Saving Lives Through Early Action: WHO’s 2025 Guide on Dengue Management in Primary Care

The World Health Organization's 2025 booklet "Dengue Case Management for Primary Health Care and Home-Based Care" emerges from a regional alliance led by the National Institute of Infectious Diseases, Sri Lanka, and the Queen Sirikit National Institute of Child Health (QSNICH), Thailand. Coordinated by Dr. Ananda Wijewickrama and Professor Siripen Kalayanarooj, this manual serves as a life-saving guide for health professionals battling dengue across South and South-East Asia. With more than 1.16 million cases and over 4,300 deaths recorded in 2023, the WHO South-East Asia Region now carries 70% of the global burden. The publication underscores the urgent need to strengthen clinical vigilance, early recognition, and referral systems at the primary health-care level, where most patients first seek help.

Understanding the Nature of Dengue

Dengue is described as a rapidly spreading mosquito-borne viral disease threatening half of the world's population, with an estimated 100–400 million infections annually. Transmitted by Aedes mosquitoes, it thrives in tropical and subtropical regions, particularly in dense urban areas. The booklet classifies dengue into four forms: undifferentiated febrile illness, dengue fever (DF), dengue haemorrhagic fever (DHF), and expanded dengue syndrome (EDS). While DF is self-limiting, DHF and EDS can progress to severe plasma leakage and multi-organ failure if untreated. The disease's progression typically unfolds in three phases: the febrile, critical, and recovery stages, each requiring distinct management approaches. During the febrile phase, high fever, severe headache, and muscle pain dominate. As the fever drops, the critical phase begins, a deceptive stage when plasma leakage can trigger shock. The recovery phase brings gradual improvement, appetite return, and the appearance of a characteristic itchy rash.

Diagnosis: Recognizing the Danger Early

In dengue-endemic regions, any fever lasting two or more days should raise suspicion. The WHO booklet promotes simple, reliable diagnostic tools accessible to primary health centres. The Tourniquet Test (TT) is a practical method to assess bleeding tendencies, considered positive when ten or more petechiae appear per square inch on the forearm after five minutes of pressure. The Complete Blood Count (CBC) remains the most crucial investigation: a white blood cell count below 5000/mm³ or platelet count under 100,000/mm³ signals entry into the critical phase, while a 20% rise in hematocrit (HCT) confirms plasma leakage. The NS1 antigen test provides early confirmation during the first three to four days of fever, though cross-reactivity with infections such as chikungunya or Zika may complicate interpretation. These affordable tools allow frontline workers to detect dengue's progression before complications set in.

Managing Dengue at Home and in Primary Care

For patients with platelet counts above 100,000/mm³ and no warning signs, home-based care is both safe and effective under medical supervision. The cornerstone of treatment is hydration and rest, as no antiviral cure exists. Paracetamol is the only recommended drug for fever, while NSAIDs and steroids are strictly prohibited because they heighten the risk of gastrointestinal bleeding and liver damage. Patients should rest under mosquito nets to prevent further transmission and consume light, nutritious foods. The guide stresses electrolyte-rich fluids, oral rehydration solution, coconut water, fruit juices, milk, or soups, while avoiding excessive plain water, which may cause electrolyte imbalance. Urine output is a vital indicator of hydration, ideally 0.5 mL/kg/hour, and caregivers are encouraged to record intake and output using a simple monitoring chart.

If patients show persistent vomiting, abdominal pain, weakness after fever subsides, or dark stools or urine, they must be referred to the hospital immediately. In cases of dengue shock syndrome (DSS), the document prescribes emergency stabilization using intravenous normal saline (10 mL/kg/hour in children, 500 mL/hour in adults), correction of hypoglycaemia, and oxygen support. Patients in shock may remain alert, so subtle signs, cold extremities, rapid, weak pulse, and low blood pressure must never be overlooked.

Building Preparedness and Preventing Deaths

The final section outlines an outbreak response plan for primary health-care centres, particularly relevant during monsoon seasons. It recommends establishing "fever corners" to triage patients, forming emergency response teams for rapid resuscitation, maintaining communication with tertiary hospitals, and ensuring adequate stockpiles of IV fluids, antipyretics, and diagnostic kits. PHC staff are also urged to participate in public awareness campaigns and vector control initiatives, reinforcing the community's role in dengue prevention.

Ultimately, WHO's Dengue Case Management for Primary Health Care and Home-Based Care transforms complex medical science into clear, actionable steps that empower nurses, doctors, and community health workers in resource-limited settings. It demonstrates that with vigilance, timely fluid management, and organized systems, dengue-related deaths can be drastically reduced. More than a manual, it is a regional call to action, a roadmap for saving lives through knowledge, preparedness, and compassionate, community-driven care.