e dengue virus after being infected by another one sometime before.

Prior immunity to a different dengue virus type plays an important role in this severe disease. Worldwide, more than 100 million cases of dengue fever occur every year. A small number of these develop into dengue hemorrhagic fever. Most infections in the United tates are brought in from other countries. !t is possible, but uncommon, for a traveler who has returned to the United tates to pass the infection to someone who has not traveled. "is# factors for dengue hemorrhagic fever include having antibodies to dengue virus from prior infection and being younger than 1$, female, or %aucasian. &ac# to 'op ymptoms (arly symptoms of dengue hemorrhagic fever are similar to those of dengue fever, but after several days the patient becomes irritable, restless, and sweaty. 'hese symptoms are followed by a shoc# )li#e state. &leeding may appear as tiny spots of blood on the s#in *petechiae+ and larger patches of blood under the s#in *ecchymoses+. Minor in,uries may cause bleeding. hoc# may cause death. !f the patient survives, recovery begins after a one)day crisis period. (arly symptoms include.ecreased appetite /ever 0eadache 1oint aches Malaise Muscle aches 2omiting Acute phase symptoms include"estlessness followed by(cchymosis 3enerali4ed rash Petechiae Worsening of earlier symptoms hoc#)li#e state %old, clammy e5tremities

weatiness *diaphoretic+