, 7 October 2012 (UTC)

Formal peer review by Open Medicine

This review is based on this version of the article from June 21st, 2012 [9]

Reviewer A:

The brief review submitted by Heilman and colleagues is generally well-organized and well-written. The overview is reasonably complete and will be useful to a general readership. There are no major errors of fact in the document. A few minor points:

1. In the section on differential diagnosis, the authors should include measles and influenza along with malaria and the other undifferentiated fevers.

   Sure added with a ref. There are a number of others but do not think we need to be exhaustive. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:20, 28 October 2012 (UTC)

2. The reference to 'founding father' (History) should be prefaced by USA - unless the readership is 100% all American.

   Done Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:29, 28 October 2012 (UTC)

3. Wolbachia should be capitalized. It might be helpful to say 'Wolbachia bacteria' since most readers won't have a clue what they are.

   Done Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:29, 28 October 2012 (UTC)

4. The authors seem to not to have read a great deal of the literature between 2009-2010 and 2012 (only a single reference in 2012). This is particularly glaring when they refer to vaccines and quote a 2009 review. A great deal has happened in the world of dengue since 2010. For example: although it is not yet published in its final form, there is considerable excitement surrounding Sanofi's tetravalent vaccine now in late Phase III in Thailand. I'm not 'pushing' the Sanofi product ... but it should probably be at least mentioned.

   Okay have added slightly more detail regarding the vaccines in development. [10]Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:46, 28 October 2012 (UTC)

5. I am not accustomed to authorship being attributed to a 'first name' only (Collin in this case). Call me old fashioned, but I don't like the idea of accepting health-related information from essentially 'anonymous' sources.

   This is just temporary. We are still working on attribution formatting. Some of those who have contributed to this are anonymous however and the expectation is that the content will stand on its references. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:29, 28 October 2012 (UTC)

6. None of the figures, maps etc show attribution. Are they all the original photos or art work of the authors? The world distribution map also seems to be a bit out of date. It would be nice to know the sources (also the quality of the map is poor).

   Attribution can be see by clicking on the image in question. They also become better quality when you click on them. This will be fixed for the published version. A more uptodate version of the map is available here but is not under an open license. [11] All images must be CC BY SA. The CDC has a more uptodate map but it is in two parts [12] and is not really that different than what we have. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:29, 28 October 2012 (UTC)

Reviewer B.

Disability-adjusted life year for dengue fever per 100,000 inhabitants in 2004.

  no data

  < 10

  10-20

  20-30

  30-40

  40-50

  50-60

  60-70

  70-80

  80-90

  90-100

  100-200

  > 200

This Wikimedicine entry provides a broad overview and review of various aspects of Dengue Fever and is an appropriate reference for both lay people and clinicians. It is thorough and accurate and touches broadly on all aspects of the disease. It is well written in language that is appropriate to the Wikipedia audience. This entry merits publication and I would accept it for publication with revisions. All of my comments are minor.

1. Some general suggestions: In terms of how the entry is organized, I suspect it is a subjective opinion but as a clinician, I would prefer to see Epidemiology, Virology and Pathogenesis up front; followed by Clinical Manifestations, Lab Diagnosis and then Treatment; finally I would end with Prevention and Research

   We typically base our layout of sections on WP:MEDMOS. This is to maintain consistency across our thousands of disease related articles. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:35, 28 October 2012 (UTC)

2. A few figures that I think would enhance the article that should be added into appropriate sections would include: a) a table with the WHO case definitions for DF/or something like Figure 1.4 in the WHO guidelines 2009 b) a CDC figure etc. with worldwide distribution under Epidemiology c) a clinical course diagram like Figure 2.1 from the WHO guidelines would also be helpful in the clinical section

   a) we have a table of the warning signs, have clarified the definition of severe dengue b) a map of prevalence has not been done before, the best data we have is from page 5 here [13] and it is really not suitable for making a map as it is imply reported cases to the WHO rather than an estimate of actual rates. We have a map of DALY based on the most recent 2004 WHO data set and it is on the subpage. c) has been done. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:14, 28 October 2012 (UTC)

3. Introduction In paragraph two it is stated that there is no vaccine. There is a dengue vaccine in development and I wonder if wording should be changed to something like “there is no dengue vaccine that is being brought to market” etc. In paragraph three they do comment that work is ongoing around a vaccine

   Add that their is "no commercially avaliable" vaccine. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:38, 28 October 2012 (UTC)

4. Transmission May want to comment that although the mosquito may bite at any time of the day it has a predeliction for dusk and dawn

   Done Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:24, 28 October 2012 (UTC)

5. Diagnosis I’m not sure if you want to comment that Chikungunya is characterized by arthrlagic involvement as a differentiating factor from Dengue

   Per this ref PMID 20581669 Arthralgia is common in both. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:29, 28 October 2012 (UTC)

6. I might also add others to the DDx for Dengue including influenza, MMR, infectious EBV and HIV seroconversion illness

   Have added a couple of more. The desire however was not to make an exhaustive list. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:37, 28 October 2012 (UTC)

7. This is grammatically awkward and there is spelling error (availability): Original: “PCR however is more accurate in the first seven days and a test available as July of 2012 which can run on equipment used to diagnose influenza will result in improved avaliability.[28]” Suggested: “However, PCR is more accurate in the first seven days and a test available as of July 2012 (which can run on equipment used to diagnose influenza) will result in improved availability.”

   Tried to improve the wording Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:37, 28 October 2012 (UTC)

8. Epidemiology The first line seems like a commentary on Prognosis and should be under management and not Epidemiology:“Most people with dengue recover without any ongoing problems.[25] The mortality is 1–5% without treatment,[5] and less than 1% with adequate treatment;[25] however severe disease carries a mortality of 26%.[5]”

   We often combine prognosis into epidemiology when their is little content pertaining to prognosis. I am of the feeling that prognosis fits best before discussing burden of disease. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:37, 28 October 2012 (UTC)

Over all

1. Introduction: para 3: "work is ongoing on a vaccine" - ref?

   We do not typically put references in the lead as this is completely supported by the body of the text. Our lead is like the abstract on pubmed. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:41, 28 October 2012 (UTC)

2. Signs and symptoms para 1: "but are more susceptible to the severe complications" - does this mean they are less likely to get severe symptoms/complications, but if they do, more likely to die?

   Have clarified Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:42, 28 October 2012 (UTC)

3. Predisposition: Severe disease is more common in...children" - i thought the course of disease was milder in children (see previous comment, under "signs and symptoms" - Para 1)

   Have clarified Doc James (talk ·contribs · email) (if I write on your page reply on mine) 19:42, 28 October 2012 (UTC)

4. Diagnosis: para 1: "BP cuff for five minutes" - above diastolic?

   Clarified Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:52, 28 October 2012 (UTC)

5. Wording: Clinical course para 2: "petechiae" - does not need bracketed definition: delete, para 3: "significant fluid accumulation" - pulmonary edema and ascites?, para 3: "decreased blood supply to vital organs" - shock?, Complications: "infection of the brain" - encephalitis?, Mechanism: para 1: "blood pressure...so low" - shock, para 1: "reduced number of platelets" - thrombocytopenia

   I guess the depends on who our audience is. On Wikipedia we are trying to write for the general populous thus use language that is understandable by both the general public and professionals. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:52, 28 October 2012 (UTC)

Further copyediting

Have placed a copy of this article here Wikipedia:WikiProject_Medicine/Collaborative_publication/Dengue_fever and adjusted the wording further. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:40, 2 November 2012 (UTC)

Symptoms and children

Right now the article cites Simmons 2012 and says "and generally have less severe symptoms than adults" but the closest thing I found in the source is that "children have high fever but are generally less symptomatic than adults during [the febrile phase]". Biosthmors (talk) 18:30, 12 November 2012 (UTC)

Those statements sound consistent to me. Fever is generally not, itself, considered a severe symptom (and the use of the qualifier "generally" provides substantial leeway). In sum, it's a good paraphrase - no need to change it. -- Scray (talk) 19:57, 12 November 2012 (UTC)

I think this is an improvement. Biosthmors (talk) 20:30, 12 November 2012 (UTC)

I disagree. The source doesn't enumerate (count) symptoms in making this comparison, does it? "Fewer" is less-well supported than the original, which I think was fine. The original is also what's generally said in medical circles about dengue - it's milder in kids, generally. -- Scray (talk) 20:41, 12 November 2012 (UTC)

I thought it implied quantity by the previous sentence, which says "The initial phase is typically characterized by high temperature ... accompanied by headache, vomiting, myalgia, and joint pain, sometimes with a transient macular rash. Children have high fever but are generally less symptomatic than adults during this phase of the illness." I thought saying fewer symptoms in the febrile phase was a better paraphrase than "generally have less severe symptoms than adults" because the source is specifying the initial phase and I wanted to avoid contradictory sounding text (see peer review "Overall" section above) -- the sentence in the article ends with children "are at greater risk of severe complications". I am only using the source for the text I proposed. Although, I can self-revert. Biosthmors (talk) 21:01, 12 November 2012 (UTC)

I can understand where this might be coming from, "fewer" (your word choice) means less numerous - the source does not imply that given the context. "Generally less symptomatic" is synonymous with "milder" or "less severe" (and would be consistent with having the same set of symptoms, generally less severe than in an adult). -- Scray (talk) 21:19, 12 November 2012 (UTC)

Thank you for clearing that up. This fixes it, right? Biosthmors (talk) 21:52, 12 November 2012 (UTC)

Looks good. It's a pleasure to work collaboratively with you. -- Scray (talk) 22:52, 12 November 2012 (UTC)

You too. Biosthmors (talk) 03:55, 13 November 2012 (UTC)

Unnecessary sentence?

