What is dengue?

Dengue is a viral infection. It can be caused by four related viruses. You can get it if an infected mosquito bites you. It is common in warm, wet areas of the world. Although rare, it can be found in some parts of the United States. Outbreaks are more common during rainy seasons.

How does dengue spread?

Dengue spreads to people through the bite of an infected mosquito. It does not spread directly from person to person. However, a pregnant person can pass the infection on to the baby. In rare cases, it can spread through a blood transfusion, organ transplant, or needle stick injury (an accidental injury from a used needle)..

What are the symptoms of dengue and severe dengue?

About one in four people infected with dengue will get sick. For those who do get sick, the infection can be mild or severe. The symptoms of dengue include:

• A high fever
• Nausea and vomiting
• Rash
• Aches and pains (eye pain, usually behind the eyes, and pain in the muscles, joints, or bones)

The symptoms usually last two to seven days.

Severe dengue is a serious form of the illness. About 1 in 20 people who get sick with dengue will develop severe dengue. It can cause shock, internal bleeding, and even death. People are more likely to develop severe dengue if they have had dengue before, are pregnant, or are infants.

Watch for signs and symptoms of severe dengue. Warning signs usually begin about 24 - 48 hours after your fever has gone away. If you or your family member have these signs, get immediate medical care:

• Severe abdominal (belly) pain and tenderness
• Vomiting at least 3 times in 24 hours
• Bleeding from the nose or gums
• Vomiting blood, or blood in the stool (poop)
• Feeling tired, restless, or irritable

How is dengue diagnosed?

There is a blood test which can show if you have been infected with dengue.

What are the treatments for dengue?

There is no specific medicine to treat dengue. Most people will get better after about a week. But if you think you might have dengue:

• See a health care provider and mention any recent travel.
• Rest as much as possible.
• Take acetaminophen to control fever and relieve pain. But do not take aspirin or ibuprofen.
• Drink plenty of fluids to prevent dehydration.

Severe dengue often requires care at a hospital.

Can dengue be prevented?

In the United States, a dengue vaccine is approved for children who are ages 9 - 16. They must also have previously had dengue and live in areas where dengue is common.

You can also help prevent dengue by avoiding mosquito bites:

• Wear insect repellent with DEET or another U.S. Environmental Protection Agency (EPA)-registered insect repellent. Make sure to follow the instructions for using the repellant.
• Wear clothes that cover your arms, legs and feet.
• Close unscreened doors and windows.

Through Mosquito Bites

Dengue viruses are spread to people through the bites of infected Aedes species mosquitoes (Ae. aegypti or Ae. albopictus). These are the same types of mosquitoes that spread Zika and chikungunya viruses.

• These mosquitoes typically lay eggs near standing water in containers that hold water, like buckets, bowls, animal dishes, flower pots, and vases.
• These mosquitoes prefer to bite people, and live both indoors and outdoors near people.
• Mosquitoes that spread dengue, chikungunya, and Zika bite during the day and night.
• Mosquitoes become infected when they bite a person infected with the virus. Infected mosquitoes can then spread the virus to other people through bites.

From mother to child

• A pregnant woman already infected with dengue can pass the virus to her fetus during pregnancy or around the time of birth.
• To date, there has been one documented report of dengue spread through breast milk. Because of the benefits of breastfeeding, mothers are encouraged to breastfeed even in areas with risk of dengue.

Through infected blood, laboratory, or healthcare setting exposures

Rarely, dengue can be spread through blood transfusion, organ transplant, or through a needle stick injury.

What is Dengue?

Dengue is spread through the bite of an infected mosquito. A pregnant woman already infected with dengue can pass the virus to her fetus during pregnancy or around the time of birth. Dengue can have harmful effects, including death of the fetus, low birth weight, and premature birth.

Protect Your Pregnancy

• If possible, avoid travel to areas with risk of dengue during pregnancy. Dengue is common in over 100 countries, including countries in the tropics.
• Find out if the country you will be visiting has dengue.
• Talk to your healthcare provider before traveling.

Protect Yourself from Mosquito Bites

If you live in or are traveling to an area with risk of dengue:

• Use an Environmental Protection Agency (EPA)-registered insect repellent.
• Wear long-sleeved shirts and long pants.
• Stay in a hotel or housing with screens on windows and doors. Use air conditioning, if available.
• Take steps to control mosquitoes in and around your home.

Use Environmental Protection Agency (EPA)-registered insect repellents with one of the active ingredients below. Higher percentages of active ingredient provide longer protection. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breastfeeding women.

• DEET
• Picaridin (known as KBR 3023 and icaridin outside the US)
• IR3535
• Oil of lemon eucalyptus (OLE)
• Para-menthane-diol (PMD)
• 2-undecanone

Find the right insect repellent for you by using EPA’s search tool.

