Feb 19

Tropical Pathogens: Dengue Fever in the Pacific

Considerations for HCWs in Aged Care

Dengue Fever is a tropical, mosquito-borne viral disease that is becoming more prevalent in the Pacific region. Indeed, it is endemic in tropical Queensland, and with climate change, is likely to impact other parts of Australasia wherever the Aedes mosquito gains a foothold. Although not transmissible person-to-person, it has the potential to infect others via an infected mosquito. Therefore, it is important to recognise the disease and consider mosquito control in endemic regions as global warming continues.

The possibility of the illness impacting aged care should be considered primarily due to staff travel, as an increasing number of healthcare workers are from tropical regions. HCWs can bring an infection back to their facility after visiting their home country. It is therefore worth considering dengue and other tropical diseases in aged care, not necessarily because of a direct risk, but of the possibility of the disease being introduced unknowingly. Person to person transmission, via Aedes mosquitoes in the immediate vicinity, could then be possible.

Facilities must then be able to distinguish a possible dengue infection from the flu and must avoid using aspirin or NSAIDs to prevent bleeding. Clinical vigilance, maintaining staff travel records, and ensuring adequate hydration are essential for safety.

2025–2026 Dengue in the Pacific

The Pacific is currently under a "blue alert" for multiple Dengue strains (DENV-1 and DENV-2).

  • Cook Islands: Reporting over 600 cases as of February 2026, including the first dengue-related death of an older person with underlying conditions.
  • Samoa: Confronting a prolonged epidemic with over 16,000 cases since early 2025.
  • Other Regions: Intensified transmission is happening in French Polynesia and New Caledonia during the current hot and rainy season.
  • Import Risk: New Zealand has already recorded over 80 "imported" cases, mainly linked to travel from the Cook Islands and Samoa.
  • Dengue isn't spread from person to person, but through the bite of a mosquito infected with the virus.

Why the Concern in Aged Care?

The interaction between a multicultural workforce and a highly vulnerable resident population can put the aged care sector at risk of tropical illnesses, especially in environments with local mosquito populations.

  • Staff as "VFR" Travellers: Many staff members are "Visiting Friends and Relatives" (VFR) in high-risk areas such as the Philippines, India, Nepal, and the Pacific Islands.
  • The "Silent" Entry: Staff may return to work during the 3-to-14-day incubation period or with mild symptoms, unaware they are carrying a pathogen.
  • Resident Vulnerability: Some residents face a substantially increased risk of Severe Dengue (Dengue Haemorrhagic Fever).
  • Comorbidities: In the older adults, high fever and dehydration can quickly worsen existing conditions such as dementia or cardiovascular disease.

Identifying the Threat: Dengue vs. Influenza

Dengue is often called "breakbone fever" because of its severe pain, but in aged care, it can be a "silent mimic".

  • Sudden Onset: High fever often reaching 40°C (104°F).
  • Pain Profile: Severe headache, particularly behind the eyes, along with muscle, joint, and bone pain.
  • The Dengue Rash: A faint red rash or small purple spots usually appear 3–4 days after the fever begins.
  • The Key Differentiator: If a resident has respiratory symptoms (cough/runny nose), it is probably the Flu or COVID-19. If they lack respiratory symptoms but have severe body aches and gastrointestinal symptoms, consider Dengue.

"Atypical" Signs in the Elderly

Nurses need to watch for subtle signs, as older adults might not always show a high fever.

  • The "Atypical" Slump: A sudden, unexplained decline in mobility, loss of appetite, or an unexpected fall.
  • Bleeding Check: Look for abnormal bleeding from the gums during oral care or spontaneous bruising on the arms.
  • The Critical Phase: The most dangerous time is paradoxically when the fever drops (Day 3–7). If the resident becomes restless, clammy, or experiences a drop in blood pressure, this is a medical emergency known as "Plasma Leakage".

Critical Treatment Protocols

There is no antiviral cure for Dengue; management is entirely supportive, but certain medications are strictly prohibited.

  • The "No Aspirin" Rule: Never use Aspirin or NSAIDs (Ibuprofen, Naproxen, Diclofenac). Because dengue affects blood clotting, these medications greatly increase the risk of severe internal bleeding.
  • Hydration Priority: Prompt oral or IV fluid intake is essential to prevent dehydration, especially if there are gastrointestinal symptoms.
  • Pain Management: Use only Paracetamol for fever and pain.

Beyond Dengue: Other Tropical Threats

Staff returning from international visits, VFR or recreational travel, may unintentionally bring back other notifiable diseases.

  • Measles: Highly contagious; can cause severe pneumonia in the elderly.
  • Tuberculosis (TB): Latent TB can reactivate in communal living settings.
  • Typhoid/Hepatitis A: Food-borne risks requiring strict enteric precautions in kitchens.

Strategic Recommendations for Facility Managers

To safeguard residents and assist your team, think about these proactive measures:

  • Travel Registry: Keep a record of staff returning from the Pacific, Southeast Asia, or South Asia.
  • Non-Punitive Reporting: Promote a system where staff can report fevers or rashes within 21 days of returning without fear of losing income.
  • Vector Control: Make sure all window screens are intact and remove any standing water (for example, in flowerpots or gutters) to prevent local mosquito populations from breeding.
  • Clinical Vigilance: Flag any resident suspected of Dengue to immediately cease blood-thinning medications until cleared by a GP

Conclusion

In modern aged care settings, being "travel-aware" is crucial to providing high-quality care. Protecting our residents is not about restricting the travel of our diverse workforce but about fostering a culture of transparency and clinical awareness of tropical threats. By recognising the subtle signs of Dengue, carefully managing medication protocols, and vector control, we can ensure these challenges remain manageable risks rather than turning into facility-wide crises.

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