The sentence "Until 2003, dengue was classified as a potential bioterrorism agent..." is a one sentence paragraph in the Epidemiology section. It seems out of place, and it begs the question. What year was it classified as a potential bioterrorism agent? By who? I wonder if it is really that relevant to the history of the virus, or if it just a vague piece of triva? I don't see why this sentence is necessary, so I'll plan on removing it. Biosthmors (talk) 23:32, 30 November 2012 (UTC)

Either remove, or expand if there are reliable sources describing its history as possible source for bioterrorism (which would be an interesting section). Agree that as a single sentence it doesn't appear to fit. Yobol (talk) 23:35, 30 November 2012 (UTC)

Fluid management

The article says "The rate of fluid administration is titrated to a urinary output of 0.5–1 mL/kg/hr, stable vital signs and normalization of hematocrit." This is qualified in the source as part of a flowchart when a warning sign is present. Simmons 2012 (for a warning sign) says "judicious use of parenteral fluids in patients with inadequate oral intake or a rapidly increasing heatocrit". And for shock syndrome, Simmons says "to limit the risk of ... fluid overload, parenteral fluid therapy should be kept to the minimum required to maintain cardiovascular stability until permeability reverts to a normal level." I get the impression Simmons suggests significantly fewer fluids than our article currently does. Biosthmors (talk) 01:51, 1 December 2012 (UTC)

I think both sort of mean the same thing. What do you suggest changing it too? Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:36, 17 December 2012 (UTC)

Hospital admission is "necessary"

I understand why Biosthmors restored this wording - it matches words in the cited WP:MEDRS - but WP is not a manual and the NEJM author's decision to word it that strongly does not require us to do so. "Indicates need for admission" suggests the same without using "necessary". I will not revert again - but wanted to comment here. -- Scray (talk) 01:42, 1 December 2012 (UTC)

When I first wrote it, I also thought "hmmm... that's a bit strong" but then told myself, no, that's what the source says so that's what I should say. When I made the edit you point out, I thought I was just copy editing, but I can see now how it can sounds more strong/prescriptive. I'm not sure where to best draw the line. The source does say they can stay at home "with instructions to return to the hospital immediately if bleeding or warning signs ... develop." That added a bit of urgency to the way I read the sentence I'm trying to convey I guess. Biosthmors (talk) 02:04, 1 December 2012 (UTC)

I typically paraphrase the wording to a more accurate reflection of reality. In medicine their or very few absolutes. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:41, 17 December 2012 (UTC)

Warning signs

It seems like the warning signs info and/or table should be in the signs and symptoms section. Or maybe we could include a sentence that introduces the concept and links down the the diagnosis section, where the table is currently. Biosthmors (talk) 04:32, 15 November 2012 (UTC)

I like the warning signs in "diagnosis" as this is how one distinguishes between different severities. They are uncommon and thus better dealt with lower in the article IMO. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:44, 17 December 2012 (UTC)

Epidemiology

Much of this I would not consider "epidemiology" but "pathophysiology" instead.

Like most arboviruses, dengue virus is maintained in nature in cycles that involve preferred blood-sucking vectors and vertebrate hosts. The viruses are maintained in the forests of Southeast Asia and Africa by transmission from female Aedes mosquitoes—of species other than A. aegypti—to her offspring and to lower primates. In rural settings the virus is transmitted to humans by A. aegypti and other species of Aedes such asA. albopictus. Both these species have had expending ranges in the second half of the 20th century. In towns and cities, the virus is primarily transmitted to humans by A. aegypti, which is highly domesticated. In all settings the infected lower primates or humans greatly increase the number of circulating dengue viruses. This is called amplification. The urban cycle is the most important to infections of humans and dengue infections are primarily confined to towns and cities. In recent decades, the expansion of villages, towns and cities in endemic areas, and the increased mobility of humans has increased the number of epidemics and circulating viruses. Dengue fever, which was once confined to Southeast Asia, has now spread to Southern China, countries in the Pacific Ocean and America, and might pose a threat to Europe.

Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:13, 17 December 2012 (UTC)

Have adjusted the wording slightly. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:26, 17 December 2012 (UTC)

Extremely minor edit: changed "expending" to "expanding" because the word "expending" makes no sense. 183.88.72.109 (talk) 06:57, 3 January 2013 (UTC)n0w8st8s

Genetically engineering male mosquitoes

I've just watched the following TED Talk: Hadyn Parry: Re-engineering mosquitos to fight disease

Would you think it could be included in the Research section? --Langus (t) 21:37, 14 January 2013 (UTC)

Looks interesting; are there other sources to build on? bobrayner (talk) 22:21, 14 January 2013 (UTC)

Here you have a few:

http://latino.foxnews.com/latino/health/2012/12/06/latest-weapon-against-dengue-genetically-engineered-mosquitos/

http://www.bbc.co.uk/news/science-environment-15491228

More in this Google search

Hadyn Parry is Oxitec's CEO.[14]www.infowarscom/ceo-hadyn-parry-of-oxitec-explains-the-benefits-of-gm-mosquitoes/ --Langus (t) 15:37, 15 January 2013 (UTC)

Experts triple estimate of world dengue fever infections

Experts triple estimate of world dengue fever infections — Preceding unsigned comment added by 173.59.163.229 (talk) 21:09, 7 April 2013 (UTC)

Bhatt S, Gething PW, Brady OJ; et al. (2013). "The global distribution and burden of dengue". Nature. doi:10.1038/nature12060. PMID 23563266. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) --Anthonyhcole (talk · contribs · email) 05:20, 13 April 2013 (UTC)

Already added. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:21, 13 April 2013 (UTC)

In2care In2trap

Perhaps mention In2care's In2trap. It's a trap for mosquitoes possibly carrying dengue — Preceding unsigned comment added by KVDP (talk • contribs)

Is there a secondary source recommending its use? If not, we will not be discussing it. JFW | T@lk 11:42, 26 May 2013 (UTC)

read about it in EOS magazine, april 2013 KVDP (talk) 13:51, 26 May 2013 (UTC)

What is the evidence that it works? Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:07, 26 May 2013 (UTC)

New image

In dengue fever in some cases, individual lesions may coalesce and are then seen as generalized confluent erythema with petechiae and rounded islands of sparing-“white islands in a sea of red”

What do people think of this image? Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:47, 8 June 2013 (UTC)

Nice, but I'd blur the ring. -- Scray (talk) 11:36, 8 June 2013 (UTC)

Have cropped. The ring is a little blurry as it is. Do not have a proper program for that. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:56, 8 June 2013 (UTC)

Edit request on 11 June 2013

I wanted to change the format to bold on the line that says the mosquito prefers to lay eggs in artificial containers to highlight the importance of that fact, maybe even add a line about making an effort to eliminate man made incubators to reduce the incidence of mosquito borne diseases.

68.97.177.219 (talk) 19:05, 11 June 2013 (UTC)

To bold text that is not the page title would contravene MOS:BOLD (part of the style guide). Which source should be quoted to support the claim that man-made incubators should be eliminated? JFW | T@lk 19:56, 11 June 2013 (UTC)

In this context, I think the term "incubator" is meant in a more general way than you might assume. -- Scray (talk) 23:49, 11 June 2013 (UTC)

dengue fever-like patients

This edit is refs to a paper about dengue fever like patients [15] and it is a primary source. Thus removed twice now. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:40, 26 June 2013 (UTC)

Agree with removal, as it is not a reliable source for such content. -- Scray (talk) 05:50, 26 June 2013 (UTC)

Sorry my talk entry didn't stick before. If you want to delete my reference, fine, but please do not delete the mention of alopecia in the main article. Hair loss is a known symptom. See http://access.health.qld.gov.au/hid/InfectionsandParasites/ViralInfections/dengue_fs.asp and http://www.eliminatedengue.com/faqs/index/type/dengue-fever and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856379/#!po=85.4839. This primary source that you have dismissed, ostensibly because there was not serologic confirmation of subjects though they received dengue diagnoses, is the only source primary though it may be, that I've found that gives details as to WHEN and to what extent the hair loss occurs. Please return that information to the main page, even if you do not cite specific references. This is critically important information for people suffering from dengue, as it is such a delayed sequelae. Believe me, having 1/3 to a full head of hair fall out after you have supposedly regained your health, is something that patients should be warned about, yet medical professionals rarely do and epidemiologist pay no attention to such distressing but benign sequelae. I self-referred for medical care during the acute phase thanks to this Wikipedia page (much improved since then, and still the most informative source), but it was only other dengue victims who were truly informative about the full course of the virus, at least until I found this study that studied dengue sequelae -- the only one of its kind as far as I can find.Gwengazorn (talk) 06:41, 26 June 2013 (UTC)

We should endeavor to find reliable secondary sources supporting alopecia in this setting; absent that support, it does not belong in WP (OTOH, with a good secondary source providing support, the use of an aligned, high-quality primary might be contributory). -- Scray (talk) 07:02, 26 June 2013 (UTC)

Dengue haemorrhagic fever

Dengue haemorrhagic fever redirects to the Dengue fever page, but is not mentioned. What is it? Diggory Hardy (talk) 10:35, 26 June 2013 (UTC)

"Dengue hemorrhagic fever" (non-UK spelling) is described (in bold letters) in the second sentence of the lead paragraph, and then in more detail under "Clinical course". -- Scray (talk) 11:33, 26 June 2013 (UTC)

