WHO Issues First Global Arbovirus Guidelines
WHO Issues New Guidelines to Combat Rising Arboviral threats
Geneva, Switzerland – The World Health Organization (WHO) has released comprehensive new guidelines aimed at equipping clinicians worldwide with the knowledge to diagnose and manage arboviral infections, a growing global health concern. The guidance addresses the increasing frequency and geographic spread of diseases like dengue, chikungunya, zika, and yellow fever, particularly in regions where these infections were previously uncommon.Designed with a focus on supporting healthcare professionals, especially in resource-limited settings, the guidelines offer evidence-based recommendations for managing these infections, acknowledging the potential limitations in access to laboratory diagnostics and advanced care.
“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,” the WHO stated in its guidance. “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 new guidelines build upon the 2022 handbook developed by the Pan American Health Organization (PAHO), the WHO’s regional office for the americas. While the PAHO handbook focused on arboviral disease management within the Americas,an international panel of experts has revised and expanded these recommendations to address global needs.
A critically important challenge highlighted by the WHO is the difficulty in distinguishing between arboviral infections, especially in areas where multiple arboviruses circulate concurrently. This clinical differentiation is particularly complex when diagnostic testing is not readily available. Given the overlapping early symptoms, the WHO guidelines stress the importance of laboratory confirmation while also providing key clinical features to aid in initial diagnosis.
Dengue, the most widespread arboviral infection, is often characterized by thrombocytopenia (low platelet count), a progressive increase in hematocrit, and leukopenia, which are crucial indicators of disease severity. Chikungunya is typically distinguished by persistent arthralgia (joint pain), while Zika infections are more commonly associated with pruritus (itching).
The WHO guidelines provide detailed treatment recommendations categorized by 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 with small, frequent sips throughout the day. Paracetamol or dipyrone is advised for pain and fever management. The use of corticosteroids is not recommended for nonsevere cases, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided irrespective of disease severity.
For hospitalized patients with suspected or confirmed severe arboviral disease, the WHO offers specific clinical guidance, including:
Prioritizing crystalloid fluids over colloids for intravenous (IV) rehydration.
Monitoring IV fluid management using capillary refill time.
Measuring serum lactate levels as part of IV fluid decision-making.
Utilizing a passive leg raise test in patients in shock when the clinician is uncertain about the need for additional IV fluids.
Avoiding systemic corticosteroids and immunoglobulins. Refraining from prophylactic platelet transfusions in patients with platelet counts below 50,000/μL unless there is active bleeding.
These updated guidelines represent a critical step in strengthening global preparedness and response to the escalating threat of arboviral diseases.