August 30, 2022


Clinical Considerations for
Dengue Virus Infection

Dengue is endemic in many popular travel destinations for U.S. travelers, such as the Caribbean. The Centers for Disease Control and Prevention (CDC) is monitoring ongoing dengue outbreaks occurring in several regions around the world. Because most dengue cases reported in the continental United States occur in travelers, CDC is advising clinicians to consider dengue in patients with a febrile illness who have traveled to dengue-endemic areas in the 2 weeks before symptom onset. 


Clinical Overview:

  • To prevent dengue infection, travelers to dengue-endemic areas should protect themselves against mosquito bites by using EPA-registered insect repellent, wearing long-sleeved shirts and long pants, and taking other protective measures while traveling.
  • Dengue is usually a mild illness. However, in about 5% of cases, it can progress to severe disease with associated shock, severe bleeding, or organ impairment.
  • Mortality for dengue can be as high as 13% in untreated patients. Common causes of death include unrecognized or prolonged shock, unrecognized hemorrhage, and secondary infections.
  • Common dengue symptoms include fever, aches and pains (headache, retroorbital pain, myalgias, and arthralgias), nausea and vomiting, and rash or petechiae. Symptoms begin abruptly after an incubation period of 5 to 7 days. Fever can last between 2 to 7 days. 

Severe Dengue:

  • Defervescence (the abatement of fever to body temperature below 38.0°C or 100.4°F) marks the beginning of the critical phase, which is when progression to severe dengue can occur and lasts 1 to 2 days.
  • Clinicians should monitor closely for warning signs that can indicate progression to severe dengue. These patients should be evaluated for observation or inpatient management. 
  • Warning signs include persistent vomiting, severe abdominal pain, extravascular fluid accumulation (e.g., pleural effusion, ascites), mucosal bleeding, lethargy/restlessness, postural hypotension, liver enlargement, and a progressive increase in hematocrit (i.e., hemoconcentration).

Testing and Treatment:

  • Patients with symptoms consistent with dengue can be tested with nucleic acid amplification tests (NAAT) AND IgM antibody tests within 7 days of symptom onset. After 7 days from symptom onset, test only with IgM antibody tests. 
  • Dengue is a nationally notifiable disease in the United States. All suspected cases should be reported to the local health department.
  • Intravenous (IV) fluid therapy and management of complications are the mainstay of treatment. Management of hospitalized dengue patients requires frequent monitoring of vital signs and hematocrit levels to determine disease progression and appropriate response to fluid replacement therapy.
  • There are currently no specific antivirals recommended for dengue treatment or vaccines available to protect people who are traveling. The FDA-approved dengue vaccine is only recommended for children living in areas where dengue is endemic, and not approved for travelers. 

For more information, visit CDC’s dengue page for healthcare providers.


The Emergency Risk Communication Branch in the Division of Emergency Operations, Center for Preparedness and Response is responsible for the management of all COCA Products. 


For information about this update or other clinical issues, or to send your feedback, please contact us at

Clinician Outreach and Communication Activity—resources for healthcare providers

COCA RSS Feed—subscribe to be notified of conference calls, updates, and CDC guidance for health providers

Crisis & Emergency Risk Communication Training—training program that draws from lessons learned during public health emergencies, and incorporates best practices from the fields of risk and crisis communication

Health Alert Network—CDC's primary method of sharing cleared information about urgent public health incidents with public information officers; federal, state, territorial, and local public health practitioners; clinicians; and public health laboratories

CDC and HHS logos are the exclusive property of the Department of Health and Human Services and may not be used for any purpose without prior express written permission. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.


Links to non-federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organizations.

CDC Facebook

CDC Twitter

CDC Streaming Health

CDC Instagram

Centers for Disease Control and Prevention

1600 Clifton Rd   Atlanta, GA 30329   1-800-CDC-INFO (800-232-4636)   TTY: 888-232-6348
Questions or Problems  |  Unsubscribe