Monday | 7 October 2024 | Reg No- 06
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Monday | 7 October 2024 | Epaper

How to combat dengue?

Published : Sunday, 12 September, 2021 at 12:00 AM  Count : 992
ZUBAIR KHALED HUQ
Dengue fever is an acute febrile viral disease transmitted by the bite of Aedes mosquitoes carrying any one of the four dengue viral serotypes. Dengue causes a wide spectrum of disease. This ranges from subclinical disease to severe flu-like symptoms in those infected. Although less common, some people develop severe dengue, which can be any number of complications associated with severe bleeding, organ impairment, and plasma leakage. Severe dengue has a higher risk of death when not managed appropriately.

Symptoms usually last for 2-7 days, after an incubation period of 4-10 days after the bite from an infected mosquito. The World Health Organization classifies dengue into 2 major categories: dengue (with/without warning signs) and severe dengue. The sub-classification of dengue with or without warning signs is designed to help health practitioners triage patients for hospital admission, ensuring close observation, and to minimize the risk of developing the more severe dengue. Dengue should be suspected when a high fever (40�C/104�F) is accompanied by 2 of the following symptoms during the febrile phase: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands, rash.

Severe dengue is called the critical phase normally about 3-7 days after illness onset. It is at this time, when the fever is dropping (below 38�C/100�F) in the patient, that warning signs associated with severe dengue can manifest. Severe dengue is a potentially fatal complication, due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment.

Warning signs that doctors should look for include: severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness, blood in vomit. Several methods can be used for diagnosing the infection. These include virologic tests and serological tests, which detect human-derived immune components that are produced in response to the virus. Depending on the time of patient presentation, the application of different diagnostic methods may be more or less appropriate. Patient samples collected during the first week of illness should be tested by both serological and virological methods.

Travelling and trading, unplanned urbanization, abundance of vector breeding places, suitable climatic conditions for vector breeding and virus transmission as well as inefficient vector control strategies are considered as determinants of the current dengue situation in the world. Infection with one serotype confers lifelong immunity against that particular serotype but subsequent infection by another serotype often creates fatal outcomes if it remains untreated. However viral virulence and host factors are also major contributing factors. Both innate and adaptive immunity contribute to the severe outcome of dengue infection.

Virus specific treatment is not yet available, so early recognition of warning signs of Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS) and immediate intervention with supportive treatment with close monitoring are of utmost importance to reduce case fatality rate. Training on dengue guidelines for health care professionals including doctors and nurses throughout the year especially prior to dengue season may contribute to better management of dengue cases.

This year, dengue, spread by Aedes mosquitoes, has taken an alarming turn in Dhaka. The picture outside the city, however, is still not that grim. Earlier, doctors used to wait for four to five days before carrying out any medical test on a patient to detect dengue. But this year, doctors suggest having the examination on the first day of the fever, saying the pattern of the disease has changed. Treatment should begin right away. If the breeding grounds of the mosquito are not detected and destroyed immediately, the mosquitoes would continue to breed and spread the disease till the end of the breeding season.

The escalating dengue situation in Bangladesh has been emerging as a serious public health problem in terms of morbidity and mortality. Despite the efforts to control dengue, based primarily on vector control and case management, the burden and costs of the disease and similar vector-borne diseases will continue to grow in future in our country. Although in recent years Bangladesh has achieved remarkable progress in controlling communicable diseases, the country has still been facing tremendous pressure in respect of public health problems especially controlling the emerging or re-emerging diseases. The upsurge in dengue cases, introduces major threats to the health of the community people. This emerging situation warrants an increased level of interventions and allocation of both human and financial resources in the health sector of Bangladesh.

Dengue will remain in Bangladesh and will continue to constitute a serious public health problem as is happening worldwide. The changing epidemiology should be clearly understood, and constant monitoring is needed, including extending the surveillance areas and addressing the challenges to reduce the impact of the disease on public health and the economy of the country. It may be very challenging to root up the disease, and a long-term investment is needed to achieve behavioural changes in the urban population to join the fight against the Aedes mosquitoes.

Bangladesh's healthcare system has already been battered by a worsening COVID crisis. In Bangladesh, a large number of dengue patients this year are being infected with DEN-3, a variant of the dengue virus which can increase mortality risk. Preventing mosquitoes from accessing egg-laying habitats by environmental management and modification; disposing of solid waste properly and removing artificial man-made habitats that can hold water; covering, emptying and cleaning of domestic water storage containers on a weekly basis; applying appropriate insecticides to water storage outdoor containers; personal protection from mosquito bites are the effective ways to reduce the possibility of being infected.

The risk of dengue transmission is increased by warming climates, as the growth and development of mosquitoes are significantly influenced by temperature and humidity. So, the best way is self-awareness. Plans on a long-term basis to mitigate the challenges have to be implemented. We should be careful about our personal protection. Prevent dengue by avoiding mosquito bites. Use insect repellent, wear long-sleeved shirts and long pants, and control mosquitoes inside and outside your home, has to be the key for containment which we can all do.
Dr Zubair Khaled Huq is
Family Medicine, Gerontology,
Public Health Specialist





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