Edit request - Indigenous but not endemic

The disease is described as endemic. Wikipedia describes endemic as meaning that the organism is unique to a particular locality. This is not the case here. Wikipedia describes indigenous as meaning naturally occurring in a place, without man importing it. That definition doesn't mention whether human importation is intentional or accidental. I think this means that we can't use endemic here (possibly used accidentally because it sounds like 'epidemic') and should use indigenous, until it is shown that that is wrong. Summerdoor (talk) 07:57, 27 August 2012 (UTC)

What do references say? Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:39, 27 August 2012 (UTC)

From the OED entry on endemic: "Of diseases: Habitually prevalent in a certain country, and due to permanent local causes". Endemic is certainly the term used in scientific and informed literature, see for example http://apps.who.int/iris/bitstream/10665/75303/1/9789241504034_eng.pdf (World Health Organisation report). — Preceding unsigned comment added by 134.148.168.29 (talk) 02:01, 24 July 2013 (UTC)

Dysfunction/permeability

In Mechanism#Severe disease, the term endothelial dysfunction is used, though it is not hyperlinked. Simmons 2012 seems to prefer the phrase "transient capillary permeability syndrome". Because we already mention capillary permeability, and I don't think we want readers to think we're talking about the concept of endothelial dysfunction (example), I think I'll change this to avoid the potential for confusion. Biosthmors (talk) 20:55, 17 November 2012 (UTC)

Changed. Biosthmors (talk) 06:56, 18 November 2012 (UTC)

User:Jmh649, I see here the term was introduced again. The term endothelial dysfunction seems vague/inappropriate to use. Biosthmors (talk) 11:31, 24 August 2013 (UTC)

Feel free to change it to capillary permeability. Open to other suggestions. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:23, 24 August 2013 (UTC)

Done, thanks. Biosthmors (talk) 16:40, 24 August 2013 (UTC)

Categories

What was the rationale of this edit, User:Ruslik0? It just seems odd. Thanks. Biosthmors (talk) 11:25, 24 August 2013 (UTC)

The Category:Dengue fever is already a member of all above mentioned categories. See WP:Overcategorisation Ruslik_Zero 04:24, 26 August 2013 (UTC)

Dengue in St. Croix USVI

Request for Additional Comment on Geographic Distribution: Dengue fever is making its way North as the climate warms. There have been multiple cases of Dengue in St. Croix. My source is my own recent trip to St. Croix and conversations with residents who report such occurrences including a key and trusted person from the St. Croix Environmental Association. 71.127.7.90 (talk) 18:12, 5 September 2013 (UTC) Noel Abbott

We discuss that it is moving north. Will need a ref. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:05, 5 September 2013 (UTC)

Harper/etymonline. com

From the archives of WP:RSN, it appears ([16][17][18][19]) we shouldn't be citing Harper, but instead perhaps Merriam-Webster or the Oxford English Dictionary. For the purposes of publishing in Open Medicine (a medical journal), should we even bother with etymology? The source currently supports "The Swahili word dinga may possibly have its origin in the Spanish word dengue, meaning fastidious or careful, which would describe the gait of a person suffering the bone pain of dengue fever." Biosthmors (talk) 11:18, 24 August 2013 (UTC)

I think it's abundantly clear from the current sources that the etymology of "dengue" is obscure. I have no access to the OED or Merriam-Webster, but if you can find anything better than the current source than by all means replace it. JFW | T@lk 07:49, 26 August 2013 (UTC)

I was able to get some online access to the OED entry for dengue, though I'm not sure exactly how to reference it. The OED had what appeared to be a caution saying it wasn't quite updated. I can email what I copied and pasted to you if you'd like, JFW. I'm also concerned that http://www.medterms.com/script/main/art.asp?articlekey=6620 isn't quite publishing quality. I've made some changes to the section. Biosthmors (talk) 11:06, 8 September 2013 (UTC)

I'd love to see whether the OED entry might replace the current low-quality sources. JFW | T@lk 15:54, 8 September 2013 (UTC)

Guppies

This was recently added to the section on prevention "A 2013 study by the Asian Development Bank and World Health Organization conducted in two districts in Cambodia and Laos showed a sharp decline in mosquito larvae in water storage tanks after guppy fish were introduced. " First of all it is a primary source. Second it is already discussed in the research section were at this point it dits better. "With regards to vector control, a number of novel methods have been used to reduce mosquito numbers with some success including the placement of the guppy (Poecilia reticulata) or copepods in standing water to eat the mosquito larvae.[52]" Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:43, 12 September 2013 (UTC)

Edit request on 17 September 2013

symptoms also include nausea and vomiting 117.254.12.100 (talk) 05:35, 17 September 2013 (UTC)

Done. Thanks! Good idea. Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 07:36, 17 September 2013 (UTC)

Why mention the same thing three times? Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:58, 17 September 2013 (UTC)

Are you talking about before or after your edit, which I thought was good, thanks. Biosthmors (talk) pls notify me (i.e. {{U}}) while signing a reply, thx 10:12, 17 September 2013 (UTC)

We are good now. It was sort of there already but now better. Thanks. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:33, 17 September 2013 (UTC)

Edit request on 27 September 2013

AYURVEDIC TREATMENT FOR DENGUE: Take 10 Leaves of "Harshingar" Tree, ( night jasmine in engish) and 8 Kaali Mirch crush it (Black Pepper), and boil it in 3 Glass of Water, when it boil downs to half, i.e. 1.5 Glass water, give 1 Sip every 1/2 Hour, for 12 Hours, Platelets will start increasing after first sip, it is a Miracle Drug, as Platelets rose to 16000 from 7000 after first sip and to 25000 after second sip, it is sure shot treatment for Dengue. Spread this message to maximum people, so that anybody who is suffering should take it to get relief from Dengue

Balasubs (talk) 07:02, 27 September 2013 (UTC)

Not done: please provide reliable sources that support the change you want to be made. Also, please note that on medical articles, sources must comply with WP:MEDRS as well. Dana boomer (talk) 17:20, 27 September 2013 (UTC)

Close out earlier references

Celestra (talk) 19:03, 22 November 2013 (UTC)

Inclusion of evidence about Corticosteroids for treating dengue shock syndrome

A systematic review found that cortiocsteroids was no more effective than no treatment or placebo in terms of mortality , need for blod transfusion or incidence of serious complications. Drsoumyadeepb (talk) 13:01, 22 November 2013 (UTC)

Note: It isn't obvious where this might be placed in the article. No mention of corticosteroids exists to which this might be a counterpoint. Could you please indicate where you would like this added? Thanks, Celestra (talk) 17:11, 22 November 2013 (UTC)

Done Thanks, Celestra (talk) 21:20, 23 November 2013 (UTC)

Summarized furtehr. Typically one does not need to state it is a systematic review and can just state the conclusions as fact. Great suggested edit. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:28, 23 November 2013 (UTC)

Recurrent shock

Not a secondary source, but one to watch out for: doi:10.1186/cc13135, predicting the risk of recurrent shock in DSS. JFW | T@lk 14:31, 9 December 2013 (UTC)

DIC

This also mentions DIC [20] as does this [21] Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:20, 8 June 2014 (UTC)

This review describes it as a well known [22] Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:24, 8 June 2014 (UTC)

And than we have "However the minor changes in PT together with the infrequent observation of fibrinogen degradation products (FDPs) do not support DIC being the cause of dengue-associated coagulopathy." [23] I guess the question is should we comment on DIC. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:35, 8 June 2014 (UTC)

If the major reviews don't cover it, we shouldn't. There are plenty of reasons why the indices of someone with severe dengue might look like DIC but not meet the criteria. JFW | T@lk 20:07, 9 June 2014 (UTC)

Dengue encephalitis?

I have added some stuff from doi:10.1016/S1474-4422(13)70150-9 (Lancet Neurol 2013) which is a systematic review of all neurological phenomena in acute dengue. The article alludes to many important points about the distinction between dengue encephalopathy (secondary to shock, hyponatraemia, hepatic dysfunction) and encephalitis (direct viral infection of the cerebrum). The difficulty is that while DENV might be identified in CSF or brain autopsy, there is limited evidence of actual inflammatory infiltrate.

I'm not quite sure how to capture these obvervations, because the authors do give the impression that dengue encephalitis is a bona fide diagnostic entity to be distinguished from encephalopathy. JFW | T@lk 10:51, 23 July 2014 (UTC)

Which version of the article was published in Open Medicine?

Neither the Open Medicine article nor the currently deployed version of Template:PubMed Indexed Talk make this clear. -- Daniel Mietchen (talk) 02:41, 3 October 2014 (UTC)

There is not one Wikipedia version that was published. The peer review by Open Medicine is above. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:45, 3 October 2014 (UTC)

Hi Daniel. Thanks again for another awesome milestone, James! Here I've made a version using the text and sources that passed expert review so readers can compare the expert-reviewed version with the current, dynamic version to see any changes. I shuffled a bit of the text to match the current sequence in order to make the diff clear, but the text and sources are exactly per the Open Medicine version, I think. --Anthonyhcole (talk · contribs · email) 06:52, 13 October 2014 (UTC)

Amazing. Thanks Anthony. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:07, 13 October 2014 (UTC)

Very useful, Anthony - thanks! -- Daniel Mietchen (talk) 11:40, 13 October 2014 (UTC)

Where is prognosis?

Under epidemiology. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:01, 28 October 2014 (UTC)

Semi-protection

Can someone please explain why this article is semi-protected? Thanks. Cullen³²⁸ Let's discuss it 03:32, 22 January 2015 (UTC)

Due to persistant vandalism. Doc James (talk · contribs · email) 05:18, 22 January 2015 (UTC)

Review in Lancet

doi:10.1016/S0140-6736(14)60572-9 - unlikely to be much news but might serve as a replacement for older citations. JFW | T@lk 10:56, 30 January 2015 (UTC)

Semi-protected edit request on 11 February 2015

There are only 4 types of Dengue fever virus, not 5 as cited in the wikipedia page 2607:B400:24:4003:1B1:D6EC:2176:28 (talk) 14:14, 11 February 2015 (UTC)Taylor

The CDC is a little out of date. Someone should give them the heads up :-) Doc James (talk · contribs · email) 14:40, 11 February 2015 (UTC)

Picture Inaccuracy?