Sick? Could it be Dengue?

See your healthcare provider, if you live in or have recently traveled to an area with dengue and have a fever and rash, aches and pains (eye pain, typically behind the eyes, muscle, joint, or bone pain). Tell your healthcare provider where you traveled.

If you develop symptoms of dengue, see your healthcare provider immediately.

Key Facts

• Dengue outbreaks are occurring in many countries of the world in the Americas, Africa, the Middle East, Asia, and the Pacific Islands.
• Anyone who lives in or travels to an area with risk of dengue is at risk for infection. Before you travel, find country-specific travel information to help you plan and pack.
• Forty percent of the world’s population, approximately 3 billion people, live in areas with risk of dengue. In many countries dengue is a leading cause of illness.
• Dengue has emerged as a worldwide problem since the 1960s. The disease is common in many popular tourist destinations in the Caribbean (including Puerto Rico), Central and South America, Southeast Asia, and the Pacific Islands. In the United States, local cases and limited spread of dengue does occur periodically in some states with hot, humid climates and Aedes mosquitoes.

Dengue Around the World

• Dengue outbreaks are occurring in many countries of the world in the Americas, Africa, the Middle East, Asia, and the Pacific Islands.
• Anyone who lives in or travels to an area with risk of dengue is at risk for infection. Before you travel, find country-specific travel information to help you plan and pack.
• For up-to-date information on areas where dengue has recently been reported, see Dengue Map (NOTE: This map is not supported if using Internet Explorer)
• Traveling? Find country-specific travel information and advice.

About the map:

• “Frequent or continuous” risk means that either frequent outbreaks occur or transmission is ongoing.
• “Sporadic or uncertain” risk means that the risk varies and is unpredictable and that country-level data is not available.
• Mosquitoes spread dengue and other germs. Prevent mosquito bites when traveling.

Dengue in the US States and Territories

• Dengue outbreaks occasionally occur in the continental United States.
• Dengue is common in the US territories of Puerto Rico, the US Virgin Islands, and American Samoa.
• Nearly all dengue cases reported in the 48 contiguous US states were in travelers infected elsewhere.
• In the United States, local dengue outbreaks most recently occurred in Hawaii (2015), Florida (2013), and Texas (2013).
  • Most outbreaks in the United States have been relatively small and limited to small areas.
  • Because the types of mosquitoes that spread dengue are common throughout many areas of the United States, local spread of dengue is possible.

Key Facts

• 1 in 4: About one in four people infected with dengue will get sick.
• For people who get sick with dengue, symptoms can be mild or severe.
• Severe dengue can be life-threatening within a few hours and often requires care at a hospital.

Symptoms

• Mild symptoms of dengue can be confused with other illnesses that cause fever, aches and pains, or a rash.

The most common symptom of dengue is fever with any of the following:

• Nausea, vomiting
• Rash
• Aches and pains (eye pain, typically behind the eyes, muscle, joint, or bone pain)
• Any warning sign

Symptoms of dengue typically last 2–7 days. Most people will recover after about a week.

Dengue viruses and the virus that causes COVID-19 can cause similar symptoms in the early stages.

What is Dengue?

Dengue is an illness spread through the bite of an infected mosquito. If you live in or are traveling to an area with risk of dengue, protect your infant from mosquito bites.

Symptoms: Your Infant Can’t Tell You He or She is Sick

Symptoms of dengue in an infant may be difficult to recognize and are similar to other common childhood infections. See a healthcare provider immediately if your infant develops a fever with any of the following symptoms:

• Fever or a low temperature (less than 36°C or 96.8°F) with any of the following:
  • Sleepiness, lack of energy, or irritability
  • Rash
  • Unusual bleeding (gums, nose, bruising)
  • Vomiting (at least 3 times in 24 hours)

Symptoms of dengue can quickly become severe, requiring immediate medical attention or hospitalization.

Caring for Your Sick Infant at Home

• Control the fever: Give acetaminophen (also known as paracetamol outside the United States). Always follow label instructions. Give cool water sponge baths.
• Give plenty of fluids such as water or drinks with added electrolytes. Dehydration occurs when a person loses too much body fluid from fever, vomiting, or not drinking enough fluids.
• Watch for signs of dehydration and seek care immediately if your infant develops signs of dehydration.

Signs of mild to moderate dehydration

• Urinates less frequently (less than 6 wet diapers per day)
• Dry mouth, tongue, lips
• Few or no tears when crying
• Sunken soft spot of the head

What to do: Contact your child’s pediatrician immediately.

Signs of severe dehydration

• Sleepiness, lack of energy, very fussy
• Sunken eyes
• Cool, discolored hands or feet
• Urinates 1-2 times per day

What to do: Go to an urgent care clinic or the emergency room.

