NEET 2024 ZOOLOGY ADDED SYLLABUS

Dengue Fever
It is a mosquito-borne viral infection transmitted through female Aedes aegypti mosquitos. The
word ―dengue‖ may have even come from a word for an evil spirit thought to cause the disease.
 Infection with one virus gives immunity to that serotype only
• The disease manifests in very severe flu-like symptoms.
• There is no cure for dengue fever, but getting the appropriate medical
care reduces mortality rates.
• The best way for prevention is to avoid mosquito bites.
It is most common in tropical and subtropical regions, particularly in poor urban, suburban and
rural areas,including Central and South America, Africa, parts of Asia and the Pacific Islands.

Children and those who are elderly are at higher risk for serious illness. Research estimates that
nearly 400 million people get infected with dengue each year, but most (about 80%) have no
symptoms. We can get immunity to a version of dengue virus once you‘ve been infected with it.
Other Names:
Dengue - Dengue Fever - Abu Al-Rukab - Breakbone Fever - Aden Fever.
Causes:
There are four different serotypes of the dengue virus: (DEN-1, DEN-2, DEN-3
and DEN-4). Getting infected with any of these types through a female Aedes
aegypti mosquito causes dengue fever. The virus may also be transmitted
through the Aedes albopictus (Stegomyia albopicta) mosquito in rare cases.
Modes of Transmission:
 Aedes aegyptii, A albopictus less commonly, Domestic day biting mosquito, Prefers to feed on
humans. First reported epidemics in 1779 –80 in Asia, Africa and North America. Considered a
mild non fatal disease. Epidemics every 10-40 years due to introduction of new serotype. A
healthy mosquito becomes infected when feeding on the blood of a person infected with the virus,
to then transmit it to healthy people when it moves to feed on their blood. Infected people can
transmit the disease to others through mosquitos for 4-5 days (up to 7 days) since the onset
of infection.
Aedes Aegypti Mosquito:
• It is a dark mosquito with white bracelet-like markings on its legs and white spots on its body.
• The mosquito is not the main cause of the disease, but only a vector that carries the virus from
one person to another.
• Early morning and before sunset are two peak hours for mosquito bites.
Incubation Period:
Symptoms begin to manifest 4-10 days after being bitten by an infective mosquito.
Symptoms:
The disease manifests in severe flu-like symptoms and is suspected when the temperature rises
(above 40° C) accompanied by two of the following symptoms:
• Severe headache. • Pain behind the eyeball. • Painful muscles and joints. • Nausea. • Vomiting.
• Rashes.
 Hepatomegaly, Facial flush, Fever subsides in 2-7 days, may be biphasic, Leukopenia
 Secondary infection with another serotype leads to ‗antibody mediated enhancement‘
 Heterotypic antibodies are non protective and fail to neutralise the virus
 Virus-antibody complexes taken up by monocytes
 Virion multiplication in human monocytes is promoted
 Activation of CD4+ and CD8+ lymphocytes  release of cytokines
 In a subsequent infection, the pre-existing heterologous antibodies form complexes with the new
infecting virus serotype, but do not neutralize the new virus
 Antibody-dependent enhancement is the process in which certain strains of dengue virus,
complexed with non-neutralizing antibodies, can enter a greater proportion of cells of the
mononuclear lineage, thus increasing virus production
 Activation of complement  Increased vascular permeability loss of plasma from vascular
compartment  hemoconcentration & shock
All of the above + evidence of circulatory failure:
 Rapid, weak pulse
 Narrow pulse pressure < =20 mm hg
 Cold clammy skin
 Restlessness