I'm no doctor, but the first picture of the resulting rash clearly shows the imprint of a hand. Does the rash cause imprints when pressed, can it naturally look like that, or is the picture wrong? 71.191.220.181 (talk) 04:13, 2 June 2015 (UTC)

Yes it is blanchable and was pressed by a hand. Will clarify this. Doc James (talk · contribs · email) 05:43, 2 June 2015 (UTC)

Copy and paste

This was copied from sources

"As part Dengue prevention and awareness, International Anti-Dengue Day is being observed on 15th June in different parts of the world especially in the Indian subcontinent and ASEAN region. ASEAN Dengue Day is an advocacy event held every 15 June from 2011 on to increase public awareness of dengue, to mobilize resources for its prevention and control, and to demonstrate the region’s commitment to tackling the disease. The advocacy event was agreed upon during the 10th ASEAN Health Ministers Meeting in 2010. The first regional event was held in 2011 in Jakarta, Indonesia, while Myanmar hosted the regional celebration in Yangon in 2012. WHO has provided technical and financial support to the ASEAN Secretariat and the ASEAN Member States for the Dengue Day activities since its inception. In 2013 ASEAN Dengue Day regional commemorative programme was held in Hanoi, VietNam, and was attended by representatives of ASEAN and international partners. The theme for 2013 was: ASEAN unity for a dengue-free community. "

Including [24] Thus moved here Doc James (talk · contribs · email) 09:22, 16 June 2015 (UTC)

Now, this should look much better but still not perfect, if needed please do 'undo' or 'edit' -wowdipu

Anti-Dengue Day

As part of Dengue prevention and awareness, International Anti-Dengue Day is being observed on 15th June in different parts of the world especially in the ASEAN region. ASEAN Dengue Day is an advocacy event held every 15 June since 2011, conducted so as:

1. To increase public awareness about dengue,
2. To mobilize resources for its prevention and control and,
3. To demonstrate the region’s commitment to tackling the disease.

The 10th ASEAN Health Ministers Meeting in 2010 went on to ratify the observation of the day from 2011.

World Dengue Day

Year	Host	Theme
2011	Jakarta, Indonesia
2012	Yangon, Myanmar
2013	Vietnam	ASEAN unity for a dengue-free community.

Formatted the refs and paraphrase slightly to condense the text. Doc James (talk · contribs · email) 15:21, 16 June 2015 (UTC)

References

link to dengue fever vaccine page?

I was thinking of adding a link from the last sentence of the third paragraph to an article titled dengue vaccine, which needs work, including addition of some recent developments. 223.204.246.120 (talk) 02:36, 30 July 2015 (UTC)

Whoops, not previously logged in. juanTamad 02:38, 30 July 2015 (UTC)

Good idea. Done. Doc James (talk · contribs · email) 10:21, 30 July 2015 (UTC)

Text for publication icon

When I hover my mouse cursor over the publication icon, I see the following text.

• This is article has been published in the peer reviewed journal Open Medicine. Click to view the published version.

The word "is" should be removed, but I do not know how to do it. Also, I prefer "peer-reviewed" with a hyphen. Please see http://www.onelook.com/?w=peer+reviewed&ls=a.
—Wavelength (talk) 16:20, 9 October 2014 (UTC)

Thanks for spotting this, I have fixed it. Graham Colm (talk) 16:48, 9 October 2014 (UTC)

prevent dengue for life — Preceding unsigned comment added by 112.198.246.103 (talk) 03:57, 8 October 2015 (UTC)

Clincal review in the BMJ

[25] Doc James (talk · contribs · email) 01:03, 11 October 2015 (UTC)

Peer review

I have moved back the tag [26]. The most important thing is the content IMO. Doc James (talk · contribs · email) 01:25, 23 November 2015 (UTC)

Semi-protected edit request on 11 December 2015

In the opening paragraphs, it states that there is no commercially available vaccine. Near the end, it mentions that Mexico just approved a vaccine (December 2015). I suggest editing the opening paragraph to say "The first commercial vaccine has been approved in Mexico and is currently under testing in several other Latin American countries. However, US approval will take additional time and is presently not forecasted." Vasky22 (talk) 04:03, 11 December 2015 (UTC)

It has been approved in Mexico but is not yet commercially available. Doc James (talk · contribs · email) 14:05, 11 December 2015 (UTC)

Management of Dengue in Tamilnadu,India

Hello KateWishing,

Like Paracetamol listed in the management section, in Tamilnadu, India, i have listed the Indian medicines which are being used by the Indian Government under Vector Borne Disease Control Programme. The source is the National health mission Tamilnadu, Department of Health & Family welfare. What is wrong in that ? Why did you remove a sourced content before discussion ? Sathishmls (talk) 18:07, 11 December 2015 (UTC)

I removed that because the source does not meet WP:MEDRS. Although it's true that alternative medicine is used in India, we should not include anything in the "Management" section without comment on its efficacy. KateWishing (talk) 18:20, 11 December 2015 (UTC)

The content is a fact that is happening in Tamilnadu, India by the Government of India for more than 2 years. Wikipedia contains facts and hence i included the exact line which is given by the Health department of India. and they clearly said that these medicines are used in management/control of Dengue in Tamilnadu. Hence the section is correct. There is no necessary to include its efficiency here. Our Indian government will not provide these medicines for its people for more than 2 years without testing its efficiency. Sathishmls (talk) 17:32, 12 December 2015 (UTC)

King_Institute_of_Preventive_Medicine_and_Research which has the Department of Virology, Guindy has already did a case-control approach [27] on these medicines. Sathishmls (talk) 17:41, 12 December 2015 (UTC)

The government of India is known to sponsor pseudoscientific medicine (Central Council of Homoeopathy, Ministry of AYUSH, etc.). It is not a reliable source for medical topics under WP:MEDRS. KateWishing (talk) 17:47, 12 December 2015 (UTC)

Please avoid discussing about your personal opinions. Talk about facts ? Sathishmls (talk) 17:51, 12 December 2015 (UTC)

I only stated facts, the key one being that your source does not meet WP:MEDRS. You can ask for more input at WP:MED if you disagree. KateWishing (talk) 18:38, 12 December 2015 (UTC)

Yup you need a better ref User:Sathishmls. Doc James (talk · contribs · email) 08:22, 13 December 2015 (UTC)

I just included that "Indian medicines such as Papaya juice extract, Nilavembu and Malaivembu kudineer along with conventional medicine are used for the control of Dengue." This content just says these are used. For this content, if you say the Department of Health website source is not a reliable source. Then do you mean to say that the Government of India is lying in their own website ??? Sathishmls (talk) 09:44, 13 December 2015 (UTC)

First, do you all accept that these Indian medicines are used by Government of India in control of Dengue ? Sathishmls (talk) 09:47, 13 December 2015 (UTC)

If they do not work than they do not control dengue. Doc James (talk · contribs · email) 11:15, 13 December 2015 (UTC)

Your answer is irrelevant for the current discussion of the content. My question is very simple. For saying that these Indian medicines are used in control of Dengue, their website i.e., Department of Health, Tamilnadu (the Government's own major health organization in India) is definitely a reliable source. How can you say that its not a reliable source ? Sathishmls (talk) 11:20, 15 December 2015 (UTC)

Thanks for the discussion which helped to get the consensus. I have added the same content. Thanks. Sathishmls (talk) 12:23, 21 December 2015 (UTC)

There is no consensus. You can try a RfC to get further input. Doc James (talk · contribs · email) 16:26, 21 December 2015 (UTC)

You are misusing your experience. You are not able to answer my questions. But you want to just hide this fact which is happening in India at Government level. Why are you trying to hide this fact ? What gain do you get by hiding this fact ? Sathishmls (talk) 09:19, 22 December 2015 (UTC)

If some government department in India believes in nonscientific things (like papaya juice being a remedy for dengue fever) that mistaken view might deserve mention somewhere in the encyclopedia, without the implication that the belief is correct. If it would be undue weight to mention it in this article, then perhaps there is an article on quack remedies and pseudoscience where it could be mentioned, such as the belief of some in Korea that operating an electric fan in a closed room causes asphyxiation or the belief of some in Japan that personality is determined by blood type.Wikipedia includes notable myths, not just "true facts." Edison (talk) 15:22, 22 December 2015 (UTC)

It is undue weight here. The section on management is a discussion of how to treat the disease. Not a list of all the things that someone says you can give to someone with the condition. Doc James (talk · contribs · email) 18:17, 22 December 2015 (UTC)

Edison, it's actually papaya leaf juice. But I am ready to remove certain material and add like "In Tamilnadu(India), Indian medicines such as Nilavembu kudineer along with conventional medicine are used for the control of Dengue under Vector Borne Disease Control Programme.", because the usage of medicine Nilavembu Kudineer during Dengue is scientifically proven[28] by the King_Institute_of_Preventive_Medicine_and_Research and it is a fact which is happening even now and growing widely in TamilNadu, India.Sathishmls (talk) 11:09, 23 December 2015 (UTC)

Shall we create a new appropriate section like Regional (without subverting the meaning) and add this content ? Sathishmls (talk) 12:04, 23 December 2015 (UTC)

