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Dengue in Puerto Rico: symptoms and warning signs that need the ER

Dengue in Puerto Rico causes fever with eye pain, muscle, bone or joint pain, headache, nausea or vomiting, and rash. Go to the emergency room right away for warning signs such as belly pain, repeated vomiting, or bleeding from the nose or gums. They usually start 24 to 48 hours after the fever goes away. Don't take aspirin or ibuprofen.

Can we help by telehealth? Sometimes: it depends on the evaluation.

Is this an emergency?

This is not an emergency service. Call 911 or go to the nearest emergency room if you have:

  • Belly pain or tenderness
  • Vomiting (at least 3 times in 24 hours)
  • Bleeding from the nose or gums
  • Vomiting blood, or blood in the stool
  • Feeling extremely tired, restless or irritable

Help lines:

Warning signs: when to go to the ER

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Dengue symptoms

According to the CDC, dengue shows up as fever plus one or more of:

  • Eye pain (typically behind the eyes)
  • Muscle pain
  • Bone pain
  • Joint pain
  • Headache
  • Nausea or vomiting
  • Rash

Most people feel better in about a week. About 1 in 20 people who get sick develop severe dengue, which is a medical emergency.

Dengue warning signs: when to go to the ER

Warning signs usually begin 24 to 48 hours after the fever has gone away, just when many people think they are recovering. If you have or recently had dengue and notice any of these, go to an emergency room or call 911:

  • Belly pain or tenderness
  • Vomiting at least 3 times in 24 hours
  • Bleeding from the nose or gums
  • Vomiting blood, or blood in the stool
  • Feeling extremely tired, restless or irritable

The CDC warns that dengue symptoms can become severe within a few hours. Don't wait to see if it passes.

What not to take (avoid NSAIDs)

Don't take aspirin or ibuprofen. For fever and pain, the CDC recommends acetaminophen.

Rest as much as you can and drink plenty of fluids: water or drinks with added electrolytes. During the first week the virus is in your blood, so prevent mosquito bites to avoid spreading it to people around you.

Dengue in Puerto Rico: recent figures

Puerto Rico declared a dengue public health emergency in March 2024. According to the CDC, 6,291 cases were reported in 2024; more than 52% (3,292) needed hospital care, and there were 13 deaths.

As of March 7, 2025, 936 cases had been reported, a 113% increase over the same period in 2024 (CDC health alert, March 2025).

For the current situation, check the Puerto Rico Department of Health's weekly arboviral surveillance reports.

Dengue, chikungunya or Zika?

The same mosquito, Aedes aegypti, spreads dengue, chikungunya and Zika in Puerto Rico, and the symptoms overlap. Only a lab test tells them apart. Until you know, take the same precautions: avoid aspirin and ibuprofen and watch for warning signs. Zika is a particular concern in pregnancy.

What visitors should know

The CDC lists dengue as a risk for travelers to Puerto Rico. Use an EPA-registered repellent (the CDC recommends products with at least 20% DEET for Puerto Rico), wear long sleeves and pants, and stay in rooms with window screens or air conditioning. If you get a fever after your trip, tell your doctor you were in Puerto Rico. For other travel health issues, see sick on vacation in Puerto Rico.

Dengue in children

Children can get severe dengue too, and the same warning signs apply. If your child has belly pain, vomits repeatedly, bleeds from the nose or gums, or is very listless or irritable, take them to the ER. If they are very drowsy or hard to wake, call 911. See also fever in children.

Can we help by telehealth?

Only for guidance when you have no warning signs. In an online doctor visit the doctor can talk through your symptoms, explain what to watch for, give you a lab order if she considers it appropriate, and assess when you need to be seen in person.

If you have any warning sign, don't book a video visit: go to the ER. See emergencies and ER, urgent care or telehealth?.

Video visit: US$79 · Pay by card · See the price and what is included

Before you book

  • You must be physically in Puerto Rico during the visit (visitors and tourists are welcome).
  • We see patients from 6 months old. Patients under 21: a parent or legal guardian must be on camera for the whole visit.
  • Real-time video only; we do not do phone-call visits.
  • We do not prescribe controlled substances.

What we don't do by telehealth

Frequently asked questions

What are the warning signs of dengue?
Belly pain, vomiting at least 3 times in 24 hours, nose or gum bleeding, blood in vomit or stool, and extreme tiredness, restlessness or irritability. They usually start 24 to 48 hours after the fever ends. Go to the ER.
What should visitors know about dengue in Puerto Rico?
Dengue is a risk in Puerto Rico. Use a repellent with at least 20% DEET, cover up, sleep in screened or air-conditioned rooms, and seek care if you get a fever during or after your trip.
Can I take ibuprofen for dengue?
No. The CDC says not to take aspirin or ibuprofen. Acetaminophen is recommended for fever and pain.
Can you get dengue more than once?
Yes. There are four dengue viruses, so a person can be infected more than once.

Sources

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