• See your healthcare provider if you have symptoms of dengue and live in or have recently traveled to an area with risk of dengue.
• If you have recently traveled to an area with risk of dengue, tell your healthcare provider.
• A blood test is the only way to confirm the diagnosis.
• Your healthcare provider may order blood tests to look for dengue or other similar viruses like Zika or chikungunya.

• There is no specific medicine to treat dengue.
• Treat the symptoms of dengue and see your healthcare provider.

If you think you have dengue

• See a healthcare provider if you develop a fever or have symptoms of dengue. Tell him or her about your travel.
• Rest as much as possible.
• Take acetaminophen (also known as paracetamol outside of the United States) to control fever and relieve pain.
  • Do not take aspirin or ibuprofen!
• Drink plenty of fluids to stay hydrated. Drink water or drinks with added electrolytes.
• For mild symptoms, care for a sick infant, child, or family member at home.

Symptoms of dengue can become severe within a few hours. Severe dengue is a medical emergency.

Caring for a Child or Family Member Sick with Dengue

There is no medicine to treat dengue. Symptoms of dengue can be mild or severe. Mild symptoms can be treated at home.

Treat Mild Symptoms at Home

• Rest as much as possible
• Control fever
  • Give acetaminophen (also known as paracetamol) to control fever and relieve pain. Always follow product label instructions. Do not give ibuprofen, aspirin, or aspirin-containing drugs.
  • Sponge the person’s skin with cool water to reduce fever.
• Prevent dehydration – Dehydration occurs when a person loses too much body fluid from fever, vomiting, or not drinking enough liquids.

Signs of mild to moderate dehydration

Signs of severe dehydration

As Fever Goes Away

Watch for warning signs

Although the fever has gone away, the next phase of dengue can be dangerous for some people. Warning signs generally begin in the 24-48 hours after the fever has gone away.

About 1 in 20 people with dengue will develop severe dengue. Severe dengue requires hospitalization and can be life threatening.

If you or a family member develop any of the following warning signs, go to an urgent care clinic or the emergency room immediately:

• Stomach or belly pain, tenderness
• Vomiting (at least 3 times in 24 hours)
• Bleeding from the nose or gums
• Vomiting blood, or blood in the stool
• Feeling tired, restless, or irritable
• Cold clammy skin
• Difficulty breathing

Severe dengue is a medical emergency and requires immediate medical attention or hospitalization.

If You Have Dengue, Protect Others

During the first week of infection, dengue virus is found in the blood of an infected person. If a mosquito bites an infected person, the mosquito becomes infected. The infected mosquito can spread the virus to other people through bites. Avoid mosquito bites indoors to keep family from getting dengue.

• Wear long-sleeved shirts and long pants.
• Keep mosquitoes outside: Use screens on windows and doors.
• Use air conditioning if available.
• Use Environmental Protection Agency (EPA)-registered insect repellent.

Use Environmental Protection Agency (EPA)-registered insect repellent with one of the active ingredients below. Higher percentages of active ingredient provide longer protection. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breastfeeding women.

• DEET
• Picaridin (known as KBR 3023 and icaridin outside the US)
• IR3535
• Oil of lemon eucalyptus (OLE)
• Para-menthane-diol (PMD)
• 2-undecanone

There is no medicine to treat dengue. Symptoms of dengue can be mild or severe. Mild symptoms can be treated at home.

Severe dengue

• About 1 in 20 people who get sick with dengue will develop severe dengue.
• Severe dengue can result in shock, internal bleeding, and even death.
• If you have had dengue in the past, you are more likely to develop severe dengue.
• Infants and pregnant women are at higher risk for developing severe dengue.

Symptoms of severe dengue

Warning signs of severe dengue

Watch for signs and symptoms of severe dengue. Warning signs usually begin in the 24–48 hours after your fever has gone away.

Immediately go to a local clinic or emergency room if you or a family member has any of the following symptoms.

• Belly pain, tenderness
• Vomiting (at least 3 times in 24 hours)
• Bleeding from the nose or gums
• Vomiting blood, or blood in the stool
• Feeling tired, restless, or irritable

Treatment of severe dengue

• If you have any warning signs, see a healthcare provider or go to the emergency room immediately.
• Severe dengue is a medical emergency. It requires immediate medical care at a clinic or hospital.
• If you are traveling, find health care abroad.

A new dengue vaccine is approved for use in children aged 9–16 years with laboratory-confirmed previous dengue virus infection and living in areas where dengue is endemic (occurs frequently or continuously). Endemic areas include some U.S. territories and freely associated states. The vaccine is not approved for use in U.S. travelers who are visiting but not living in an area where dengue is common.

