In a landmark move to strengthen global healthcare response to mosquito-borne diseases, the World Health Organization (WHO) has issued its first integrated clinical management guidelines for arboviral diseases — including dengue, chikungunya, Zika, and yellow fever. Released earlier this month, the guidelines aim to standardize care and improve outcomes across regions grappling with the growing burden of these infections.
Designed for frontline healthcare providers and hospitals, the new WHO guidelines offer evidence-based protocols to manage both mild and severe cases of arboviral infections. They also serve as a vital resource for policymakers and health administrators, supporting epidemic preparedness and pandemic response.
Arboviral diseases — primarily transmitted by Aedes mosquitoes — pose a risk to over 5.6 billion people worldwide. Aedes aegypti, the most common vector, can transmit multiple viruses in the same area, often simultaneously. These diseases typically begin with flu-like symptoms such as fever, joint pain, and rash, making diagnosis challenging in the absence of laboratory testing. In some instances, complications may become severe or life-threatening.
According to the WHO, the frequency, scale, and severity of arboviral outbreaks are escalating due to ecological, social, and economic changes. As a result, these infections are spreading to new geographical regions and placing greater strain on healthcare systems.
The clinical challenge is compounded by the similarity in early symptoms across diseases like dengue, chikungunya, Zika, and yellow fever — especially in low-resource settings with limited access to diagnostics. In some areas, more than one virus may be circulating at the same time.
The new guidelines aim to simplify clinical decision-making through a unified, evidence-informed framework. They are also intended to support national and regional health systems in designing effective outbreak preparedness and response strategies.
The guidelines include distinct protocols for non-severe and severe cases:
Use oral rehydration protocols to prevent dehydration.
Treat pain or fever with paracetamol or metamizole.
Avoid NSAIDs (non-steroidal anti-inflammatory drugs) regardless of disease severity.
Do not use corticosteroids in non-severe cases.
Administer crystalloid fluids for intravenous hydration, avoiding colloids.
Monitor capillary refill time and lactate levels to guide fluid therapy.
Use passive leg raise test in patients with shock to assess fluid responsiveness.
Avoid corticosteroids and immunoglobulin therapies in severe cases.
Avoid platelet transfusions unless there is active bleeding, even with low platelet counts.
Administer intravenous N-acetylcysteine in yellow fever patients with liver failure.
Use experimental treatments such as monoclonal antibody TY014 or sofosbuvir for yellow fever only within research settings.
The WHO emphasized that these recommendations are based on the most recent scientific evidence and will be updated as new data becomes available.
With arboviral diseases continuing to emerge in new regions, WHO’s first-ever integrated clinical guidelines represent a significant milestone in harmonizing global care standards. The goal is to improve early recognition, guide appropriate management, and ultimately reduce mortality in regions where these diseases are endemic or on the rise.