Dengue in epidemic form unlikely

Ghulam Ahad

Dengue fever might break out in the city anytime in the current or next month. Experts, however, think that it will not take as serious a turn as it did the previous year.

At least 225 people have so far been attacked by dengue fever this year and two patients died of it in the city till August 6, according to official sources. Unofficial sources, however, said that the number of dengue cases was much higher.

Last year, 93 persons died of dengue and 5,551 persons were attacked by the disease, according to the Directorate of Health Services (DHS). But unofficial sources say dengue claimed more than 150 lives last year. 
Experts think that the people and the government are much more conscious about the dengue menace this year, and nature is also not now favourable for Aedes mosquitoes, the carriers of dengue germs.

However, the risk of an outbreak of dengue will remain till the end of the rainy season, which might be prolonged to September, according to experts. 

The Dhaka City Corporation (DCC) medical officer, Dr Shahidur Rahman, who is in charge of mosquito control, said that the country was under risk of a dengue outbreak this year also as neighbouring countries like Thailand and Singapore are witnessing epidemics that are 20 per cent severer this year than in the previous year. Some 108 people have already died of dengue and over 50,000 have been afflicted by the disease in those countries, he mentioned, and added that the situation in Dhaka was still good as the weather is not in favour of the Aedes mosquitoes and because the DCC has taken extensive measures to check the mosquito population.

Daily rainfall in the city is not allowing the mosquito larvae enough time to get matured. Larvae need five to six days to develop into mosquitoes, Dr Shahid said, adding that rain without adequate interruption was destroying the larvae. Moreover, the DCC has undertaken a dengue surveillance project and formed a task force and a rapid action force to prevent dengue. It is also conducting anti-Aedes drives in different parts of the city with the cooperation of the Bishwa Sahitya Kendra.

Dr. Shahid said the population density of mosquito larvae has decreased at different parts of the city in the last few days.

Dr. Nurul Islam, in charge of the control room of the Directorate of Health Services, said a severe outbreak of dengue might not occur this year, as the disease is unlikely to take an epidemic form in two consecutive years. “Those who are attacked by the fever develop anti-bodies to resist the disease for at least one year." Moreover, the people are now conscious about dengue, he added. However, he did not rule out the possibility of an outbreak of the disease by the end of the current monsoon.

Dr. A.S.M. Alamgir, medical officer of the Institute of Epidemiology, Disease Control and Research (IEDCR), said that the possibility of a dengue outbreak in the city would persist until the advent of winter.
He said that those who were attacked by any of the four types of dengue virus—Den-1, Den-2, Den-3 and Den-4 — might be attacked by one of the remaining three types, though not by the previous one. In that case, the patient would suffer from dengue haemorrhagic fever, the worst form of the disease. The other form of the disease, known as classical dengue, is almost like normal fever and is often curable without any major treatment.

Dr. Alamgir said only three to four suspected dengue patients were coming to the IEDCR for blood tests a day. Dengue germs are being detected this year in the blood of 40 per cent of these few daily patients following tests at the laboratory of the Institute of Epidemiology, Disease Control and Research (IEDCR) at Mohakhali, he said. The IEDCR, supported by the World Health Organisation (WHO), tests the blood of suspected dengue patients free of cost. Dr. Alamgir said that the IEDCR would be able to test the blood of many more patients and was ready to tackle the situation in case dengue broke out in epidemic proportion this year.

He said blood test for dengue fever was expensive. Private laboratories usually take about Tk. 800 for each test. He suggested that the dengue patients should avail themselves of the free blood tests at the IEDRC.
Dengue Preparedness

Last year the health care authorities of the government did very little to control dengue. The government has mobilised resources and some manpower to deal with dengue cases this year.

Sources in the Communicable Diseases Control (CDC) of the Directorate of Health Services said the Directorate has gained some valuable experience in dealing with dengue last year and it will not be very difficult to deal with the disease if it breaks out this year. 

The government has imparted training on dengue case management to 134 doctors and 45 professors of 13 government medical colleges, the Bangabandhu Sheikh Mujib Medical University and the Dhaka Shishu Hospital. Doctors at district level were also trained. 

Plight of Dengue Control Room

The Natural Disaster Control Room at the Directorate of Health Services (DHS), now better known as the dengue control room, when contacted on August 5 could not provide information about the latest situation of dengue for it “had been detached from the outer world as both of its telephones, numbering 8818736 and 8819353, were inactive since August 1”.

Dr. Nurul Islam, in charge of the control room, said that he has informed the higher authorities, but they were yet to take any step to reactivate the telephones. The telephone is their lone means of collecting information from different hospitals about the outbreak of dengue, he explained.
Sources in the dengue control room said on July 8 that they were yet facing the problem though technicians from the local office of the Bangladesh Telegraph and Telephone Board (BTTB) came on July 7 and reactivated the phones which began to misbehave as soon as the technicians left. 

Feature and Treatment of Dengue

Physicians said dengue fever is an acute febrile illness of 2 to 7 days’ duration, sometimes with two peaks. Dengue fever and dengue haemorrhagic fever are not distinguishable in the febrile phase and treatment is essentially the same. The modality of treatment is symptomatic and supportive : rest, sponging with tepid water at room temperature and ingestion of paracetamol. Aspirin, antibiotics or any other NSAIDs should not be given to the patient. Steroids should be avoided. 

Cases of dengue haemorrhagic fever should be monitored every hour. Timely intravenous therapy—of isotonic crystalloid solution—can prevent shock and lessen the severity. Oxygen should be given to the patient in case of shock.