Dengue viruses are spread to people through the bites of an infected Aedes species Ae.aegypti or Ae. albopictus) mosquitoes. For people who get sick with dengue, symptoms can be mild or severe. The most common symptom of dengue is fever with any of the following: nausea, vomiting, rash, aches and pains.

A safe and effective dengue vaccine is available to prevent dengue caused by the four dengue viruses. Three doses, given 6 months apart, are needed for full protection.

Who Can Get a Dengue Vaccine?

CDC recommends the dengue vaccine, Dengvaxia, for use in children and adolescents 9–16 years old with laboratory-confirmed evidence of a previous dengue virus infection and living in areas of the United States where dengue is common. Dengue is common in the U.S. territories of American Samoa, Puerto Rico, and the U.S. Virgin Islands, and freely associated states, including the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau.

Testing Before Vaccination

Only children with laboratory-confirmed evidence of previous dengue infection can be vaccinated. Testing before vaccination will confirm if the child has had a previous dengue infection.

• If test results are positive, the child can be vaccinated.
• If test results are negative, the child cannot be vaccinated at the time.

Contact your child’s healthcare provider to learn more about the vaccine.

Who Should Not Get a Dengue Vaccine?

• Children under 9 years of age
  • Children under 9 years of age are less likely to have had a prior dengue infection. For this reason, if your child is under the age of 9, they are not eligible for dengue vaccination.
• People over 16 years of age
  • The dengue vaccine is not licensed for people over 16. There is not enough data to show how well the vaccine works in that population.
• Children who have not had a prior dengue infection.
  • In children who have not had dengue, the vaccine could increase the risk of severe dengue, if they are infected with dengue after vaccination.
• Children who are immunocompromised.
• Travelers and non-residents of areas where dengue is common. The U.S. Food and Drug Administration has not approved dengue vaccine for use in travelers.

Prevent Dengue

While the vaccine is highly effective, there is a low risk that some vaccinated people can still get infected with dengue. Everyone should take steps to avoid dengue infection by preventing mosquito bites.

• Use insect repellent.
  • Use Environmental Protection Agency (EPA)-registered insect repellents with one of the active ingredients below.
    

    *See EPA’s search tool here.

• Wear long-sleeved shirts and long pants or treat clothing and gear with 0.5% permethrin.
• Take steps to control mosquitoes inside and outside your home.

Dengue Symptoms and Treatment

Most people infected have mild or no symptoms. However, symptoms of dengue can become severe within a few hours. Severe dengue is a medical emergency. Learn more about dengue symptoms and treatment.

Planning a Trip? Do Your Homework Before Traveling

• The dengue vaccine is not approved for use in U.S. travelers who are visiting but not living in an area where dengue is common.
• Pack a travel health kit. Remember insect repellent and use it to prevent mosquito bites.
• Learn about destination-specific health risks and recommendations by visiting CDC Travelers’ Health website.
• See a healthcare provider familiar with travel medicine, ideally 4-6 weeks before your trip. Go to the Find a Clinic webpage for help in finding a travel medicine clinic near you.

After your trip

• Visit your healthcare provider right away if you develop a fever, headache, rash, muscle or joint pain.
• Tell your healthcare provider about recent travel.

• The U.S. Food and Drug Administration (FDA) approved Dengvaxia for use in children and adolescents 9–16 years old with laboratory-confirmed evidence of a previous dengue virus infection and living in areas of the United States where dengue is common.
• In June 2021, the Advisory Committee on Immunization Practices (ACIP) recommended use of Dengvaxia to prevent dengue in children aged 9–16 years, with laboratory-confirmed previous dengue virus infection and living in areas where dengue is endemic.
• Dengue is common in the U.S. territories of American Samoa, Puerto Rico, and the U.S. Virgin Islands, and the freely associated states, including the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau.

Your child must have had dengue before vaccination

• Laboratory confirmation of a previous dengue infection is required for vaccination with Dengvaxia.
• Testing before vaccination will confirm if your child has had dengue before.
• In children who have not already had dengue, the dengue vaccine increases the risk of hospitalization and severe illness if the child gets dengue after vaccination.
  • Therefore, to reduce the risk of vaccinating children who have never had dengue, a blood test can check for a previous dengue infection.
    • If the test results are positive, your child can be vaccinated.
    • If the test results are negative, your child won’t be able to get vaccinated.

Children need three doses of the dengue vaccine for full protection

• Dose 1 can be given after confirming that your child had a prior dengue infection.
• Dose 2 is given 6 months after the first dose.
• Dose 3 is given 1 year after the first dose.

Who should NOT get a dengue vaccination

• Children under 9 years of age
  • Children under 9 years of age are less likely to have had a prior dengue infection. For this reason, if your child is under the age of 9, they are not eligible for dengue vaccination.
• People over 16 years of age
  • The dengue vaccine is not licensed for people over 16. There is not enough data to show how well the vaccine works in that population.
• Children who have not had a prior dengue infection.
• Children who are immunocompromised.
• Travelers and non-residents of areas where dengue is common. The FDA has not approved dengue vaccine for use in travelers.

