Dengue takes eight lives

Ghulam Ahad

The city is now suffering from an outbreak of dengue with about 50 of its residents being attacked daily by the infectious disease, spread by the Aedes mosquito. 

According to official sources at least eight people have died of dengue fever and about 573 have been afflicted by the disease till September 6 this year. Unofficial sources, however, believe that the actual number of dengue cases so far were much higher—approximately 2,000. 

Many dengue patients, mostly suffering from dengue haemorrhagic fever, the worst form of the disease, are rushing to different hospitals and clinics in the city everyday.

Experts believe that this year's dengue outbreak may be less serious than that of the last year. Unlike the situation in the previous year, the physicians as well as the people are now aware of the disease—much more is known about its identification and case management, they say.

Last year, 93 persons died of dengue and a total of 5,551 persons were attacked by the disease, according to sources in the Directorate of Health Services. But unofficial sources say dengue claimed more than 150 lives last year.

Bridg (retd) M.A. Malek, Adviser in charge of the Ministry of Health and Family Welfare, told the Holiday on September 5 that the government was fully prepared to tackle the dengue menace. He stressed the need for all-out cooperation to eliminate the Aedes mosquito, the carrier of dengue germs, in order to check the disease and check its recurrence. 

There is no need to panic, the Adviser said. He called upon everyone to take care of their houses and surroundings and keep them clean so that Aedes mosquitoes cannot breed. Controlling of mosquitoes is not possible by the government alone. It needs the active cooperation of the people, the Adviser observed.

He refuted press reports that the government was neglecting the dengue issue, being busy with the upcoming parliamentary elections, is not true. “The Ministry of Health has nothing to do with the election,” he said. He pointed out that in addition to the dengue control room at the Directorate of Health Services, a cell was opened at the Ministry of Health on September 5 to monitor the dengue situation.

To create awareness among the people against Aedes mosquitoes, special programmes will be aired through radio and television and letters will be sent to Imams of mosques to deliver khutbas (sermons) on the issue before Jumma prayers. The decision was taken at a meeting at the Ministry of Health on September 5. Besides government officials, representatives from the World Health Organisation (WHO), the Dhaka City Corporation, Rotary Club and Bishwasahitya Kendra were present at the meeting.

Dr. Kanak Ranjan Talukdar, Director, Disease Control of the Directorate of Health Services, thinks that dengue will not take as serious a turn as it did the previous year. The fatality rate will remain below one per cent this year compared to 1.6 per cent last year, he hoped. The fatality rate of the disease in many countries was 13 to 14 per cent, he mentioned. 

Dr. Talukdar said that dengue had become a recurrent phenomenon in the country and it would break out here every year. 

He said about 30 per cent of the dengue patients are likely to be suffering from dengue haemorrhagic fever. Those who were earlier attacked by any of the four dengue viruses—Den-1, Den-2, Den-3 and Den-4— will be afflicted by dengue haemorrhagic fever if they are attacked by any other dengue virus. The other form of the disease is very simple and usually can be cured without any treatment, Dr. Talukdar said.

According to entomologists, a favourable condition for multiplication of the Aedes mosquito larvae is prevailing in the city now. Surveys conducted by the government and non-government organisations say that presence of the Aedes mosquito was found in more than 60 per cent households in the city.
A study conducted by the Dhaka City Corporation found the density of the Aedes mosquito population to be exceptionally high. The density was very high compared to that of the previous years, the study said.

The DCC has taken up a special programme to destroy the larvae of the Aedes mosquito. Letters have been issued to ward commissioners asking them to identify areas and houses where Aedes larvae are found. All hospitals and clinics have also been asked to report dengue cases to the DCC so that it can carry out spraying in the areas where the patients came from.

The WHO, in a message on August 28, warned that dengue was spreading in the Asia-Pacific region, including Bangladesh, and suggested adequate preventive measures on an emergency basis. Thailand and Singapore have already witnessed dengue epidemics that were 20 per cent severer than those in the previous years.

Meanwhile, the government's decision to collect eight cell separator machines has not been implemented fully. Only four machines were so far collected, but the number is reportedly inadequate to meet the demand. However, a source in the DHS said that the cell separator machine was not useful for dengue patients. It might be effective for treatment of some other diseases, including blood cancer, but not for dengue, he added.

The government is offering free blood test facilities to suspected dengue patients through the laboratory of the Institute of Epidemiology Disease Control and Research (IEDCR) at Mohakhali. The tests conducted by the IEDCR are financed by the World Health Organisation (WHO). 

Sources in the Communicable Diseases Control (CDC) of the DHS said the Directorate of Health gained valuable experience in dealing with dengue last year so it will not be difficult to deal with the disease this year. 

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

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 Dhaka Shishu Hospital. Doctors at district level were also trained. 

According to doctors, the symptomatic manifestations of Dengue Fever (DF), Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome ((DSS) are overlapping in nature and not differentiable at the beginning ; the symptoms appear to shift from one category to another. 

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

Cases of DHF should be observed every hour. Timely intravenous therapy—isotonic crystalloid solution—can prevent shock and lessen the severity of the attack. In case of shock, oxygen should be given to the patient.