No. That source is not sufficient. Please read WP:MEDRS. We do not use primary sources from no pubmed indexed journals. Doc James (talk · contribs · email) 15:30, 23 December 2015 (UTC)

Agree. In addition to the weak sources, this is WP:WEIGHT and really of no relevance to the general readership. JFW | T@lk 08:26, 24 December 2015 (UTC)

The content says "In Tamilnadu(India), Indian medicines such as Nilavembu Kudineer is used along with the conventional medicine ..." and it does not claim that it cures Dengue or anything explicitly. For the said content, it is a position statement from a nationally reputable expert body i.e., the Indian Government's Department of Health body website (a secondary source since its a major health body) as per WP:RS/MC. Sathishmls (talk) 05:04, 25 December 2015 (UTC)

With respect to a claim of benefit of a treatment no that is not sufficient IMO. It is descripting a practice that takes place I agree. But do not think it is sufficiently notable for this article. Doc James (talk · contribs · email) 06:03, 25 December 2015 (UTC)

Sorry. You have nothing but your personal opinion to object the sourced content that I am trying to add. Sathishmls (talk) 17:03, 29 December 2015 (UTC)

Disagreements like this happen hundreds of times a day and they are resolved by consensus, not persistence. Editors do not have to provide gold-plated reasons that satisfy everyone regarding why material should not be added. By consensus, articles on medical topics stick to what is known, as established by reliable sources for such topics. There is no need to mention that certain supplements are provided in certain places—either the supplements have nothing to do with dengue fever (perhaps they assist with nutritional problems common in that area), or they are claimed as beneficial for treating the disease. Nothing is needed in the former case because articles should not accumulate factoids that confuse the core issues, and the material must not be added in the second case because opinions on what is effective are definitely not added at Wikipedia. Johnuniq (talk) 03:53, 30 December 2015 (UTC)

Vaccine approved in Brazil

Sanofi Pasteur, the vaccine division of France's Sanofi SA, said Monday it has secured approval from Brazilian authorities to market its dengue fever vaccine amid an explosion of cases across Latin America's largest nation.

Approval was granted by Anvisa, Brazil's food and drug administration, which said the price for the vaccine will be set by the government. Neither the agency nor the company disclosed how soon the vaccine, with the brand name Dengvaxia, will become available in Brazil. FROM: http://www.marketwatch.com/story/brazil-approves-sanofis-dengue-fever-vaccine-2015-12-28 OrganicPsychologyist (talk) 17:15, 28 December 2015 (UTC)

Cool. Will add. We already state that Mexico has approved it. Doc James (talk · contribs · email) 09:28, 29 December 2015 (UTC)

Vaccine and Singapore

To further bolster the ongoing trials in Thailand and Philippines, the vaccines division of Sanofi-Aventis Group (Sanofi Pasteur) has initiated clinical studies of its investigational tetravalent dengue vaccine in Singapore and Vietnam. See: http://www.pss.org.sg/whats-happening/e-bulletin/issue-no-46/new-hope-dengue-vaccine-trials-start-singapore-vietnam#.Vob00FKAyF8

here is currently no approved vaccine for the dengue virus, but this looks set to change. A team of scientists in Singapore has found out that the solution may be in our skin. T cells, a type of white blood cells, recognise and kill viruses in the body. And as scientists from the DUKE-NUS Graduate Medical School and the NUS Yong Loo Lin School of Medicine have discovered after a five-year study, they are also able to deal with dengue. See: http://www.channelnewsasia.com/news/singapore/local-researchers-may/1803328.html AsianScientist (Jun. 15, 2015) - Since 2011, 15th June has been designated by the Association of Southeast Asian Nations (ASEAN) as the ASEAN Dengue Day. Sanofi Pasteur, the vaccines division of the multinational pharmaceutical company Sanofi, has supported the ASEAN Dengue Day since its inception. Sanofi Pasteur also owns the leading dengue vaccine candidate, having completed Phase III trials for their CYD-TDV vaccine. Read more from Asian Scientist Magazine at: http://www.asianscientist.com/2015/06/features/dengue-day-2015-interview-dr-joselito-sta-ana/ OrganicPsychologyist (talk) 21:54, 1 January 2016 (UTC)

Yes agree. Sounds like it will be commercially avaliable in a mouth or two. Doc James (talk · contribs · email) 01:59, 2 January 2016 (UTC)

That would be good, given that I travel to that part of the world OrganicPsychologyist (talk) 22:04, 2 January 2016 (UTC)

foreteen is not a word

Symptoms typically begin three to fourteen days after infection.

Corrected, thank you. Graham Beards (talk) 15:15, 5 February 2016 (UTC)

Balapiravir

The article for the polymerase inhibitor balapiravir states that it is used as part of the treatment of dengue, but it is not mentioned in this article and is a stub. If it is used then it should probably be expanded. Alcherin (talk) 19:21, 10 February 2016 (UTC)

Except it found no benefit for dengue. Doc James (talk · contribs · email) 19:42, 10 February 2016 (UTC)

doi:10.1016/j.antiviral.2013.09.013 is secondary source that discusses failed agents. JFW | T@lk 09:27, 11 February 2016 (UTC)

Semi-protected edit request on 3 March 2016

The world map which shows the distribuation of the disease in the 2006, obviously dates back to the time before the fall of the iron curtain, or at least the very early nineties. Because there czechoslovakia is still one country, the Ukraine is is displayed as part of Russia and Yugoslavia also still exists. So I actually think this map should be deleted. Thanks!

Tkruspel (talk) 13:30, 3 March 2016 (UTC)

Dengue distribution in 2006

---

  Epidemic dengue and A. aegypti

  A. aegypti, without epidemic dengue

 Not done Tkruspel is referring to the map on the right, which does indeed still have the borders of c.1990-91 (Namibia exists, but so does the Soviet Union and Yugoslavia). The map quality isn't particularly good either - the Persian Gulf and Sea of Azov are filled in, several coastline borders are missing, several borders are miscolored in Central Africa, and there's an unexplained black line cutting through Colombia, Venezuela, Guyana and Suriname that divides red areas only. However, the current map still serves to identify the areas involved, and should be kept. If a better map is available then it should be included. Alcherin (talk) 14:36, 3 March 2016 (UTC)

virus or filterable agent?

Wouldn't it be more correct to say 'shown to be caused by a filterable agent, the term used for viruses before the much was known about them, or something similar? -- "In 1906, transmission by the Aedes mosquitoes was confirmed, and in 1907 dengue was the second disease (after yellow fever) that was shown to be caused by a virus" JuanTamad (talk) 10:41, 27 April 2016 (UTC)

In retrospect we know it was a virus so I think the current wording is easier to understand. Doc James (talk · contribs · email) 16:32, 10 July 2016 (UTC)

papaya for dengue fever

I live in Southeast Asia. Everybody (well almost) thinks papaya (the leaf extract I think) is the way to treat it, at least the common mild form, I think. There is no good evidence of course, and the disease is self-limiting so almost anything would seem to work. But, does it deserve a mention and some assessment of any evidence? Here's a recent review: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071726/ JuanTamad (talk) 11:33, 8 July 2016 (UTC)

The journal that published it has no impact factor[29]. It is an extraordinary claim. Therefore I would deem that not to be a suitable reference. Doc James (talk · contribs · email) 16:30, 10 July 2016 (UTC)

Right, it’s not a great journal, but the paper seems like a fair assessment of the evidence so far. It doesn’t make any claims. Concludes: "However, currently, it is also necessary not to rely entirely on the leaf extract and ignore standard treatment for dengue until the benefits are established. Large scale randomized clinical trials in dengue-confirmed patients is [sic] necessary to establish their usefulness.” There seems to be one fairly large RCT, published in the journal, Evidence-based Complementary and Alternative Medicine, conclusion: "it can be concluded that the administration of CPLJ [Carica papaya leaf juice] in DF and DHF is safe and does induce the rapid increase in platelet count. It may play a valuable role in the management of DF in the near future.”) A potential benefit seems to be reducing hospitalization by improving thrombocytopenia. The publisher is Hindawi and has an impact factor of 1.9 (http://www.hindawi.com/journals/ecam/). Hindawi is legit, not on Beall’s list (http://www.nature.com/news/investigating-journals-the-dark-side-of-publishing-1.12666). Here’s another from PLOS Neglected Tropical Diseases that is about beliefs and practices in general: http://www.ncbi.nlm.nih.gov/pubmed/23875045. If interested, I’ll attempt to draft a short statement using any other reliable sources I can find. I’ll put it here on the talk page for review. JuanTamad (talk) 02:51, 11 July 2016 (UTC)

The journal shows how poor the evidence base is, and calls for more research. Generally speaking we avoid discussing popular remedies. JFW | T@lk 14:28, 11 July 2016 (UTC)

Economic impact

doi:10.1016/S1473-3099(16)00146-8 - Lancet Infect Dis. Not sure if this qualifies as WP:MEDRS but it would fit in neatly with the current content. JFW | T@lk 18:05, 19 July 2016 (UTC)

I would say it does. In the Lancet, a systematic review, or analysis they call it, since its economics I guess. In fact, I would say the wiki page is deficient if this is not added to it. April 2016. Same author as ref 63, a 2013 analysis. There is no section on economic aspects or burden of disease> Maybe a new section instead of placing in epidemiology? I got a copy from sic-hub.cc. Can add to epi for now, let me know. JuanTamad (talk) 01:46, 21 November 2016 (UTC)

Sounds good. Doc James (talk · contribs · email) 12:33, 22 November 2016 (UTC)

Mechanism behind ADE

Dear Sirs,

Although there is a statement "The exact mechanism behind ADE is unclear.", in my recent paper

http://www.nature.com/articles/srep44016

I have written as follows:

"To our knowledge, this is the first report to identify the genes downstream from ADE-DENV using a bioinformatic (meta) analysis rather than experiments."

