WHO Issues First Global Arbovirus Guidelines
With over 5.6 billion people at risk, the World Health Organization (WHO) has released its first global guidelines for the clinical management of four major arboviral infections: dengue, chikungunya, Zika virus, and yellow fever.
The guidance highlights the global spread of Aedes aegypti and Aedes albopictus mosquitoes, the primary vectors for these diseases, which significantly increases the risk for outbreaks in regions where such infections were previously uncommon.
Designed to support clinicians, particularly in resource-limited settings, the guidelines provide evidence-based recommendations for diagnosing and managing these infections, where access to laboratory diagnostics and advanced care may be restricted.
'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,' the WHO guidance stated.
The new guidelines are based on a thorough systematic review and follow the 2022 handbook developed by the Pan American Health Organization, based in Washington, DC, the regional office of the WHO for the Americas. While the 2022 handbook focused on arboviral disease management in the Americas, a group of international experts revised and expanded the guidelines to address global needs.
One of the key challenges highlighted in the new WHO guidelines is the difficulty in distinguishing between arboviral infections in regions where multiple arboviruses may circulate simultaneously, making clinical differentiation challenging, particularly where diagnostic testing is not readily available. Because early symptoms often overlap, WHO guidelines emphasize the need for laboratory confirmation while also providing clinical features to help differentiate between arboviral infections during the initial diagnosis.
Dengue, the most prevalent arboviral infection, is typically marked by thrombocytopenia (low platelet count), progressive increase in hematocrit, and leukopenia. These are key clinical indicators of disease severity.
In chikungunya, persistent arthralgia (joint pain) is the most prominent distinguishing feature. Pruritus (itching) is more commonly observed in Zika infections.
The WHO guidelines present comprehensive recommendations for treating these diseases based on disease severity, dividing cases into nonsevere and severe.
For patients with suspected or confirmed nonsevere dengue, chikungunya, Zika, or yellow fever, the WHO recommends oral rehydration using small and frequent sips throughout the day. Paracetamol or dipyrone is advised for managing pain and fever.
The use of corticosteroids is not recommended in nonsevere cases.
Nonsteroidal anti-inflammatory drugs should be avoided regardless of disease severity.
For hospitalized patients with suspected or confirmed severe arboviral disease, the WHO provides detailed clinical guidance, including.
Prefer crystalloid fluids over colloids for intravenous (IV) rehydration.
Monitor IV fluid management using capillary refill time.
Measure serum lactate levels as part of IV fluid decision-making.
Use a passive leg raise test in patients in shock when the clinician is unsure about the need to administer more IV fluids.
Avoid systemic corticosteroids and immunoglobulins.
Avoid prophylactic platelet transfusions in patients with platelet counts < 50,000/μL unless active bleeding.
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