No respite from dengue

Karachi: The dengue epidemic is gradually tightening its grip on the city as 161 new cases have surfaced in a single day this week.

According to the data issued by the Health Ministry of Sindh, the majority of the cases, 36 to be exact, were reported from District East on September 14, followed by 32 in Korangi, 25 in South and 21 in Central. Cases from other districts remained in single digits.

The report adds that a total of 1,227 dengue cases have been reported in the metropolitan since the start of September while the number of cases since the start of the year is 3,434. In Sindh so far, nine people have lost their lives to dengue this year.

Since the situation in the city is taking an alarming turn, Bolnews sat down with two leading experts on infectious diseases, Dr Farheen Ali and Dr Shobha Luxmi, to know more about the outbreak of dengue.

According to Dr Farheen, it is a viral illness, caused by the bite of a particular type of mosquito – Aedes Aegypti. Unlike malaria, caused by the bites of infected female Anopheles mosquitoes, dengue is typically a self-limited disease, with an overall mortality rate of less than one per cent, she said. Only about five per cent of cases require hospitalisation.

She stressed the fact that the dengue mosquito bites primarily in the daytime – being most active around sunrise and sunset. The malaria mosquito, on the other hand, usually bites at night. Both malaria and dengue are not contagious, which means it does not spread from person to person. They are vector-borne, only transmitted by infected mosquitoes. Incidentally, both these diseases are on the rise due to the lack of an effective mosquito eradication programme. In a press conference held this week, the Sindh Information Minister Sharjeel Memon said that as many as 3,072 people were diagnosed with malaria and 1,098 others with dengue this month. This report is indeed alarming as Malaria is spreading at a much faster rate and it kills approximately 50,000 Pakistanis annually.

Talking about dengue, Dr Farheen and Dr Shobha said that the coming months could be of concern because this disease commonly occurs in a particular season, especially after rainfall as the vector multiplies. “Unlike the malaria-transmitting mosquito, dengue is a daytime biter when you are not sleeping under a mosquito net,” Dr Shobha said. Most of the patients are treated with Paracetamol and that too only for pain and fever.

Explaining the clinical presentation of dengue, Dr Farheen said, “Dengue, when symptomatic, presents as a fever which can be associated with severe headaches, body aches, sore throat, and mild cough. Occasionally a patient may have a rash on his body. The diagnosis is carried out with blood tests which can detect either the antigen (if taken early) or the antibodies against the virus (taken after 5 or 6 days of the start of the symptoms)”

Speaking about the management of dengue, Dr Shobha said, “The treatment by far requires supportive care. There are no specific medicines for it and there is no indication to use antibiotics. A patient should remain well-hydrated and take paracetamol for the relief of fever and pain.”

Dr\ Farheen adds that the disease is often monitored by serial Complete Blood Count (CBC( testing to look for a rising concentration of blood by evaluating the trend of the haemoglobin/hematocrit in the CBC.

It is important to emphasise that although the platelet count drops, it does not require transfusion or any intervention unless there is significant bleeding which does not happen commonly.

Dr Shobha stresses the point that patients should seek immediate medical care if any of the danger signs are there of severe abnormal pain, shortness of breath, persistent vomiting and drowsiness.

Both doctors believe that the government singlehandedly cannot prevent the spread of dengue. It can only be prevented with the support of the general public. To decrease or eliminate the breeding areas of mosquitoes, it is necessary to use insect repellent, wear long-sleeved shirts and long pants, and control mosquitoes inside and outside every home. The government should make arrangements to disinfect and decontaminate different affected areas of the city to check the spread of dengue.

According to a report published in a local English language Daily, the provincial government has not issued funds to six out of the seven DMCs to operate fogging machines. The Sindh government has issued a fund of Rs20 million to DMC Malir only. The remaining six DMC are still deprived of the funds needed to carry out fogging operations necessary to control the dengue epidemic in the city. Karachi’s 33 fumigation vehicles are out of order, sources said.

Typically, people infected with the dengue virus are asymptomatic (80 per cent) or have only mild symptoms such as an uncomplicated fever. Others have more severe illnesses (5 per cent), and in a small proportion, it is life-threatening. The incubation period (time between exposure and onset of symptoms) ranges from 3 to 14 days, but most often it is 4 to 7 days. So all required is effective measures to prevent the disease from spreading.

Meanwhile, a vaccine for dengue fever has been approved and is commercially available in several countries. As of 2018, the vaccine is only recommended in individuals who have been previously infected, or in populations with a high rate of prior infection by age nine.

A report published in a British medical journal about controlling dengue in Pakistan urged both the federal and provincial governments to jointly strengthen the dengue surveillance system.  There is a need for awareness campaigns on protection measures, safe use of insecticides for larval control, and community-based approaches for integrated vector management throughout the year. Also, there is an urgent need to establish a separate cell for its control within the Ministry of Health to allocate enough funds for dengue control and treatment nationwide, particularly in high transmission areas.