With detection of two cases of dengue fever, including one death, in twin cities of Islamabad and Rawalpindi during the current month, the threat of an outbreak of dengue and dengue haemorrhagic fever (DF-DHF) looms large, health experts told ‘The News’ on Tuesday.
“The outbreak of dengue fever may be more deadly this time around. It may result in complications, including hemorrhagic manifestations,” said Head of Pathology Department at Rawalpindi Medical College Professor Dr. Abbas Hayat while talking to ‘The News’.
He said that the situation might be alarming after the monsoon as the climate then would be most suitable for breeding of mosquito Aedes Aegypti that causes DF and DHF. Dengue hemorrhagic fever is a cause of the disease and death primarily among children in tropical Asia.
Director Emergency at Rawalpindi General Hospital Dr. Muhammad Mujeeb Khan said that the infection this time might be more deadly as a patient’s second exposure to dengue virus might cause DHF.
Head of Community Medicine at Islamabad Medical & Dental College Colonel (r) Professor Dr. Muhammad Ashraf Chaudhry, when contacted, said that the DF and DHF have emerged as a major public health problem in Pakistan during last couple of years.
“Factors responsible for emergence of the infection include rapid population growth, unplanned urbanisation, deficiencies in water supply and solid waste management, inadequate health budgets for dengue control, expanding mosquito breeding due to unreliable water supply, traditional water storage practices, changing lifestyles, inadequate health education and poor garbage collection that creates more mosquito breeding places,” he added.
In Pakistan, the first confirmed dengue outbreak was reported in 1994 in Karachi, in which 145 cases and one death was reported. In October 1995, the southern Balochistan was hit by dengue fever with reporting of 76 cases. In October 2003, the outbreak was detected in Haripur district of NWFP for the first time. In November 2005, the DF and DHF hit Karachi again, in which two doctors also died. In 2006, Dengue again hit Karachi, Hyderabad, Haripur, Lahore, Rawalpindi, Islamabad and Kotli (AJK).
“In 2006 outbreak, 5,500 cases and 58 deaths were reported convincing the concerned authorities to take preventive measures in future. However, misconceptions, ignorance and myths surrounding the disease are making it more difficult to deal with,” said Dr. Ashraf.
Talking about key facts of the disease, he said, it is a flu-like viral disease, transmitted by mosquitoes and there is no direct human-to-human transmission. “The DHF is often severe and fatal. There is no vaccine and no specific treatment for dengue. Prevention centres on avoiding mosquito bites by using mosquito repellents on the skin and using insecticide-treated bed nets during sleeping.”
He said the most worrisome fact is that mosquito Aedes Aegypti is a daytime biter when it is difficult to sense the bite. Aedes Aegypti tends to breed in water storage tanks of houses and in discarded tyres, flowerpots and old drums etc.
To a query, Dr. Ashraf said dengue shows itself in shape of high fever, severe headaches, extreme joint and muscle pain — also called break-bone fever, nausea and vomiting and rash. “A few victims develop DHF — bleeding from nose, gums and under the skin causing purplish bruises. The DHF is fatal in 5 per cent cases. Then there is dengue shock syndrome (DSS) that can lead to circulatory failure. About 10% of such cases can be fatal,” he said. He added that in case of high fever with bleeding symptoms, the patient should immediately rush to the hospital.
To a query, he said, the main thrust of dengue control should be in households and neighbourhoods. “Individuals, families, community support groups, self-help groups, NGOs, local authorities and the department of health should work in coordination for vector control.”
He said that individuals and families should be educated to empty all water containers, scrub them and dry them to remove eggs glued to their edges. “It is also important to drain, scrub and dry water coolers and flower vases regularly, at least once a week. All water containers in the house should be kept covered to prevent laying of eggs by the dengue vector.”
The use of mosquito repellents such as oils, mosquito coils, vapour mats etc are recommended to reduce human-mosquito contact. “During the peak biting time of the mosquito at dusk and dawn, families should avoid human-mosquito contact by the use of protective clothing, long sleeve shirts, full length pants, socks, and boots to avoid mosquito bites,” said Dr. Ashraf.
Source: The News, 23/7/2008