Is it possible for anyone to modify the statement "The exact mechanism behind ADE is unclear." such that reflects the result of my paper?

Y-h. Taguchi, the author of the above paper. — Preceding unsigned comment added by Tag (talk • contribs) 23:14, 11 March 2017 (UTC)

Thanks for your note. Content about health in WP is generally sourced to reviews, not to research papers. This is described in WP:MEDRS. Jytdog (talk) 23:24, 11 March 2017 (UTC)

Wolbachia update

Could this article be updated with the latest progress in this area --FDent (talk) 11:34, 21 January 2018 (UTC)

Exciting and interesting but quite speculative at this point. As the author states near the end of the commentary, in referring to unknowns about spread of Wolbachia in the real world, "The extent to which this matters will in turn depend on the local epidemiology of dengue viruses and whether patches of Wolbachia-free mosquitoes have a substantial effect on the burden of disease in the human population." Might be worth adding to Research, but one should note that this commentary was published as a companion to this article by Schmidt et al in the same journal - i.e. this is not an independent review article but rather a commentary solicited by the editors who chose the primary research for publiction (there is a conflict of interest to consider). I suggest waiting to see if an unconflicted review article provides evidence of notability. — soupvector (talk) 20:33, 21 January 2018 (UTC)

We have a section in the article on the topic Dengue_fever#Wolbachia. What do you suggest adding / changing? Doc James (talk · contribs · email) 23:12, 25 January 2018 (UTC)

References

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Dengue

In 1959 less than 1,000 cases of Dengue where reported world wide. Now as estimated 20 other vector-born disease have also emerged during this time due to ecological changes. — Preceding unsigned comment added by 139.94.248.208 (talk) 20:54, 8 March 2018 (UTC)

Do you have sources for your assertion? Also, are you proposing that the article should be changed? JFW | T@lk 21:42, 8 March 2018 (UTC)

Per instructed?

Were are the instructions to move the template? Anyway have adjusted to just leave the little icon in the right upper corner. Doc James (talk · contribs · email) 14:58, 12 April 2018 (UTC)

NSAIDs and dengue fever

@Doc James: The lead sentence about the NSAID contraindication violated WP:NPOV (specifically, WP:WikiVoice/WP:ASSERT since this statement was unattributed) prior to my recent edit. Feel free to tweak the wording that I used in my edit; however, if you remove the explicit attribution of the medical advice/opinion in this sentence, the ensuing discussion about your revert will take place at WP:NPOV/Noticeboard, not here. Since the lead statement about this is currently more verbose than the analogous statement in the body, I'd be fine with swapping the lead/body sentences about NSAIDs and bleeding. The current sentence in the body about NSAIDs does not express an opinion, so it does not need to be reworded.

I'm going to go through this article sometime soon to address issues with images sandwiching article text (WP:SANDWICH/WP:SANDWICHING) and other violations of WP:WikiVoice/WP:ASSERT. Seppi333 (Insert 2¢) 23:45, 27 April 2018 (UTC)

Fixing the text sandwiching between staggered images:  Done

Checking for other issues with WP:WikiVoice:  Pending

Seppi333 (Insert 2¢) 00:46, 28 April 2018 (UTC)

My opinion is that the statement that was in the lead before is not only policy-compliant, it is preferable for a lead. The statement is uncontroversial and needs no attribution; adding the attribution only clutters the lead. At any rate, I have started a DRAFT RFC at Wikipedia:Request for comment on tone in medical writing‎. Please discuss how to improve the wording of the RFC on its talk page, and please let's not launch it prematurely. I will launch it once we know we have it framed in a way that will result in community consensus. SandyGeorgia (Talk) 01:00, 28 April 2018 (UTC)

@SandyGeorgia: I'm ok with doing an RFC on this. Once you've created it, it would be a good idea to post a notice about the RFC at WT:NPOV and WT:MED, as a consensus that medical opinions do not require attribution would necessitate changes to WP:NPOV. Seppi333 (Insert 2¢) 01:38, 28 April 2018 (UTC)

If you will reread my post above, you will see that I did create it, and that we should work on framing it BEFORE it is launched community-wide. (not my first rodeo :) Please add comments on talk regarding the framing of the RFC. (I will point out that I added example number 6 as one that I think should be attributed, because it goes against conventional wisdom and could cause harm.) It is your opinion that changes to NPOV would be needed; that is because you have a different view on opinion vs. fact than some others. I added example 5 to help you see the inconsistency in the stance you take at one article vs. another. SandyGeorgia (Talk) 01:53, 28 April 2018 (UTC)

What I meant when I said "Once you've created it" was exactly the same thing that you were referring to when you said "it is launched community-wide"; i.e., once you start the RFC, not a start writing a draft RFC. Seppi333 (Insert 2¢) 02:13, 28 April 2018 (UTC)

Have adjusted to "Paracetamol (acetaminophen) is recommended instead of nonsteroidal anti-inflammatory drugs (NSAIDs) for fever reduction and pain relief in dengue due to an increased risk of bleeding from NSAID use."

As no one contradicts this statement IMO it can be said in the voice of Wikipedia without explicit attribution. Doc James (talk · contribs · email) 23:47, 28 April 2018 (UTC)

Agree, SandyGeorgia (Talk) 23:53, 28 April 2018 (UTC)

Also agree. Rewording it was a much simpler solution. Seppi333 (Insert 2¢) 02:53, 29 April 2018 (UTC)

Semi-protected edit request on 18 August 2018

Please correct image 'Dengue fever deaths per million persons in 2012'. It is not correct. The WHO data linked to image does not correspond to the data shown on the map. For example Ireland had no Dengue deaths in 2012. Degle101 (talk) 17:09, 18 August 2018 (UTC)

Agree User:Degle101 the ref says there were zero cases in Ireland. User:Chris55 can you fix? Doc James (talk · contribs · email) 00:46, 20 August 2018 (UTC)

I've checked the Dengue deaths in Ireland from the WHO data and they correspond with the spreadsheet available from the WHO. This has arisen before with developed countries having a hotspot with essentially tropical diseases: the statistics measure the countries in which the people died, not necessarily where they contracted the disease. The incidence (37 deaths) does seem high but it corresponds to 8 per million. Note that the numbers that appear in the spreadsheet are rounded to 1 decimal place so Ireland appears as 0.0 but this is misleading. It is actually 0.037 (thousand). Chris55 (talk) 20:17, 20 August 2018 (UTC)

I'd make two other points: 1. This map has been there at least 2 years and there is no suggestion of vandalism so the semi-protected request is unjustified. 2. The ECDC statistics on Dengue seem totally at variance with the WHO figures. They claim 7 cases in 2012 (deaths not recorded). The French case is more puzzling: 110 cases in 2012 with WHO reporting 0; Germany had 616 cases but didn't report to the WHO. (Thailand seems to be the main culprit.) These are not deaths so could be consistent although the Irish case cannot be. I'm not a medical person and Doc James would be better to take this up with the WHO. Chris55 (talk) 20:52, 20 August 2018 (UTC)

Thank User:Chris55. It all mostly makes sense now. Doc James (talk · contribs · email)

Ok, since we agree that it must be a mistake, I've removed the Ireland hotspot from the map. Chris55 (talk) 16:13, 22 August 2018 (UTC)

urgent

Article states: Deaths ~20,000[6] This figure is nowhere to be seen on the cited source . — Preceding unsigned comment added by 85.170.149.102 (talk) 06:09, 22 October 2018 (UTC)

In the second sentence. Ruslik_Zero 20:06, 22 October 2018 (UTC)

Thank you, i missed that

Article is protected, it would be helpfull if one of you will add the following info to the table on the right. Under Frequency. "50 to 528 million per year... of which 96 million display signs of severity". Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001629/ It is important to distinguish between dengue (a flu like disease) and severe dengue (lethal) --Thip (talk) 23:26, 5 November 2018 (UTC)

Where exactly do you want to insert this text? And how will it comport with what is already written? Ruslik_Zero 20:15, 6 November 2018 (UTC)

Blood donation in "Society and culture"

@Doc James: Rather than continue after your second revert of my edit and trigger 3RR, although WP:MEDMOS#Society and culture does prescribe a suggestion for a "Society and culture" section, the effect of dengue fever on blood donors really does not have much to do with society and culture. MarkH21 (talk) 01:17, 9 January 2019 (UTC)

Blood donation is a social and culture issue. Similar to legal issues being social and cultural. IMO it is the section were those details fit best. Doc James (talk · contribs · email) 02:50, 9 January 2019 (UTC)

Philippines 2019

Under "Epidemiology" we currently say that "[i]n 2019 the Philippines declared a national dengue epidemic due to the deaths reaching 622 people that year." The reference is about an epidemic in Indonesia 15 years ago. Anyone got a better source? JFW | T@lk 19:33, 7 August 2019 (UTC)

Moving here

"But, after over seven years of study and research, the first anti-dengue drug in the world may soon be released and become available in the market by the end of 2020.It was developed by a group of Filipino researchers from DOST and DOH of the Philippines, and they said that the drug would fully cure a patient with this type of disease."

Issues include it is copied and pasted and the sources are insufficient. Doc James (talk · contribs · email) 02:45, 23 December 2019 (UTC)

References

Template

This was a dreadful template to add to an article, looking like a maintenance tag, dominating the citations used in this article, and placed in a way that has nothing to do with how it is used (with citations). Additionally, an 8-year-old peer review templated in a way that dominates the (hopefully) more recent sources used?

