219.3 🩺 內科專科考前版

219.3.0.1 1⃣ Dengue vs Chikungunya vs Zika (Aedes Mosquito Family)

Feature Dengue Chikungunya Zika
Pain Severe muscle + bone Severe joint pain (arthralgia, days-weeks) Mild
Rash 50% maculopapular Variable Maculopapular common
Hemorrhage Severe possible Rare Rare
Shock DSS possible Rare Rare
Microcephaly No No YES (congenital Zika)
GBS Rare Rare Documented association
Vaccine Dengvaxia, Qdenga None licensed None licensed

219.3.0.2 2⃣ Taiwan Dengue Outbreak Pattern

  • Every 2-3 years major outbreaks
  • 2015: Tainan + Kaohsiung ~ 43,000 cases
  • 2023: ~ 40,000 cases (record Taiwan)
  • 2024-2025: ongoing transmission
  • Imported cases trigger local outbreaks
  • Aedes aegypti south + A. albopictus throughout
  • 公費 control programs
  • 盧醫垫 hint: 倏 + 秋 + 旅遊 endemic 病人 fever → dengue NS1 + PCR; warning signs admit

219.3.0.3 3⃣ Fluid Management Algorithm in Severe Dengue

  • Initial: 10-20 mL/kg over 15-30 min isotonic crystalloid
  • Reassess (HR, BP, urine output, Hct)
  • If improving: 5-10 mL/kg/h × 1-2 h, then taper
  • If not improving: 10-20 mL/kg over 1 h, then reassess
  • Persistent shock: switch to colloid
  • Risk: over-resuscitation → fluid overload in recovery phase

219.3.0.4 4⃣ Platelet Transfusion in Dengue

  • NOT routine for low platelet count alone (even < 20K)
  • Only if active bleeding + need
  • Counterintuitive but evidence-based (TRACT trial 2017)
  • Bleeding clinically significant → platelet, FFP, packed RBC

219.3.0.5 5⃣ Dengue + Pregnancy

  • Often more severe
  • Vertical transmission can occur (late pregnancy)
  • Hemorrhagic complications + preterm birth + fetal loss
  • ICU monitoring + obstetric coordination
  • No specific vaccine recommendation for pregnant

219.3.0.6 6⃣ Imported Dengue in Returning Travelers

  • Tropical destination + acute febrile illness within 14 days
  • NS1 antigen + IgM + PCR
  • Most mild, but warning for severe
  • 通報 in many countries

219.3.0.7 7⃣ Dengvaxia Tragedy

  • Philippines 2017: mass vaccination of school children
  • Subsequent reports of severe dengue post-vaccination in seronegative
  • Sanofi confirmed paradoxical risk
  • Vaccine restricted to seropositive in 2018
  • Pre-vaccination dengue screening mandatory now (rapid test)

219.3.0.8 8⃣ Qdenga + Mass Vaccination Strategies

  • Broader population indication
  • Endemic country deployment 2023+ (Brazil, Indonesia, Peru, Mexico)
  • WHO prequalified 2024 — accelerates global rollout
  • Cost considerations remain in low-income

219.3.0.9 9⃣ 健保 / Taiwan

  • 通報 mandatory
  • 衛生局 outbreak response
  • Mosquito control programs
  • 健保 hospital admission + supportive care
  • Dengue vaccine 自費 / 公費 limited (depending serotype availability)

219.3.0.10 10. Future + Climate Change

  • Aedes range expanding north (Europe, USA)
  • Local transmission USA southern + Spain + Portugal
  • Climate adaptation in vector control
  • mRNA dengue vaccines (Moderna mRNA-1893 in trials)
  • Pan-flavivirus vaccines researched