In Reply

We are pleased that our article on dengue fever (1) generated so much interest, and we thank our readers for their extremely interesting additional points.

Bittmann adds important aspects on dengue in children and adolescents. Because of the predetermined scope of the article and our technical expertise we concentrated on explaining dengue infection in adults. Ultimately, however, the points raised by Bittmann as regards dengue-associated Kawasaki syndrome are of the utmost importance. Co-infections after an Aedes mosquito bite were not dealt with owing to their low prevalence: infections with Dirofilaria are known primarily in cats and dogs; individual case reports have focused on human infection with Dirofilaria immitis or repens (thread-like nematodes) (2). The possibility of simultaneous infection with dengue and microfilariae should be considered especially in symptoms of fever, cough, and blood-tinged sputum as a potential differential diagnosis (2).

We thank Slesak and Schäfer for their clear distinction between the symptoms of limb pain and arthralgia as regards the diagnosis of dengue or chikungunya. In older studies the diagnostic evaluation of these important infectious diseases is blurred or overlapping and therefore not exact, owing to methodological issues. This resulted in a mix-up in naming the typical symptoms of these diseases (3). Considering the now notably reduced case fatality rate of dengue, we refer readers to reference 4 cited in our article (1). It is conceivable that the case fatality declined owing to the fact that the diagnostic and therapeutic management improved over the years.

Our thanks go to Früh et al. for critically working out a vaccination recommendation for dengue. As rectified in the erratum in issue 25/2024, the Qdenga vaccine is licensed for seronegative and seropositive persons from age 4 in Europe. We took our steer from the STIKO recommendations, even though it is possible to deviate from these in individual cases (5). In our view, for most travelers into endemic regions, in view of the primarily touristic, time-limited trips and provided that basic preventive measures are followed (insect repellents, light-colored clothing), no indication for vaccination exists that goes beyond the STIKO recommendation.