More to the point, see the section just above this one; this article has not been updated, so what is the point of an eight-year-old peer review dominating the sources in the article via an unsightly tag? SandyGeorgia (Talk) 13:20, 24 February 2020 (UTC)

I have a COI, but I agree that this tag is too bulky. There is already an icon in the top right corner of the article, which should be sufficient. JFW | T@lk 21:18, 24 February 2020 (UTC)

Ack, another six-year-old peer review? This article is outdated; that peer review is no longer relevant, and I suggest the icon should be removed. That sort of thing belongs on the talk page. SandyGeorgia (Talk) 23:00, 24 February 2020 (UTC)

The template was in the hope of engaging further academics to take and improve Wikipedia articles followed by bringing them through formal peer review. This is just as relevant to any 6 year old FA review (we do not generally remove FAs after a specific period of time). Doc James (talk · contribs · email) 18:55, 29 February 2020 (UTC)

Six-year-old FA reviews are only flagged in article space via a small star in the upper-right corner. Further, these templates are NOT references (and considering how dated that are, certainly not references MEDRS would recommend); if they belong in article space at all, at best, they are external links, and the template should be designed to look more like what it is. And these peer reviews are already linked in the article in the upper-right corner, just as FAs are. That little bronze star in the upper-right corner is not making any representation to our unknowing readers about how out-of-date our articles are: the large peer review template IS noticeable to readers, and is conveying misinformation that this article is updates (it is not). I notice at Talk:Rotavirus that Graham Beards has that same template on talk, which is where it belongs IMO (even though, in that case, it actually is an up-to-date peer review, and that article probably is actually maintained in an up-to-date state by Graham. That is not the case here, and yet we have unsightly templates in article space, misleading our readers. SandyGeorgia (Talk) 22:36, 1 March 2020 (UTC)

Okay restored just the icon than. It clearly states when it was last formally peer reviewed. Doc James (talk · contribs · email) 22:53, 1 March 2020 (UTC)

Vaccine and epidemiology updates needed AND MORE

• PMID 31515144
• PMID 26874619

James, look at it this way: The Largest Crisis Ever in the Americas is underway in Venezuela. There is limited water, power, health care, food, medicine and millions of people walking out of the country. It is obvious there will be an impact, considering dengue is endemic there. It is important to keep this article up to date as that crisis is predicted to only get worse. @Jfdwolff: SandyGeorgia (Talk) 15:36, 28 January 2020 (UTC)

PS, ditto for malaria, but I digress ... and it is not a Featured article. SandyGeorgia (Talk) 16:00, 28 January 2020 (UTC)

I've been thinking this article also needed to be updated. I was hoping to get deep vein thrombosis (then pulmonary embolism) in great shape first, but maybe I'll help out here too before I get DVT and PE rewritten. Biosthmors (talk) 17:53, 28 January 2020 (UTC)

Thanks Biosthmors. I didn't look beyond the issues that I know well because I had dengue when I lived in Venezuela, but I suspect a much broader update than the two PMIDs I gave above is in order. SandyGeorgia (Talk) 18:30, 28 January 2020 (UTC)

The 2019 vaccine review was covered by the 2018 WHO vaccine review but sure added it. And clarified that in populations with known high infection rates vaccination is also recommended.

The 2016 data is a little old. Have updated to the 2017 GBD published in 2018. Doc James (talk · contribs · email) 18:58, 29 February 2020 (UTC)

Doc James, thanks for those edits. As I read the source, the wording was not correct, so please review my edits. There is still considerable work needed here. A list (for starters only):

• There are two very dated (and uncited) charts in Epidemiology.
• There are awareness efforts listed in Society and culture, but also under Anti-Dengue day in Prevention (probably an unnecessary sub-heading, but this content needs to be consolidated somewhere).
• There is considerable outdated information (I have flagged only some of it), and there are several probably unnecessary section headings (for example in Research), creating short, stubby sections.
• Most of the Research section is cited to ten-year-old sources.
• Threat to blood supply cited to 2009 source: is that info still true?
• There are 2009 sources everywhere one looks, eg, "In countries such as Singapore, where dengue is endemic, the risk is estimated to be between 1.6 and 6 per 10,000 transfusions."

This is just a partial listing of things that stand out on a very quick scan: someone really needs to get hold of the most recent sources, and check all of the information cited to dated sources. SandyGeorgia (Talk) 22:30, 1 March 2020 (UTC)

A copyedit is also needed (and that is not my strength, so I can't help). A sample:

• A pregnant woman who develops dengue may be at a higher risk of miscarriage as well as low birth weight and premature birth.

• Pregnant women do not have low birth weight; their babies do. SandyGeorgia (Talk) 22:42, 1 March 2020 (UTC)

Have adjusted it to "As of 2018, the vaccine is only recommended in individuals who have been previously infected or, in populations with a high rate of infection among those nine or older."

It is the rate of prior infection at nine and older (and actually probably just nine) that determines if use in that population should take place or not (without pre screening to determine prior infection). Doc James (talk · contribs · email) 23:04, 1 March 2020 (UTC)

Source says "in very high transmission settings, some countries which have subnational areas with very high transmission intensity, as defined by seroprevalence of ≥80% in children aged 9 years" Doc James (talk · contribs · email) 23:04, 1 March 2020 (UTC)

Very confusing: is that saying they screened for seroprevalence in up to nine-year-olds, and based the recommendation on that? So, this also needs to be adjusted in the body of the article where it is mentioned. SandyGeorgia (Talk) 23:13, 1 March 2020 (UTC)

Protection

Why is this article protected ? It has not been kept up to date, and yet, we don't allow most readers to edit it, to possibly update it, or to note where it is out of date. It is understandable for many medical topics to be protected (vagina, penis, HIV/AIDS, Tourette syndrome, sexual intercourse); it does not seem that we cannot handle the normal and routine edits this article might incur. And in fact, the article history shows that the last time it was unprotected for a few days, the hits were not that bad, and not all vandalism as indicated. SandyGeorgia (Talk) 22:45, 1 March 2020 (UTC)

Yah not unreasonable to give it a try. Doc James (talk · contribs · email) 22:54, 1 March 2020 (UTC)

I'm watchlisting, so we should be able to manage vandals. SandyGeorgia (Talk) 23:17, 1 March 2020 (UTC)

Needs checking

... relative to source; this edit changes the meaning. SandyGeorgia (Talk) 23:08, 9 March 2020 (UTC)

Fixed. [30] SandyGeorgia (Talk) 15:08, 10 March 2020 (UTC)

Lancet, Venezuela

• Grillet ME, Hernández-Villena JV, Llewellyn MS, et al. (May 2019). "Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region". Lancet Infect Dis (Review). 19 (5): e149–e161. doi:10.1016/S1473-3099(18)30757-6. PMID 30799251.

Significant because of the scale of the Crisis in Venezuela and the likelihood of diseases crossing borders via emigration. SandyGeorgia (Talk) 23:15, 10 March 2020 (UTC)

Treatment: Papaya Leaf Juice

See also, Wikipedia talk:WikiProject Medicine#Carica papaya as treatment for dengue fever.

There's been a lot of research to support the use of papaya leaf juice as a potential treatment to dengue fever (example: ) and I have personally experienced its beneift in curing my own dengue fever. Before I edit the treatment section, wondering if there has been discussion on this or pushback on it? Nnikkhoui (talk) 20:36, 18 September 2020 (UTC)

References

First, because this is a featured article (which require highest quality sources per WP:WIAFA), we should discuss the quality and breadth of sources before adding. Unless I am reading it incorrectly, the source you give is a one-person response to a review, rather than a review itself. Second, PubMed shows multiple very recent WP:MEDRS-compliant secondary reviews indicating there is insufficient evidence in favor of papaya. I will post them when on a real computer, unless someone else does first ... ipad typing now. SandyGeorgia (Talk) 21:05, 18 September 2020 (UTC)

OK, checking back in from a real computer.

• Senenayake 2015 is a review, PMID 26374064 to which you posted a response, which is one person's opinion-- not the kind of source we would use for this kind of content.

Searching for recent WP:MEDRS-compliant secondary reviews within the last five years reveals five articles:

1. Hampilos 2019, PMID 32549843: is a review and case series of four (!?!?) patients, concluding that "a larger trial is warranted". I don't know anything about the journal it was published in, but others might.
2. Singh 2019, PMID 32367410-- I cannot comment on the journal, it concludes that "In spite of the promising data available, from a number of biochemical, cell culture, animal, and few human studies, there is a need for in depth studies and clinical trials to investigate the potential role of papaya in the management of various human diseases."
3. Rajapakse 2019, PMID 31601215, PMC 6788024, systematic review and meta-analysis, nine studies met inclusion criteria. "Current clinical evidence on the beneficial effects of Carica papaya extract in the treatment of dengue infection is limited, and is based on a few trials of low to moderate quality. Improvements in platelet counts and reduction in hospital stay have been demonstrated, however significant methodological flaws in many of the studies makes it difficult to make clear recommendations. The routine use of CP extract for treating dengue cannot be recommended based on current available evidence."
4. Sobhia 2019, PMID 31339068, I cannot access.
5. Charan 2016, PMID 27857891, PMC 5108100, four trials, 439 subjects included. "C. papaya leaf extract can be considered as a potential candidate for increase in platelet count in patients of dengue, however; there is need of high-quality evidence in the form of large clinical trials before a decision related to the use of such extract is made." And, "These trials were conducted in Asian countries where the prevalence of dengue fever is high, so the results of these trials cannot be applied to other countries and people with different genetic makeups. On the basis of this systematic review and meta-analysis, it can be concluded that C. papaya leafs extract has a definitive role in improving the platelet count in patients of dengue. Looking at the wider CI, the rise in platelet count may be very less and may not be clinically significant. There is a statistically significant positive effect on the rise of platelet count, but whether this rise is clinically significant or not? That can be explored further by designing high-quality clinical trials based on large sample size with all measures to prevent incorporation of bias."

