Dengue fever
Also called: dengue, break-bone fever, dengue haemorrhagic fever, severe dengue, dengue viral fever
Dengue fever is a viral illness spread by Aedes mosquito bites. It causes high fever, headache, pain behind the eyes and body aches. Most people recover in about a week, but a few develop severe dengue. Paracetamol is used for fever; aspirin and NSAIDs are avoided.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Dengue is an infection caused by the dengue virus. There are four types of the virus, so a person can catch dengue more than once. The virus is passed to people through the bite of an infected female Aedes mosquito, which bites mostly during the day. Dengue does not spread directly from one person to another, although rare spread through blood transfusion, organ donation or from a mother to her baby during pregnancy has been reported.
Most people who are infected have no symptoms or only a mild illness. When symptoms do appear, they usually start four to ten days after the bite and last two to seven days. The typical picture is sudden high fever with severe headache, pain behind the eyes, muscle and joint pain, nausea, vomiting and a rash. A small number of people (about 1 in 20 of those who fall ill) go on to severe dengue, where fluid leaks out of the blood vessels and serious bleeding or shock can follow. This usually happens around the time the fever settles, which is why the days after the fever drops need the most care.
There is no medicine that kills the dengue virus. Treatment is supportive: rest, plenty of fluids, paracetamol for fever and pain, and close watching for warning signs. People with warning signs or severe dengue are admitted to hospital for fluid treatment through a drip. In Pakistan, dengue is endemic (present all year) with large seasonal outbreaks after the monsoon, so prevention of mosquito bites and breeding is important for every family.
In Pakistan: what studies show
Dengue comes back to Pakistan every year, with big outbreaks after the monsoon. WHO reported 53,498 cases in 2019 and 48,906 cases with 183 deaths in 2021, when Punjab was worst hit. The main virus type changed from DENV-2 in 2022 to DENV-1 in 2023.
- In the large 2011 dengue epidemic, 20,864 cases were reported in Punjab, according to an analysis of Punjab surveillance data.[6] (surveillance data analysis, data 2011)
- WHO described 2019 as a major dengue outbreak year in Pakistan, with 53,498 cases and 95 deaths.[1] (surveillance, data 2019)
- From 1 January to 25 November 2021, Pakistan reported 48,906 dengue cases, including 183 deaths.[1] (surveillance, data 1 Jan - 25 Nov 2021)
- Punjab had the most dengue in 2021: 24,146 cases and 127 deaths by 25 November, with deaths mainly in Lahore district.[1] (surveillance, data 1 Jan - 25 Nov 2021)
- Between 1 January and 27 September 2022, the year of the floods, Pakistan reported 25 932 confirmed dengue cases and 62 deaths (0.25% of cases died).[2] (surveillance, data 1 Jan - 27 Sep 2022)
- Pakistan's health ministry reported 18,262 confirmed dengue cases across the country in 2023.[3] (official report, data 2023)
- In a 2022 outbreak study of 343 dengue patient samples from 11 districts, DENV-2 was the most common virus type (62%).[4] (cross-sectional, data Aug - Oct 2022)
- In the 2023 outbreak, a study of samples sent to NIH Pakistan from 153 patients found DENV-1 was the main virus type (84.7%), followed by DENV-2 (15.3%).[5] (cross-sectional, data Jul - Oct 2023)
Pakistan guidance: Advisory for the Prevention and Control of Dengue Fever (Ministry of National Health Services, Regulations and Coordination, with Center for Disease Control, NIH Pakistan, 2024)[3]
What we do not know yet: No national dengue seroprevalence survey was found, and full-year national totals with deaths for 2022 and 2023 were not available in the opened sources (WHO's 2022 count stops at 27 September). The 2011 Punjab figure comes from a conference abstract with no authors listed, and Punjab's own clinical dengue guidelines were not opened.
