Plagued by Dengue

With 23,139 cases reported so far, is Sri Lanka heading towards another Dengue epidemic?:

by Carol Aloysius

Variously referred to as, ‘Devil’s Disease’, ‘Break Bone Disease’, and ‘Killer Disease’, Dengue Fever (DF) has spread dramatically on the global scale, with the worst affected regions being South East Asia and the Western pacific. According to the 2014 report of the World Health Organisation (WHO), although estimates from various studies vary, the undeniable fact is that Dengue is now endemic in over 100 countries. This, the report states is a shocking increase from the 9 countries affected by severe dengue epidemics in 1970.

In Sri Lanka, although the number of suspected cases and those with clinical manifestations of the disease have dropped sharply in the past two years, mainly due to various interventions by the Health Ministry, the fact that nearly 24,000 cases have been reported up to November this year indicates that Dengue fever still continues to be widely prevalent. It also highlights the need for effective measures to control the spread and prevent a future epidemic.

The Ministry of Health has adopted a number of emergency measures to tackle the issue, including readying over 20 sentinel hospitals across the island with needed equipment and vital drugs to deal with any sudden surge in the outbreak of the disease. However, there is no specific cure for Dengue Fever as the disease is caused by a virus – in fact several viruses. There are four distinct, but closely related, serotypes of the virus that cause Dengue (DEN-1, DEN-2, DEN-3 and DEN-4). Proper medical care and new techniques have lowered fatality rates drastically globally and in Sri Lanka. But more importantly, the infection is both preventable and controllable.

This however depends solely on effective vector control. Spread by a tiny mosquito, the Aedes aegypti, which thrives in tropical and sub tropical climates, Dengue can only be effectively controlled by destroying the breeding sites of the female mosquitoes before the larvae left in such sites, hatches, which happens in a very short span of time.

Here, the Sunday Observer talks to Community Consultant Physician, Dengue Control Unit, Ministry of Health, Dr Preshila Samaraweera, about Dengue prevention, early detection, symptoms to watch out for and the more severe Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) – that often ends up being fatal for young children.

Excerpts

Q: Dengue fever is currently raging in the island with nearly 24,000 cases reported up to November this year. Is it a common illness due to the prevailing weather patterns - heavy rainfalls followed by short periods of sunny skies and even drought? And which Districts have the most number of reported cases?

A: Dengue Fever is one of the commonest prevailing medical conditions in Sri Lanka at present. A total of 23,139 Dengue cases have been in record so far in 2015. Nearly 50% of the case load is from the Western Province.

Q: What exactly is Dengue? How is it caused and how long does it take for a patient to become infected?

A: Dengue is a viral infection transmitted by Aedes mosquitoes. Many patients infected with the Dengue virus remain asymptomatic. Others, after an incubation period of 4-7 days, develop febrile illness, which could lead to Dengue Fever or Dengue Haemorrhagic Fever.

Q: What are the common symptoms of Dengue Fever?

A: If you have at least two of the following symptoms you need to suspect of having Dengue Fever:

*High grade fever
*Headache and pain behind the eyes (retro- orbital pain)
* Generalized muscle pain and joint pain
* Nausea and vomiting
* Red spots on the skin and bleeding tendencies

It is also important to take into consideration whether you are living in highly endemic area.

Q: When you have fever what should you do?

A: Take adequate physical rest; don’t send your child to school during the illness; take only paracetamol to bring down the fever on a doctor’s advice; make sure it is given in recommended doses. Also tepid sponging of the body helps to bring down a high fever.

Q: What are the things you should not do?

A: You should avoid all Non-steroidal Anti-inflammatory Drugs (NSAIDS) and steroids like Mefenamic acid, Ibuprofen, Diclofenac

Q: What kind of food /drinks should be consumed by a patient?

A: Give him/her adequate amounts of fluid to prevent the body from becoming dehydrated. Nourishing drinks such as rice ‘kunjee’, fruit juices, jeewani, milk and soup are preferable to water.

If the patient has an appetite, let him/her take his usual meals if possible, but avoid red, brown, black, and coloured foods.

Q: If the fever persists what should you do?

A: Consult a qualified doctor if the fever persists for more than two days. A full blood count (FBC) should be done on the third day.

Q: What are the more severe forms of dengue fever?

A: Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS)

Q: How serious are they in terms of outcomes?

A: DHF is a serious condition in which there is a leakage of plasma into body cavities.

This can lead to a state of shock, which if left untreated can lead to even death.

Q: Who are most at risk of developing this condition?

A: Young children from 1-5 years and primary school children.

Q: What are the signs and symptoms that indicate a Dengue patient is progressing into this more sever stage of the illness?

A: -Clinical deterioration with settling of fever

-Inability to tolerate oral fluids

-Severe abdominal pain

-Cold and clammy extremities

-Lethargy or irritability/restlessness

-Not passing urine for more than 6 hours

-Bleeding tendency including inter-menstrual bleeding or menorrhagia

Q: How can you identify Dengue Fever and Dengue Haemorrhagic Fever?

A: Through Dengue Antigen test (NS1) and Dengue Antibody test (IgM and IgG)

Q: Let’s talk about prevention. How can the Dengue infection be prevented?

A: If you are in an area where there are plenty of mosquitoes, try to avoid mosquito bites by resting under a net at night and even during the day time.

You can also use natural mosquito repellents, but it is more important to get rid of any mosquito breeding sites in your immediate environment and make your garden free of all small containers that attract mosquitoes and provide breeding places for their larvae.

Q: Could you elaborate on this? Where can these breeding sites be found?

A: There are two kinds of mosquitoes that spread Dengue. They are Aedes aegypti and Aedes albopictus. They breed on clear stagnant water.

They can breed in even very small amount of water. Most of the breeding sites are man – made or natural water receptacles.

These include multitude of receptacles and roof gutters found in and around both urban and rural environments e.g. (houses, construction sites, religious places, schools and factories) Commonly found breeding places are tyres, water storage tanks/barrels, containers, machinery parts, discarded items like tins, coconut shells, plastic and glass ware, flower pots and flower pots, trays, bird baths, earth pipes, leaf axils, ant traps, bamboo stumps, tree holes, blocked roof gutters etc.

Q: Your message to the public?

A: The most effective method of preventing dengue is proper elimination of these breeding sites from our surrounding.

Therefore, we urge the public to inspect their premises regularly and prevent mosquito breeding places.