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The dengue danger

by Dr Yasmin Jahan and Prof AKM Kafiluddin
THE people of Bangladesh have been panic-stricken by the emergence of sporadic dengue cases. Many cases have been suspected, but at least a few were confinned by laboratory investigations. Nowadays, several people are suffering from fever that is similar to dengue in symptoms. However, inadequate laboratory facilities have stood as a barrier to the confirmation of the disease. At present, dengue diagnosing facility is only available at Armed Forces Institute of Pathology (AFIP) and BIRDEM At this crucial moment awareness for its prevention and control among community people and health service providers is urgently required before It turns Into an epidemic. There Is no regular dengue surveillance programme in Bangladesh as it is not yet Identified as a common health problem.
But Bangladesh cannot remain complacent as in its neighbouring countries like Thailand. India and Myanmar the disease has taken both endemic as well as epidemic proportion Spread of this disease from these countries to Bangladesh seems inevitable Therefore, Bangladesh health authority (Primary Health Gare. Communicable Disease Control Programme) should be more concerned and take neces-sarv steps to prevent and control any outbreak of this fatal disease. Early diagnosis, prompt treatment and vector control can prevent the spread of dengue.
Dengue (pronounced Dhen Gey") Is a serious viral infection common throughout he tropical region of the world. It is spread by certain species of day biting Aedes mosquitoes, particularly Aedes aegyptl. Dengue occurs in two forms. Dengue Fever (DF) and Dengue Haemorrhagic Fever (DHF). The Incubation period for DF/DHF can be as short as three days and as long as 14 days The average incubation period is four to six days Dengue haemorrhagic fever is a deadly disease but early diagnosis and treatment can save lives Unless projx-r treatment
Is given promptly, the patient may go into shock and die.
Dengue Prevalence in Bangladesh:
Some studies in Dhaka and Chittagong noticed that dengue is endemic in Bangladesh A study conducted at the Institute of Epidemiology Disease Control & Research (IEDCR), Mo-hakhall. Dhaka, in the year 1997-1998. found 1 1 per cent sero-positive cases among children below 10 years of age in Chittagong Medical Hospital. In the year 1999, suspected 44 samples from a different Institute in Dhaka (e g BIRDEM) were also examined in the same Institute, of which 22 per cent was found positive for dengue fever.
Guidelines for management of dengue as recommended by
WHO
1. Characteristics of Dengue (Fever (DF)/ Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS)
DF: Dengue fever is an acute febrile illness of 2-7 days duration (sometimes with two peaks) with two or more of the following manifestations:
Severe frontal headache, Caln behind the eyes (retro-or-ilal pain), which worsens with eye movement, deep rnuselc and Joint pains (the disease Is nicknamed break bone fever' for these two symptoms), rash, haemorrhagic manifestation (Petechlae and positive tourniquet test) and leucopoenla.
DHF: During the acute phase of Illness. It Is difficult to distinguish DHF from dengue fever DHF Is a probable case ol dengue and haemorrhagic tendency evidenced by one or more of the following:
Severe and continuous pain in abdomen, bleeding from the nose/mouth /gums, frequent vomiting with or whiteout blood, black stools like coal tar, t hrombocytoaenla (Platelets lOO.OOOcumin or less), positive tourniquet test
Evidence of plasma leakage due to Increased capillary permeability manifested by one or more of the following.
A 20% rise in haematocrit for age and sex; -a > 20% drop in haematocrit following treatment with fluids as compared to baseline: — signs of plasma leakage (pleural effusion, ascites or hypoproteinamia).
DSS; All of the above symptoms of DHF plus signs of circulatory failure manifested by rapid weak pulse, hypotenison for age. cold and clammy skin, sleepiness and restlessness, deep breathing.
2. Treatment: There Is no vaccine and there is no cure, so if one contacts dengue, the treatment is 'supportive' which means rest, plenty of fluids, paracetamol and hospitalization If the hemorrhagic fever or shock developed. Rapid and appropriate treatment can relieve the symptoms and prevent complications and death Severe abdominal pain, black stool, bleeding from skin or nose or gums, sweating and cold skin. etc. are danger signs. If any one of them is noticed, take the patient to a hospital immediately. Give the patient fluids or drink while transferring him/her to the hospital.
3 Prevention of Dengue: Prevention Is really the only choice There are two key measures that can be applied to prevent the spread of dengue.
Prevent mosquito bites:
Dengue mosquito bites during day time; protect yourself from such mosquito bite.
Wear full sleeve long loss-fitting dresses to cover the limbs.
Repellents can be applied to exposed parts of the body.
Use mosquito colls and electric vapour mats during the daytime.
Use mosquito nets to protect babies, old people and others who may rest during the day. The effectiveness of such things can be improved by treating them with permethrlm (pyrethroid Insecticide). Curtains. screens can also be treated with insecticide and hung at windows or doorways, to repel or kill mosquitoes.
Break the cycle of mosquito-human-mosquito infection. Mosquitoes become infected
when they bite people who are sick with dengue. Mosquito nets and coils will effectively prevent more mosquitoes from biting sick people and help stop the spread of dengue.
Prevent multiplication of mosquitoes:
Mosquitoes which spread dengue, live and breed in stagnant water In and around houses.
Drain out the water from air coolers (when not in use), tanks, barrels, drums, buckets. Jars, pots etc.
Remove all objects containing water (eg plant saucers, etc).
All stored water containers should be kept covered all the times.
Collect and destroy discarded containers where rain water collects or is stored, eg. bottles, plastic bags. tins, tyres, coconut shells, etc.
Vaccines: There Is no therapeutic cure or vaccine currently available. The vaccine is currently undergoing clinical trials. but it is uncertain when it will be available for general use.
4. Role of community and municipal leaders: Introduce reliable rubbish collection, health education campaigns. fgarbage cleaning campaigns, nvite the municipality to be involved and to provide trucks and personnel, hold a community meeting to focus attention on clean-up day and its purpose, advertise the clean-up day on radio, television and through osters.
Invite the communltv group to participate. Schoo) students can be Involved; they will cany the message home to their parents and neighbours. Students can begin by ( leaning up their school compound, then take action around their homes.
And now attention of (lie Mayor of Dhaka City Corporation Is solicited In order to Implement the dengue prevention strategy as per WHO guidelines
The writer are Assistant Professor (cc). Microbiology Department (NIPSOM) and Professor Emeritus. NIPSOM respectively.