Pakistan studies cited
- World Health Organization Dengue fever - Pakistan (Disease Outbreak News). World Health Organization 2021;published 14 December 2021. Open source
- World Health Organization Dengue - Pakistan (Disease Outbreak News, DON414). World Health Organization 2022;published 13 October 2022. Open source
- Ministry of National Health Services, Regulations and Coordination; Center for Disease Control, National Institute of Health Advisory for the Prevention and Control of Dengue Fever. Government of Pakistan (M/o NHSR&C / NIH Islamabad) 2024;April 2024. Open source
- Umair M, Haider SA, Rehman Z, et al. Genomic Characterization of Dengue Virus Outbreak in 2022 from Pakistan. Vaccines 2023;11(1):163. doi:10.3390/vaccines11010163. PMID 36680008. Open source
- Jamal Z, Haider SA, Hakim R, et al. Serotype and genomic diversity of dengue virus during the 2023 outbreak in Pakistan reveals the circulation of genotype III of DENV-1 and cosmopolitan genotype of DENV-2. Journal of Medical Virology 2024;96(6):e29727. doi:10.1002/jmv.29727. PMID 38864343. Open source
- Authors not listed on the abstract page Analysis of dengue surveillance data in Punjab, Pakistan, 2013. Journal of Emergency Medicine, Trauma and Acute Care (ICEPQ 2016 conference proceedings, abstract 92) 2016;2016(2). Open source
Symptoms
- Sudden high fever, often with chills
- Severe headache
- Pain behind the eyes (retro-orbital pain)
- Muscle, joint and bone pain, sometimes very severe
- Nausea and vomiting
- A flat or slightly raised red rash, which may peel and itch as you recover
- Swollen glands
- Minor bleeding such as nosebleeds, bleeding gums or small red spots on the skin (petechiae)
- Tiredness that can last for weeks after the fever has gone
Causes and risk factors
Causes
- Infection with one of the four types of dengue virus (DENV-1 to DENV-4)
- The bite of an infected female Aedes mosquito, mainly Aedes aegypti, which bites during the day
- Mosquitoes become infected by biting a person who already has the virus in their blood, then pass it on with later bites
- Rarely, the virus can pass through blood transfusion, organ donation, or from a pregnant mother to her baby
What makes it more likely
- Living in or travelling to an area where Aedes mosquitoes are common, especially during and after the monsoon season
- Standing water near the home (uncovered water tanks, old tyres, flower pots, coolers and containers) where mosquitoes breed
- A previous dengue infection with a different virus type, which raises the risk of severe dengue the second time
- Being pregnant, a baby under one year old, or an adult over 65
- Long-term conditions such as diabetes, high blood pressure, asthma, kidney disease, liver disease, stomach ulcers or obesity
- Taking blood-thinning (anticoagulant) medicines
- Living in crowded conditions, flood-affected areas or camps with poor water and sanitation
- Poor access to health care, so warning signs are missed
Complications
The main danger is severe dengue, which usually develops one to two days after the fever drops. Fluid leaks out of the small blood vessels into the chest and abdomen (plasma leakage). If enough fluid is lost, blood pressure falls and the person goes into shock, which can be fatal if fluids are not replaced quickly. Severe bleeding can occur, for example vomiting blood, black stools or heavy menstrual bleeding, and is more likely after prolonged shock. Less common complications include inflammation of the liver (hepatitis), heart muscle (myocarditis), pancreas or brain (encephalitis). Dengue in pregnancy has been linked to premature birth and low birth weight. With early recognition and good hospital care, deaths from severe dengue become rare.
When to see a doctor
- Severe or constant stomach pain or a tender abdomen
- Vomiting again and again, or unable to keep fluids down
- Bleeding from the nose or gums, blood in vomit or stools, or heavy menstrual bleeding
- Fast or difficult breathing
- Feeling very drowsy, confused, restless or irritable
- Cold, pale or clammy skin, extreme thirst, or passing very little urine
- Any of these signs in the two days after the fever settles: go to an emergency department at once
Diagnosis
A doctor will suspect dengue when someone has a fever with two or more typical features (such as nausea or vomiting, rash, aches and pains, a low white cell count or any warning sign) and lives in or has recently visited an area where dengue is spreading. Because the early symptoms look like many other fevers, including malaria and typhoid, a blood test is needed to confirm it.
In the first week of illness, tests that look for the virus itself are most useful: the NS1 antigen test (a protein from the virus), rapid diagnostic kits, or a PCR test that detects the virus genetic material. After the first few days, antibody tests (IgM and IgG) show whether the body has started to fight the infection. A complete blood count is done at the start and repeated, often daily, because a falling platelet count, a low white cell count and a rising haematocrit (the thickness of the blood) help the doctor judge whether fluid is leaking and whether hospital admission is needed. Liver tests may also be checked.
Treatment
- See a doctor early if you have fever in dengue season. There is no antiviral medicine for dengue, so treatment aims to keep you safe while the body clears the virus.
- Rest and drink plenty of fluids such as water, oral rehydration solution, fresh juice or soup to replace what is lost through fever and vomiting.
- Use paracetamol only for fever and pain, at the dose your doctor advises. Tepid sponging can also help bring the fever down.
- Do not take aspirin or NSAIDs such as ibuprofen, diclofenac or naproxen, because they raise the risk of bleeding in dengue.