Often present with abdominal pain; mistaken for acute abdominal emergency
Immune response to Dengue infections
 Primary Infection: IgM antibody in late acute/ convalescent stage; later IgG which lasts for
several decades
 Secondary infection: High IgG level, small rise in IgM
 Cross reactions with other flaviviruses
 Dengue HI test in paired sera showing 4 fold rise or fall: cross reactivity
 IgM type antibodies in late acute/convalescent sera in primary infection
 IgG type antibodies in high titre in secondary infection
 Viral isolation: sensitivity < 50%
 RT- PCR: sensitivity > 90%
 CF + Supportive Serology: Acute HI titre > 1280, comparable IgG ELISA or +ve IgM
 or occurrence at same location & time as other confirmed cases
When to see a doctor?
Medical attention should be sought in case of developing emergency symptoms after returning
from an area where the disease is endemic. Such symptoms include:
• Severe abdominal pain.
• Persistent vomiting.
• Bleeding gums and nose.
• Blood in the urine, stool or vomit.
• Bruise-like subcutaneous bleeding.
• Difficult or rapid breathing.
• Pallor and cold skin.
• Exhaustion.
Diagnosis:
• The disease is difficult to diagnose by its symptoms and signs, given their similarity to several
other diseases, such as malaria.
 Laboratory Tests: The disease can be diagnosed by blood tests that confirm it and specify the
type of the virus. However, the results take time and therefore have no place in making the
therapeutic decision.
Confirmed case:
 isolation of virus from serum/ autopsy specimen
 Demonstration of dengue virus antigen in serum/ CSF/ Autopsy tissue
 Detection of dengue virus genome by PCR
 DHF: Hct >20% above normal
Complications:
The virus can destroy parts of blood that form clots and give structure to blood vessels. This,
vessels and cause internal bleeding. This leads to the life-threatening symptoms of severe dengue.
Pregnant have dengue fever, it can cause miscarriage, low birth weight or premature birth. It‘s
important to take steps to prevent getting dengue during pregnancy to protect and the developing
fetus.
. When infected, patients are recommended to: • Get enough rest.,• Drink enough fluids.,• Take
analgesics. • Avoid blood thinners, such as: Aspirin. • Avoid exposure to mosquito bites to
prevent the spread of the disease. In case of severe dengue fever, medical care and fluid
compensation may help prevent the further development of the disease and preserve the patient's
life.
Prevention:
Dengue is spread by Aedes mosquitos, which also carry viruses like Zika and chikungunya.
Dengue fever isn‘t contagious directly from one person to another like the flu. The only way to
get dengue from another person is if a pregnant person becomes infected. If a pregnant get
dengue, can pass it to baby during pregnancy or childbirth.
Dengue vaccine
The dengue vaccine (Dengvaxia™) is recommended only if anyone already had dengue before. It
can reduce risk of severe dengue (dengue hemorrhagic fever) if they get a different version of the
dengue virus in the future.
Getting the vaccine isn‘t recommended if anyone have never had dengue before. Because getting
infected once with dengue makes more likely to get sicker if you get another version of the virus
(antibody-dependent enhancement), getting vaccinated before having dengue for the first time can
increase risk of severe dengue. Healthcare provider will do a blood test to check for signs of a
previous dengue infection to confirm that had dengue before getting the vaccine.
Vaccination isn‘t available to everyone.
• The vaccine has been approved in some countries for people between 9- and 45-years old living
in areas where the disease is endemic.•
Revised WHO classification (2009)
Probable dengue Warning signs Severe dengue