• Laboratory confirmation of a previous dengue infection is required for vaccination with Dengvaxia.

• Testing before vaccination will confirm that your child has had dengue before.
• In children who have not already had dengue, the dengue vaccine increases the risk of hospitalization and severe illness if the child gets dengue after vaccination.
  • Therefore, to reduce the risk of vaccinating children who have never had dengue, a fingerstick blood test can check for a previous dengue infection.
    • If the test result is positive, your child can be vaccinated.
    • If the test result is negative, your child won’t be able to get vaccinated.

Types of testing to confirm a prior dengue infection

• Your child’s healthcare provider will order a blood test to confirm a previous dengue infection. The healthcare provider will order a test that has been approved by the local or territorial health department.

OR

• If your child had a previous dengue illness that was confirmed by a specific type of laboratory test, your child may not need an additional blood test.

Talk to your child’s healthcare provider

• Talk to your child’s healthcare provider to find out if your child is eligible for a dengue vaccine.

• For children who test positive for previous dengue infection, a dengue vaccine can protect against future dengue infections or from getting severe disease.

• Dengue is common in the U.S. territories of American Samoa, Puerto Rico, and the U.S. Virgin Islands, and freely associated states including the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau.
  • The risk of getting dengue while living on the islands is high. In Puerto Rico, about half of children 9–16 years old have had dengue before and would be eligible for the vaccine.
• Dengue can be caused by any of the four dengue types: dengue 1, 2, 3, and 4.
  • People can be infected with dengue up to four times in their life.
• Dengue can be life threatening.
• There is no medicine to treat dengue. Mild symptoms can be treated at home. Severe dengue requires hospitalization.
  • Children are at the highest risk of hospitalization with the second dengue infection.
  • Every dengue infection has a risk of hospitalization and severe illness.
• If not treated, severe dengue can lead to death.

The vaccine provides years of protection

• We are still learning about how long the vaccine protects children. To date, we know that the vaccine can provide protection against dengue for at least 6 years.
• Over time, we will learn more about how long vaccine protection lasts.

Talk to your child’s healthcare provider about getting a dengue vaccine

• Talk to your child’s healthcare provider to find out if your child is eligible for a dengue vaccine.

The dengue vaccine protects against all four types of dengue

• Dengue is a disease caused by any of the four dengue virus types: dengue 1, 2, 3, and 4. Therefore, people can be infected with dengue up to four times in their life.
• If they have previously had dengue, the dengue vaccine can protect your child against illness or hospitalization caused by dengue.

The dengue vaccine is safe and effective

• The vaccine is safe and effective among children who have previously had dengue.
• Dengvaxia protects against illness from dengue 8 out of 10 times in children who had dengue before vaccination.
• While the vaccine is highly effective, there is a low risk that some vaccinated people can still get infected with dengue. This is called vaccine breakthrough.

The vaccine has few side effects

For children who HAVE already had dengue

• The most common side effects include soreness, itchiness, or pain in the injection site, headaches, lack of energy, and general discomfort. These side effects are normal signs that the body is building protection, and the side effects should go away within a few days.
• People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears.
• As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death.

Why people without a previous dengue infection should not be vaccinated

• The dengue vaccine is the only vaccine available in the United States that requires testing prior to vaccination to confirm that your child has had dengue before.
• In children who have NOT already had dengue, the dengue vaccine increases the risk of severe illness and hospitalization if the child is later infected with dengue.
  • Therefore, to reduce the risk of vaccinating children who have never had dengue, a blood test can check for a previous dengue infection.
    • If the test results are positive, your child can be vaccinated.
    • If the test results are negative, your child won’t be able to get vaccinated.

What is the new dengue vaccine?

Dengvaxia is approved for the prevention of dengue caused by all four dengue viruses. It is a live attenuated (weakened) virus vaccine.

Who can get the dengue vaccine?

• It is approved for use in children 9–16 years old who have a previous history of laboratory-confirmed dengue infection. Only children with laboratory-confirmed evidence of previous dengue infection should be vaccinated.
• Children must also be living in areas where dengue occurs frequently or continuously, which include American Samoa, Puerto Rico, the U.S. Virgin Islands, and the freely associated states of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

Why is the vaccine recommended for children 9–16 years old only?

Data from the clinical trials showed that the vaccine worked better at preventing hospitalization or severe dengue in children 9–16 years old than in younger children. Most of the clinical trials testing the vaccine were done in children 16 years old and younger, because that age group is at highest risk for dengue in areas where dengue occurs frequently.

