The viral challenge

Controlling mosquito populations is not the only challenge; identifying symptoms of dengue, alarming signs, diagnosis and timely management also pose serious challenges

The viral challenge


his monsoon season Pakistan faced a serious flooding resulting in death tolls running into thousands. The water-borne and vector-borne diseases are rising at an alarming rate. Dengue fever is a mosquito-borne viral disease that causes a drastic decline in the patient’s platelet count. The flooding has worsened the spread of the disease.

The global incidence of dengue fever has grown dramatically with about half of the world’s population now at risk. Although an estimated 100-400 million infections occur each year, over 40,000 people die from severe dengue fever (according to the Centre of Disease Control).

Dengue fever is caused by one of four related viruses: Dengue virus 1, 2, 3, and 4. Hence, a person can be infected with a dengue virus as many as four times in his or her lifetime.

Dengue virus is transmitted by female mosquito aedes aegypti mainly and, to a lesser extent, ae. albopictus. These mosquitoes also carry chikungunya, yellow fever and Zika viruses. There is evidence, however, of the possibility of maternal transmission (from a pregnant mother to her baby). When a mother has a dengue fever infection during her pregnancy, the baby may suffer from pre-term birth, low birthweight and fetal distress. Rare cases of transmission via blood products, organ donation and transfusion have been recorded.

The current challenges include not only controlling the mosquito spread but also identifying symptoms of dengue fever, alarming signs and timely management. My recent medical camp experience at Thatta was very disheartening. Thousands of people in flood affected areas lacked basic medical facilities. The calamity has taken away their local dispensaries making access to medical help extremely difficult.

Many children and adults running fever are not diagnosed for the disease. No lab test facility is available to establish diagnosis. People are unaware of overlapping symptoms of malaria, dengue and typhoid.

Severe dengue presents show signs that include severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums or nose, fatigue, restlessness, blood in vomit or stool. In such cases, immediate hydration and transfusion might be needed to save lives.

There is a rush in both urban and rural areas to get people admitted to hospitals and for arranging blood and platelets. There is a call for blood donors in big cities. Many healthcare organisations are trying to meet the need by offering free-of-cost blood bags and platelets. They need healthy individuals to come forward for blood donation. Unfortunately, many rural areas still lack transfusion services. Many organisations are working and sending healthcare professionals for help.

A lot of people are unaware of medicines and precautions to be taken at home for less severe disease. Since it is an outbreak in the current scenario, the non-medical personnel going for help in flood affected areas can play a role in educating the people about the management of the illness and controlling its spread. Fever and pain can be best managed with acetaminophen or paracetamol. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin should be avoided due to increased risk of hemorrhage.

Sponging patient’s skin with tepid water helps control high grade fever. They should be advised to watch for signs of dehydration by checking for decreased urination, reduced tearing in a child, dry mouth, restlessness, fast heartbeat, cold or clammy fingers and toes, sunken fontanel in an infant. ORS and water should be used for those who are sick.

People also need education regarding mosquito control. Bed nets and repellants should be used by those diagnosed with or suspected of dengue fever to prevent transmission to others.

A few steps have been recommended by the World Health Organisation (WHO) and the Centre of Disease Control (CDC) for dealing with mosquitoes. Mosquitoes rest in dark, humid places like under sinks, in showers, in closets, under furniture, or in the laundry room. Once a week, empty and clean, turn over, cover, or throw out any items that hold water, such as vases or flowerpot saucers, to remove mosquito eggs and larvae. Repair windows and screens if they have holes to prevent mosquitoes from coming in through these. Use an indoor insecticide frequently on a daily basis. Tightly cover water storage containers so that mosquitoes cannot get inside to lay eggs. For containers without lids, use wire mesh with holes smaller than adult mosquitoes. When using insecticides, always follow label instructions. Repellents, coils and vaporisers should be used during the day both inside and outside the home (e.g., at work/ school) because the primary mosquito vectors bite throughout the day. Wearing clothes with full sleeves minimises exposure to mosquitoes. The state governments should execute fumigation on a large scale.

The role of vaccination has not yet been established for this infection. The safety lies in taking precautionary measures and educating the masses through social media and print media. Schools should take the initiative in spreading awareness among children. Hospitals should organise awareness programmes.

The writer is MBBS, FCPS Family Medicine, MRCGP(INT)

The viral challenge