Live in/travel to Abdominal pain or tenderness Severe plasma leak

endemic area
Fever + 2 of : Persistent vomiting Shock

Nausea, vomiting Clinical fluid accumulation Fluid accumulation with

respiratory distress

Rash Lethargy/ restlessness Severe bleeding

Aches & pains Liver enlargement > 2 cm Severe organ involvement

Tourniquet test +ve Laboratory increase in HCT concurrent with Liver ALT or AST >=1000
rapid decrease in platelet count

Leucopenia Impaired consciousness

Chikungunya
Chikungunya (CHIKV) is a virus that spreads to people through mosquito bites — specifically, through
the Aedes aegypti mosquito and Aedes albopictus mosquito. Chikungunya infection happens when a
mosquito with the virus bites a person. The virus doesn‘t spread from person to person through bodily
contact or saliva, although blood transmission may be possible.

•Chikungunya was first described in Tanzania, Africa in 1952.

•An outbreak of chikungunya was discovered in Port Klang in Malaysia in 1999 affecting 27
people.
• . Dengue also has similar symptoms to chikungunya. Zika is another virus that has similar
symptoms and transmission
Virus classification
• Group: Group IV ((+) ssRNA)
• Family: Togaviridae
• Genus: Alphavirus
AEDES MOSQUITOES
• Household container breeders
– Breeds in
– clean water
– In all stored water for drinking, washing and bathing
– Rainwater collected in unused materials like coconut shells, mud pots, plastic cups, tyres etc
• Aggressive day time Bite
• Major period of activity – sunrise and sunset
TRANSMISSION
• This virus is transmitted only by mosquitoes
• The mosquito picks up the virus from an infected person during the viraemic period – within five
days from the day of starting of symptoms
An infected mosquito will remain infected all its life span and can transmit the virus each time it
bites. An infected person cannot spread the infection directly to other persons. Pregnant people
with the virus don‘t transmit the virus to the fetus. There‘s also no evidence that shows the virus
spreads to an infant through breast milk. But, people who are pregnant and near their due date
should avoid traveling to countries with known cases because it may pass to their baby at delivery
SYMPTOMS
Fever Which Can Reach 39°C, (102.2 °F) , Petechial or Maculopapular Rash Usually Involving
the Limbs and Trunk, Arthralgia or Arthritis Affecting Multiple Joints Which Can Be
Debilitating. Headache, Conjunctival Injection and Slight Photophobia, Headache. Muscle pain.
Swelling in joints. Rash. Fatigue. Nausea. Most people experience symptoms for about one
week and go on to make a full recovery. Although some people have chronic joint pain after
recovery.
DIAGNOSIS
The diagnostic tests include detection of antigens or antibodies in the blood, using
ELISA (or EIA - enzyme immunoassay) polymerase chain reaction (PCR.
TREATMENT
• Self-limiting and Will Resolve With Time.
• No Specific Treatment for Chikungunya.
• Supportive or Palliative Medical Care With Anti-inflammatories
• Vaccine Trials Were Carried Out in 2000, the Project Was Discontinued and There Is No Vaccine
Currently Available.
• Supportive care with rest is indicated during the acute joint symptoms.
• Movement and mild exercise tend to improve stiffness and morning arthralgia, but heavy exercise
may exacerbate rheumatic symptoms.
• aspirin and nonsteroidal antiinflammatory drugs, chloroquine phosphate (250 mg/day) has given
promising results."
• Currently there is no marketable vaccine available for man
Chikungunya confers a life-long immunity on the infected person
• Analysis of the recent outbreak has suggested that the increased severity of the disease may be
due to a change in the genetic sequence, altering the virus' coat protein, which potentially allows
it to multiply more easily in mosquito cells. Most people recover from chikungunya within seven
to 10 days of noticing symptoms
PREVENTION
• Elimination of stagnant water at home, schools and work place to avoid breeding of mosquitoes.
• Using insect repellents over the exposed parts of the body.
Using mosquito screens or nets in non – Air-conditioned rooms.
• Wearing the long sleeved clothes like long trousers of a light shade for protection against
mosquitoes.
CONTROL
• Aedes species is the main target of control
 •Source reduction of breeding sites of mosquitoes
•Requires community involvement to keep the water storage containers free of mosquitoes
Eliminate other breeding places in and around houses Since there‘s no medication to treat
chikungunya, getting lots of rest and drinking plenty of water is the best thing you can do to care
for yourself. Taking over-the-counter (OTC) pain relievers containing acetaminophen can help
manage your pain and fever
BIOLOGICAL CONTROL
Introduction of larvivorous fish, namely Gambusia and Guppy in water tanks and other water
sources
• The organophosphorous insecticide ABATE is being used in a large scale
• ABATE can prevent breeding upto 3 months when applied to sand granules
• It does not affect man or the taste of water
VACCINE PREPARATION & TYPES
Proper preparation is critical for maintaining the integrity of the vaccine during transfer from the
vial to the syringe. Always use aseptic technique and follow infection prevention guidelines when
preparing vaccines. Aseptic technique refers to the manner of handling, preparing and storing
medications and injection equipment/supplies (e.g., syringes, needles) to prevent microbial
contamination and infection.
1. Prepare vaccines in a clean, designated medication area away from where the patient is being
vaccinated and away from any potentially contaminated items. This is to prevent inadvertent
contamination of the vial through direct or indirect contact with potentially contaminated surfaces
or equipment.