- Have a daily check-up and blood count while you are unwell, and learn the warning signs. The critical period is usually the one to two days after the fever drops.
- If warning signs appear, or if you are pregnant, very young, elderly or have another illness, your doctor may admit you to hospital for fluids through a drip and close monitoring.
- Severe dengue (shock, serious bleeding or organ damage) is treated in an intensive care unit with carefully measured intravenous fluids and, if needed, blood transfusion. Routine platelet transfusion and steroids are not recommended.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Simple analgesics and antipyretics | first choice for fever and pain in dengue; your doctor decides the dose | Paracetamol (350 brands) |
| Oral rehydration solutions | replace fluid and salts lost through fever, sweating and vomiting; help prevent dehydration at home | Oral rehydration salts (ORS) (10 brands), Oral rehydration salts (low-osmolarity) |
| Antiemetics | may be prescribed by a doctor if vomiting stops you keeping fluids down; persistent vomiting is a warning sign that needs review | Ondansetron (256 brands), Metoclopramide (51 brands), Domperidone (3 brands) |
| NSAIDs and aspirin (avoid) | these should NOT be used in dengue because they increase the risk of bleeding | Ibuprofen (378 brands), Diclofenac (26 brands), Naproxen (5 brands), Acetylsalicylic acid (Aspirin) (59 brands) |
Also used (not yet in our price list): Intravenous fluids (normal saline or Ringer's lactate) given in hospital for warning signs or shock, Blood transfusion in hospital for serious bleeding
Self-care and prevention
Self-care
- Rest as much as possible until you have fully recovered
- Drink plenty of fluids and watch for signs of dehydration such as dry mouth or passing little urine
- Take paracetamol for fever and pain as your doctor advises; do not take aspirin, ibuprofen, diclofenac or other NSAIDs
- Sponge with lukewarm water if the fever is high
- Check yourself for warning signs every day, especially in the two days after the fever drops, and go to hospital immediately if any appear
- Keep your follow-up appointments for repeat blood counts
- Sleep under a mosquito net while unwell so that mosquitoes do not carry the virus from you to your family
- Everyone in the house should use mosquito repellent for about three weeks after a case
Prevention
- Empty, scrub and cover water containers, tanks, coolers and drums every week so mosquitoes cannot breed
- Clear rubbish, old tyres, bottles and anything that can collect rain water around the home
- Wear long sleeves and trousers, especially in the early morning and late afternoon when Aedes mosquitoes bite most
- Use insect repellent on exposed skin and put screens on doors and windows
- Use bed nets, mosquito coils or vaporisers, particularly for babies and people sleeping in the day
- Support community spraying and larvicide (mosquito-larva killing) campaigns during the outbreak season
Common questions
Is dengue contagious from person to person?
No. Dengue does not spread by touching, coughing or sharing food. It spreads only when a mosquito bites an infected person and then bites someone else. A person with dengue can infect mosquitoes from about two days before the fever starts until about two days after it ends, so sleeping under a net protects your family.
Which painkiller is safe in dengue?
Paracetamol is the recommended medicine for fever and pain. Aspirin and NSAIDs such as ibuprofen, diclofenac and naproxen should be avoided because they can increase bleeding. Ask your doctor or pharmacist before taking any other medicine, including cold and flu combinations that may contain an NSAID.
Can I get dengue twice?
Yes. There are four types of dengue virus. Infection with one type protects you against that type for life but only briefly against the others. A second infection with a different type carries a higher risk of severe dengue, so take warning signs seriously even if you have had dengue before.
When is dengue most dangerous?
The critical period is usually the one to two days after the fever comes down, roughly three to eight days from the start of illness. This is when fluid can leak from the blood vessels and blood pressure can fall. Severe stomach pain, repeated vomiting, bleeding, drowsiness or cold hands and feet at this stage need emergency care.
Is there a dengue vaccine in Pakistan?
A dengue vaccine is licensed in some countries, mainly for children and teenagers in areas with a lot of dengue, but no dengue vaccine is currently available in Pakistan. Preventing mosquito bites and removing breeding sites remain the main ways to protect yourself.
Sources
- WHO fact sheet. Dengue (2025).
- CDC. About Dengue | Dengue | CDC (2025).
- CDC. Clinical Features of Dengue | Dengue | CDC (2025).
- CDC. Clinical Care of Dengue | Dengue | CDC (2026).
- MedlinePlus. Dengue: MedlinePlus (2024).
- WHO Disease Outbreak News. Dengue - Pakistan (2022).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.