What does “laboratory-confirmed” mean?

A blood test is the only way to confirm dengue infection. Your child’s healthcare provider will review your child’s medical records or order blood testing to confirm a previous dengue infection.

• If test results show evidence of previous dengue infection, your child can be vaccinated.
• If test results do not show evidence of previous dengue infection, your child should not be vaccinated.

If a child has a dengue infection, how soon afterwards can they be vaccinated?

Children with dengue should wait at least 6 months after the date the dengue illness is confirmed to begin the Dengvaxia vaccine series.

Why is the vaccine only approved for use in children with a previous history of dengue infection?

Children without previous dengue infection are at increased risk for severe dengue disease and hospitalization if they get dengue after they are vaccinated with Dengvaxia. For this reason, healthcare providers should check for evidence of a laboratory-confirmed previous dengue infection before vaccination.

Where does dengue occur frequently or continuously?

Dengue occurs frequently or continuously in the U.S. territories of American Samoa, Puerto Rico, and the U.S. Virgin Islands, and in the freely associated states of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.

• Dengue is rare in the continental United States. Most dengue cases in the continental United States are imported cases. Imported cases happen when travelers become infected overseas, and then return to the United States.

Can the vaccine be administered to children who travel to or are visiting, but not living, in an area where dengue is common?

No. The vaccine is not approved for children traveling to or visiting areas where dengue is common. It is only recommended for children living in areas where dengue occurs frequently or continuously.

Who should NOT get vaccinated against dengue?

The vaccine should not be administered to:

• Children who do not meet the age requirement.
• Children without a laboratory-confirmed previous dengue virus infection.
• Children who have had a severe (life-threatening) allergic reaction to a previous dose of the vaccine.
• Children who have a severe (life-threatening) allergy to any ingredient in this vaccine.
• Children with weakened immune systems.

How many doses of the dengue vaccine are recommended?

Children need three doses of Dengvaxia for protection.

• The first dose can be given to children 9–16 years old after laboratory confirmation of a previous dengue infection.
• The second dose should be given 6 months after the first dose.
• The third dose should be given 6 months after the second dose.

Can children who turn 17 years old after their first dose receive the second and third doses?

Yes. If your child turns 17 years old after the first dose, they should continue to receive the second and third doses of the vaccine according to the recommended vaccination schedule.

How is the dengue vaccine administered?

The vaccine is given by injection.

What are side effects of the vaccine?

The most common side effects after vaccination with Dengvaxia are soreness, itchiness, or pain where the vaccination was given. Headaches, lack of energy, and general discomfort can also occur.

• Not everyone will have side effects, but if a person does, the side effects normally go away within a few days.

How effective is the vaccine?

Overall, Dengvaxia protects children from dengue illness, hospitalization, and severe dengue 8 out of 10 times.

How long will protection last?

We are still learning about how long the vaccine protects children, but data from clinical trials indicate that the vaccine can protect children against dengue for at least 6 years. Over time, we will learn more about how long vaccine protection lasts.

Does the vaccine help prevent other mosquito-borne diseases, such as Zika or chikungunya?

No. This vaccine is only effective in preventing dengue, which is caused by the four dengue viruses.

• Prevent dengue by avoiding mosquito bites.

• All four dengue viruses are spread primarily through the bite of an infected Aedes species (Ae. aegypti and Ae. albopictus) mosquito. These mosquitoes also spread chikungunya and Zika viruses.

• The mosquitoes that spread dengue are found in most tropical and subtropical regions of the world, including many parts of the United States.

• Ae. aegypti and Ae. albopictus bite during the day and night.

• A dengue vaccine is available for use in some parts of the world, including United States territories.

Use the Tips Below to Protect Yourself and Others from Dengue

• Following these tips will help to protect you, your partner, your family, your friends, and your community from dengue.
• The more steps you take, the more protected you are.

Prevent Mosquito Bites

• Dengue is spread to people through the bite of an infected mosquito.
• Mosquitoes that spread dengue virus bite during the day and night. These types of mosquitoes also spread chikungunya and Zika viruses.
• The best way to prevent these diseases is to protect yourself from mosquito bites.
• Find an insect repellent right for you by using EPA’s search tool.

What you can do

• Traveling? Visit CDC’s country-specific travel recommendations.
• Take steps to prevent mosquito bites.
• Take steps to control mosquitoes inside and outside your home.

If You Have Dengue, Protect Others

• During the first week of infection, dengue virus is found in the blood of an infected person. If a mosquito bites the infected person, the mosquito becomes infected. The infected mosquito can spread the virus to other people through bites.
• Not everyone infected with dengue gets sick. Even if you do not feel sick, travelers returning to the United States from an area with risk of dengue should take steps to prevent mosquito bites for 3 weeks so they do not spread dengue to mosquitoes that could spread the virus to other people.