Significantly, no broad review of dengue mentions C. papaya (these are all limited reviews specifically of papaya), so there is a due weight issue. Based on this, I would feel comfortable adding one sentence to the "Research" section: Low to moderate quality studies on limited samples suggest that carica papaya may increase platelet counts and decrease hospital stays, but the clinical significance of these findings requires higher quality studies on larger numbers of people before recommendations can be made. SandyGeorgia (Talk) 22:59, 18 September 2020 (UTC)

I'd avoid Hampilos regardless of contents; the journal is about altmed, and even within that field, whose journals are not known for their rigor, the journal ranks in the bottom third.[31] I do not recommend using it. I contrast this with the Rajapakse article, which is also in an altmed journal, but at least it's in one of the better altmed journals. Rakapakse would be theoretically usable for narrow, uncontroversial claims (e.g., "they're studying it").[32]

Singh is in a MEDLINE-indexed, middle-quintile, open-access Iranian journal from Springer.[33] It's not so bad that we couldn't use it, but there are better options.

The Sobhia paper comes from a solid journal.[34]

I can't find any numbers forr the journal Charan published in, but it's from Medknow Publications (which is a strike against) and is connected to an association for medical students (which is another strike against). It is not a top-quality journal, but where, exactly, it falls on the spectrum is not clear.

You might consider a different source, such as https://www.google.com/books/edition/New_Look_to_Phytomedicine/68h0DwAAQBAJ (page 42), which could support a claim that it is currently being used in hospitals but that the research hasn't progressed to the point of proving that it works. WhatamIdoing (talk) 02:02, 19 September 2020 (UTC)

@Sandy: looking at https://www.researchgate.net/publication/334663412_A_Multi-Perspective_Review_on_Dengue_Research, it states that the Sobhia 2019 full text can be requested as a pdf from the author by following a link there and registering for an account if you don't have one. --RexxS (talk) 14:18, 19 September 2020 (UTC)

On a more general point, we've struggled over the last few years to document actual practice, when the actual practice (which is approximately half of medicine) doesn't come with a meta-analysis that proves efficacy. A good article reports both what's done and what's proven to work, and is written in a way that makes the distinction clear. WhatamIdoing (talk) 16:55, 19 September 2020 (UTC)

Thanks, RexxS; it sounds like someone needs to get hold of Sobhia 2019 to rewrite the dated Research section here. For now, based on what WAID found, I added this, without going in to all the methodological problems (since I haven't read Sobhia). (WAID, I was adding that as you were typing this-- edit conflict-- adjust as needed.) SandyGeorgia (Talk) 17:01, 19 September 2020 (UTC)

I can't get the Sobhia paper from either of two prominent medical libraries that tend to have paid subscriptions to most important journals. I agree that "Current Drug Targets" probably is not a gutter journal, but it is not first echelon, either. Is it possible to get the information that is referenced to the Sobhia paper form another source? Note that ResearchGate is not a reliable way to get papers. It requires that the author of the paper provide the paper to you, which needs to be under fair use or other copyright allowance, and not all authors participate with much frequency in ResearchGate. Jaredroach (talk) 17:07, 20 September 2020 (UTC)

Thanks so much, Jaredroach. I think we've got enough for now, and any further expansion will probably be WP:UNDUE. Because UptoDate frequently updates their pages, and archived versions are not available, and a subscription is required, it would be most helpful if you could place a quote here on talk of their specific text related to c. papaya extract and dengue, when you have time. I adjusted your text a bit to reflect MOS:CURRENT, and the citations for WP:CITEVAR, since FAs should maintain a consistent citation format. Regards, SandyGeorgia (Talk) 18:23, 20 September 2020 (UTC)

Quotes from UpToDate:

"Treatment guidelines have been published by the World Health Organization (WHO; 2009) and the WHO South-East Asia Regional Office (SEARO; 2011)". "Clinical practice is informed by the above guidelines as well as clinical experiences with managing dengue in different populations. There have been no rigorous trials comparing clinical approaches or establishing endpoints (clinical or laboratory based) for management of severe disease." "Thus far, data do not support a role for corticosteroids, intravenous immunoglobulins, pentoxifylline, or activated factor VII." "Several approaches are under investigation for specific treatment of dengue, including direct viral inhibitors and modifiers of virus-host interactions. Direct-acting agents have included small molecule inhibitors of essential viral enzymes (NS2B-3 protease, NS3 helicase, NS5 methyltransferase, the NS5 polymerase) or small molecule or antibody inhibitors of viral entry/fusion." "Randomized trials of chloroquine, lovastatin, balapiravir (a polymerase inhibitor), and celgosivir (an alpha-glucosidase inhibitor) among adults with dengue have not noted a significant benefit on viremia, NS1 antigenemia, or fever." Refs: World Health Organization. Dengue: Guidelines for diagnosis, treatment, prevention and control, New edition. WHO, Geneva 2009. http://www.who.int/tdr/publications/documents/dengue-diagnosis.pdf WHO Regional Office for Southeast Asia. Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever. Revised and expanded version. SEARO Technical Publication Series, New Delhi 2011. Jaredroach (talk) 21:33, 20 September 2020 (UTC)

I now have Sobhia 2019, and it adds nothing on c. papaya leaf extract to what we already have. It has some very outdated portions. Not sure how helpful it will be, but if anyone plans to globally update this article, they should look at it. SandyGeorgia (Talk) 15:39, 21 September 2020 (UTC)

Thanks a bunch SandyGeorgia for all your research and insight! I'm fairly new to editing in general, and with a medical article I understand the need to be incredibly accurate and unbiased. Appreciate the edit you made to the research section Nnikkhoui (talk) 00:10, 24 September 2020 (UTC)

Associated problems: hair loss

Back in 2013 my edit to include hair loss as an associated problem was deleted, due a to a lack of secondary sources. Well finally, this aspect of the disease is being written about! I'd like to re-add my prior deleted edit, with the following citation: https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/5-side-effects-of-dengue-that-may-last-for-a-while-after-recovery/photostory/77784296.cms and include the medical term telogen effluvium.Gwengazorn (talk) 14:32, 21 October 2020 (UTC)gwengazorn

We don't cite medical content to the popular press (see WP:MEDRS). The best PubMed turns up is an eight-year-old limited study that has not been mentioned in any secondary review. PMID 23295867 Google scholar turns up limited case studies on small samples. I am not sure any of these books are scholarly. SandyGeorgia (Talk) 15:51, 21 October 2020 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 12 August 2020 and 25 November 2020. Further details are available on the course page. Student editor(s): BPCM21.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 19:18, 16 January 2022 (UTC)

Historical aspect

I ran across this old article on an epidemic of dengue (as breakbone fever). Other contributors can decide if this is suited to be appear in the History section.

• Scientific American, "The Epidemic of Breakbone Fever in the South", 30 October 1880, p. 281

One possible place:
History
The first 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.[14][78] The primary vector, A. aegypti, spread out of Africa in the 15th to 19th centuries due in part to increased globalization secondary to the slave trade.[25] There have been descriptions of epidemics in the 17th century, but the most plausible early reports of dengue epidemics are from 1779 and 1780, when an epidemic swept across Southeast Asia, Africa and North America.[14][79] From that time until 1940, epidemics were infrequent.[14] One such outbreak occurred in the the southern United States in the 1880s when it was known as breakbone fever.
SloppyTots (talk) 18:07, 6 June 2021 (UTC)

diarrhea ia a symptoms?

Diarrhea ia a symptoms? Only Wikipedia stated this. Anyone please advice. —Preceding unsigned comment added by 202.184.144.199 (talk • contribs) 07:17, 5 January 2010

The article states that diarrhea is a symptom in children—which is also stated in many sources.[35] SandyGeorgia (Talk) 12:58, 1 November 2021 (UTC)

Recent edits

Re these edits, perhaps Graham Beards knows how to correct this dense terminology without removing hyperlinks. SandyGeorgia (Talk) 12:53, 1 November 2021 (UTC)

There isn't a way round. The endoplasmic reticulum is an internal component of cells; it doesn't have any other name and is best linked. For exocytosis, we could say "a transport mechanism called exocytosis", but it doesn't help much. This is why we have links. It saves us from having to define complex terms every time we have to use them.-Graham Beards (talk) 13:21, 1 November 2021 (UTC)

Biological weapon

Newone do you have a source for that? I haven't been able to find one. SandyGeorgia (Talk) 04:24, 24 August 2022 (UTC)

None of these seem helpful here. SandyGeorgia (Talk) 22:14, 24 August 2022 (UTC)

Agreed. I think Newone is adding navboxes to the pages they carry links to. The problem is the navboxes often contain problematic links, and no one is watching the navboxes. I've removed the navboxes in question, and will remove the Dengue links from each as well. Ajpolino (talk) 22:27, 25 August 2022 (UTC)

Current photo

I personally can't tell there even is a rash in the current picture Denguerash.JPG. Is there a different one we can use? Toobigtokale (talk) 21:49, 15 April 2023 (UTC)

Perhaps it is a problem with your screen resolution; I see it fine (and I've had dengue, and that's just what it looks like). SandyGeorgia (Talk) 22:53, 15 April 2023 (UTC)

Got a good screen; just a subjective thing. If disagree then no worries Toobigtokale (talk) 04:56, 16 April 2023 (UTC)