2. Health care personnel should ensure their clinic has the supplies needed to administer vaccines.
3. Health care personnel should complete proper hand hygiene before preparing vaccines.
4. Use a separate needle and syringe for each injection.
5. Always check the expiry dates on the vaccine and diluent, if needed. Some syringes and needles
have expiry dates, so check those, too. NEVER use expired vaccine, diluent, or equipment.
6. Prepare vaccines only when you are ready to administer them.
7. Only administer vaccines you have prepared. This is a medication administration best practice
standard. If vaccine is drawn up by one person but administered by another, the person
administering the vaccine cannot be sure what is in the syringe and whether it is safe.
Vaccine Types
There are several different types of vaccines. Each type is designed to teach your immune system
how to fight off certain kinds of germs and the serious diseases they cause.
When scientists create vaccines, they consider:
 How your immune system responds to the germ, Who needs to be vaccinated against the germ
 The best technology or approach to create the vaccine, Based on a number of these factors,
scientists decide which type of vaccine they will make. There are several types of vaccines,
including:
 Inactivated vaccines,Live-attenuated vaccines, Messenger RNA (mRNA) vaccines, Subunit,
recombinant, polysaccharide, and conjugate vaccines, Toxoid vaccines,Viral vector vaccines
A. Inactivated vaccines
Inactivated vaccines use the killed version of the germ that causes a disease.
Inactivated vaccines usually don‘t provide immunity (protection) that‘s as strong as live vaccines.
So you may need several doses over time (booster shots) in order to get ongoing immunity
against diseases.
Inactivated vaccines are used to protect against: ,Hepatitis A, Flu (shot only), Polio (shot
only), Rabies
B. Live-attenuated vaccines
Live vaccines use a weakened (or attenuated) form of the germ that causes a disease.
Because these vaccines are so similar to the natural infection that they help prevent, they create a
strong and long-lasting immune response. Just 1 or 2 doses of most live vaccines can give you a
lifetime of protection against a germ and the disease it causes.
But live vaccines also have some limitations. For example:
 Because they contain a small amount of the weakened live virus, some people should talk to their
health care provider before receiving them, such as people with weakened immune systems, long-
term health problems, or people who‘ve had an organ transplant.
 They need to be kept cool, so they don‘t travel well. That means they can‘t be used in countries
with limited access to refrigerators.
Live vaccines are used to protect against: Measles, mumps, rubella (MMR combined
vaccine) Rotavirus, Smallpox, Chickenpox, Yellow fever
C. Messenger RNA vaccines—also called mRNA vaccines
Researchers have been studying and working with mRNA vaccines for decades and this
technology was used to make some of the COVID-19 vaccines. mRNA vaccines make proteins in
order to trigger an immune response. mRNA vaccines have several benefits compared to other
types of vaccines, including shorter manufacturing times and, because they do not contain a live
virus, no risk of causing disease in the person getting vaccinated. mRNA vaccines are used to
protect against: COVID-19
D. Subunit, recombinant, polysaccharide, and conjugate vaccines
Subunit, recombinant, polysaccharide, and conjugate vaccines use specific pieces of the germ—
like its protein, sugar, or capsid (a casing around the germ).
Because these vaccines use only specific pieces of the germ, they give a very strong immune
response that‘s targeted to key parts of the germ. They can also be used on almost everyone who
needs them, including people with weakened immune systems and long-term health problems.
One limitation of these vaccines is that you may need booster shots to get ongoing protection
against diseases.
These vaccines are used to protect against: Hib (Haemophilus influenzae type b) disease,
Hepatitis B, HPV (Human papillomavirus), Whooping cough (part of the DTaP
combined vaccine), Pneumococcal disease, Meningococcal disease, Shingles
E. Toxoid vaccines
Toxoid vaccines use a toxin (harmful product) made by the germ that causes a disease. They
create immunity to the parts of the germ that cause a disease instead of the germ itself. That
means the immune response is targeted to the toxin instead of the whole germ.
Like some other types of vaccines, you may need booster shots to get ongoing protection against
diseases.
 Toxoid vaccines are used to protect against: Diphtheria, Tetanus
F. Viral vector vaccines
For decades, scientists studied viral vector vaccines. Some vaccines recently used for Ebola
outbreaks have used viral vector technology, and a number of studies have focused on viral vector
vaccines against other infectious diseases such as Zika, flu, and HIV. Scientists used this
technology to make COVID-19 vaccines as well.
Viral vector vaccines use a modified version of a different virus as a vector to deliver protection.
Several different viruses have been used as vectors, including influenza, vesicular stomatitis virus
(VSV), measles virus, and adenovirus, which causes the common cold. Adenovirus is one of the
viral vectors used in some COVID-19 vaccines being studied in clinical trials. Viral vector
vaccines are used to protect against: COVID-19
The future of vaccines
Scientists are still working to create new types of vaccines? Here are 2 exciting examples:
 DNA vaccines are easy and inexpensive to make and they produce strong, long-term immunity.
 Recombinant vector vaccines (platform-based vaccines) act like a natural infection, so they're
especially good at teaching the immune system to fight germs.