Protect yourself and your family from mosquito bites

Use Insect Repellent

Use Environmental Protection Agency (EPA)-registered insect repellents with one of the active ingredients below. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breastfeeding women.

• DEET
• Picaridin (known as KBR 3023 and icaridin outside the US)
• IR3535
• Oil of lemon eucalyptus (OLE)
• Para-menthane-diol (PMD)
• 2-undecanone

Tips for babies and children

• Dress your child in clothing that covers arms and legs.
• Cover strollers and baby carriers with mosquito netting.
• When using insect repellent on your child:
  • Always follow label instructions.
  • Do not use products containing oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD) on children under 3 years old.
  • Do not apply insect repellent to a child’s hands, eyes, mouth, cuts, or irritated skin.
    • Adults: Spray insect repellent onto your hands and then apply to a child’s face.

Tips for Everyone

• Always follow the product label instructions.
• Reapply insect repellent as directed.
  • Do not spray repellent on the skin under clothing.
  • If you are also using sunscreen, apply sunscreen first and insect repellent second.

Natural insect repellents (repellents not registered with EPA)

• We do not know the effectiveness of non-EPA registered insect repellents, including some natural repellents.
• To protect yourself against diseases spread by mosquitoes, CDC and EPA recommend using an EPA-registered insect repellent.
• Choosing an EPA-registered repellent ensures the EPA has evaluated the product for effectiveness.

Wear long-sleeved shirts and long pants

Treat clothing and gear

• Use permethrin to treat clothing and gear (such as boots, pants, socks, and tents) or buy permethrin-treated clothing and gear.
  • Permethrin is an insecticide that kills or repels mosquitoes.
  • Permethrin-treated clothing provides protection after multiple washings.
  • Read product information to find out how long the protection will last.

  If treating items yourself, follow the product instructions.

• Do not use permethrin products directly on skin.

Take steps to control mosquitoes indoors and outdoors

• Use screens on windows and doors. Repair holes in screens to keep mosquitoes outdoors.
• Use air conditioning, if available.
• Stop mosquitoes from laying eggs in or near water.
  • Once a week, empty and scrub, turn over, cover, or throw out items that hold water, such as tires, buckets, planters, toys, pools, birdbaths, flowerpots, or trash containers.
  • Check indoors and outdoors.

Prevent mosquito bites when traveling overseas

• Choose a hotel or lodging with air conditioning or screens on windows and doors.
• Sleep under a mosquito bed net if you are outside or in a room that does not have screens.
  • Buy a bed net at your local outdoor store or online before traveling overseas.
  • Choose a WHOPES-approved bed net: compact, white, rectangular, with 156 holes per square inch, and long enough to tuck under the mattress.
  • Permethrin-treated bed nets provide more protection than untreated nets.
    • Do not wash bed nets or expose them to sunlight. This will break down the insecticide more quickly.

What is dengue?

Dengue viruses are spread to people through the bite of an infected mosquito.

Dengue symptoms usually start within a few days of being bitten but can take up to 2 weeks to develop. Symptoms can be mild or severe and can include fever, nausea, vomiting, rash, headache, eye pain, joint and muscle pain. In severe cases, dengue can cause shock, internal bleeding, and even death. Learn more about severe dengue.

Not everyone who gets infected with dengue will feel sick, only about 1 out of 4 infected people get sick. You are more likely to develop severe dengue if you were infected before. Infants and pregnant women are more likely to develop severe dengue.

Who is at risk?

Mosquitoes that spread dengue bite during the day and less frequently at night and are found in countries throughout the world in tropical and subtropical areas. Dengue occurs in many countries of the world in the Americas, Africa, the Middle East, Asia, and the Pacific Islands. Check if dengue is a concern at your destination.

The following activities can increase a traveler’s chance of getting infected:

• Spending a lot of time outdoors
• Traveling to destinations with risk of dengue during times of the year when mosquitoes are more common, such as during warm weather.

What can travelers do to prevent dengue?

Travelers can protect themselves from dengue by taking the following steps.

Use an EPA-registered insect repellent

• Use Environmental Protection Agency (EPA)-registered insect repellents with one of the active ingredients below. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breastfeeding women. If also using sunscreen, always apply insect repellent after sunscreen.
  • DEET
  • Picaridin (known as KBR 3023 and icaridin outside the US)
  • IR3535
  • Oil of lemon eucalyptus (OLE)
  • Para-menthane-diol (PMD)
  • 2-undecanone

Find the right insect repellent for you by using EPA's search tool.

