WHO Issues First Global Guidelines for Arboviral Disease Management

Climate Change and Travel Fuel Global Spread of Dengue, Zika, and More

Arboviral illnesses, once confined to tropical zones, are now a worldwide concern. Factors like climate shifts, expanding cities, population growth, and increased travel are driving this alarming trend, putting over 5.6 billion people at risk.

New Guidance Targets Key Arboviruses

The World Health Organization (WHO) has unveiled its inaugural global directives for the clinical care of four major arboviral infections: dengue, chikungunya, Zika virus, and yellow fever. These guidelines aim to equip healthcare providers, particularly in underserved areas, with evidence-based strategies for diagnosis and treatment.

The spread of *Aedes aegypti* and *Aedes albopictus* mosquitoes, the primary carriers of these diseases, is a major factor. This significantly elevates the risk of outbreaks in regions previously unaffected by these infections.

Differentiating Overlapping Symptoms

A significant challenge identified by the WHO is the difficulty in distinguishing between these infections, especially when multiple viruses circulate simultaneously and diagnostic testing is limited. Early symptoms often present similarly.

“The simultaneous circulation, frequency, and magnitude of outbreaks of these arboviruses are increasing globally, driven by the convergence of ecological, economic, and social factors, with consequent expansion of areas in which cases occur. This increasing incidence in endemic areas and the occurrence of imported and autochthonous (sometimes referred to as indigenous) disease cases in new areas require clinician awareness to recognize the disease and manage cases according to evidence-based guidance, a task complicated by the challenges in differentiating clinically between these infections, particularly in the early phases of illness.”

—World Health Organization

Key indicators can help differentiate. Dengue, the most common, often involves low platelet counts (thrombocytopenia), a rising hematocrit, and reduced white blood cell counts. Persistent joint pain is characteristic of chikungunya, while itching is more frequently seen with Zika infections.

Management Strategies for Varied Severity

The WHO provides comprehensive treatment recommendations, categorizing cases into non-severe and severe. For milder presentations, oral rehydration with small, frequent sips and paracetamol or dipyrone for pain and fever are advised. Corticosteroids are not recommended for non-severe cases, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided entirely, regardless of severity.

Severe Case Protocols

For hospitalized patients with severe arboviral disease, the guidelines detail specific interventions. These include prioritizing crystalloid fluids over colloids for IV hydration, monitoring fluid management via capillary refill time, and using serum lactate levels to guide IV fluid decisions. A passive leg raise test is suggested for shock patients when fluid resuscitation needs are uncertain.

Systemic corticosteroids and immunoglobulins are to be avoided. Prophylactic platelet transfusions are not recommended for patients with platelet counts below 50,000/μL, unless active bleeding is present.

Global Impact and Prevention

The new guidelines build upon a 2022 handbook from the Pan American Health Organization and were expanded by international experts to meet global needs. With millions affected, understanding and implementing these clinical approaches is crucial for mitigating the impact of these spreading diseases. For example, in 2023, over 1.5 million dengue cases were reported in the Americas alone (PAHO).

The development of these comprehensive, evidence-based guidelines marks a critical step in addressing the growing global threat of arboviral infections.