• Insect Repellent Tips for Babies and Children
  • Dress your child in clothing that covers arms and legs.
  • Cover strollers and baby carriers with mosquito netting.
  • When using insect repellent on your child:
    • Always follow label instructions.
    • Do not use products containing oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD) on children under 3 years old.
    • Do not apply insect repellent to a child’s hands, eyes, mouth, cuts, or irritated skin.
      • Adults: Spray insect repellent onto your hands and then apply to a child’s face.
    • If also using sunscreen, always apply insect repellent after sunscreen.

Wear long-sleeved shirts and long pants

Treat clothing and gear with permethrin

• Use 0.5% permethrin to treat clothing and gear (such as boots, pants, socks, and tents) or buy permethrin-treated clothing and gear.
  • Permethrin is an insecticide that kills or repels mosquitoes.
  • Permethrin-treated clothing provides protection after multiple washings.
  • Read product information to find out how long the protection will last.
• If treating items yourself, follow the product instructions.
• Do not use permethrin products directly on skin.
• Watch the CDC video How to Use Permethrin.

Keep mosquitoes out of your hotel room or lodging

• Choose a hotel or lodging with air conditioning or window and door screens.
• Use a mosquito net if you are unable to stay in a place with air conditioning or window and door screens or if you are sleeping outside.

Sleep under a mosquito net

• Sleep under a mosquito net if you are outside or when screened rooms are not available. Mosquitoes can live indoors and bite during the day and night.
• Buy a mosquito net at your local outdoor store or online before traveling overseas.
• Choose a mosquito net that is compact, white, rectangular, with 156 holes per square inch, and long enough to tuck under the mattress.
• Permethrin-treated mosquito nets provide more protection than untreated nets.
  • Permethrin is an insecticide that kills mosquitoes and other insects.
  • To determine if you can wash a treated mosquito net, follow the label instructions.

If you are bitten by mosquitoes, avoid scratching the bites and apply over-the-counter anti-itch or antihistamine cream to relieve itching.

If you traveled and feel sick, particularly if you have a fever, talk to a healthcare provider, and tell them about your travel. Avoid contact with other people while you are sick.

Dengue Vaccine and Travel

Currently there are no dengue vaccine recommendations for travelers.

Key Facts

• Dengue is spread to people through the bite on an infected Aedes species (primarily Ae. aegypti or Ae. albopictus) mosquito. These types of mosquitoes also spread chikungunya and Zika viruses.
• The best way to protect yourself from dengue is to protect yourself from mosquito bites.
• Dengue is spread in more than 100 countries around the world.
• Almost half of the world’s population, about 4 billion people, live in areas with risk of dengue. Dengue is a leading cause of illness in areas with risk.
• Each year, up to 400 million people get infected with dengue. Approximately 100 million people get sick from infection, and 40,000 die from severe dengue.

Before Your Trip

Do your homework. Find out your risk.

4-6 weeks before travel

• Review country-specific travel recommendations, health notices, and warnings.
• Visit a travel clinic or your healthcare provider for pre-travel medical care.
• Pack an Environmental Protection Agency (EPA)-registered insect repellent. Dengue is spread through mosquito bites. Prevent mosquito bites to reduce your risk of getting dengue or other viruses like chikungunya or Zika.
  • Find the insect repellent right for you.
• Pack acetaminophen (also known as paracetamol outside of the United States), not aspirin or ibuprofen, in your first aid kit. These medications can be used to manage fever and body pain in case you get dengue.

During Your Trip

• Follow steps to prevent mosquito bites to protect yourself and your family.
• Stay in places with air conditioning and with window/door screens.
• Use a bed net if air conditioned or screened rooms are not available or if sleeping outdoors.
• See a healthcare provider if you develop a fever or have symptoms of dengue.

After Your Trip

Protect yourself from mosquito bites

• Even if you do not feel sick, travelers returning from an area with risk of dengue should take steps to prevent mosquito bites for 3 weeks so they do not spread dengue to mosquitoes that could spread the virus to other people.

Sick with a Fever?

• Symptoms of dengue usually begin within 2 weeks after being bitten by an infected mosquito.
• See a healthcare provider if you develop a fever or have symptoms of dengue. Tell him or her about your travel.
  • How to find healthcare overseas
• Take acetaminophen (also known as paracetamol outside of the United States) to reduce fever and manage body aches. Do not take aspirin or ibuprofen. If you have dengue, aspirin and ibuprofen thin the blood and may increase the risk of bleeding.
• Rest and drink plenty of fluids.

Dengue Vaccine for U.S. Territories and Freely Associated States

• A dengue vaccine is now available for the U.S. territories of American Samoa, Puerto Rico, and the U.S. Virgin Islands, and freely associated states, including the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau.
• The vaccine is approved for use in children aged 9 through 16 years with laboratory-confirmed previous dengue virus infection and living in areas where dengue is endemic (common).
• The vaccine is not approved for use in U.S. travelers who are visiting but not living in an area where dengue is common.