12 August 2005

Dreadful Dengue

A DOH update released 3 days ago revealed that from January 1 to August 3 this year, the figure you see on the left is the number of Dengue cases reported in the country. The real figure might be higher if we are to take into account unreported cases.
A TOTAL 12,308 cases of dengue fever, including 159 deaths, have been reported from January 1 to August 3, according to a Department of Health update released on Tuesday.

The figures represented a 15-percent rise in the number of dengue infections registered during the same period last year.

Metro Manila came second with 25 deaths out of 1,853 cases.

[ INQ7.net, Aug 09 2005 ]

If the US has the West Nile virus problem, the Philippines has the Dengue virus problem in this season of rain and typhoons where pools of stagnant water harboring mosquito larvae can be seen in almost every place.

The 12,308 figure, while significant, is still below the more than 30,000 cases recorded in the 1998 Dengue epidemic. Neighbor countries, like Indonesia, have far worse figures than ours. Recently, there are also more reported dengue cases in Vietnam.

But you should take care not to be bitten by mosquitoes this time of year. Some pointers you should know about Dengue:
Dengue fever is caused by a virus belonging to the genus Flavivirus. It is a self-limiting disease. It is not necessary to give antibiotics. Most patients self-medicate themselves or their febrile children thinking it can help.

The terms Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF) are used interchangeably.
Classic dengue fever (DF) has the following manifestations: sudden fever, headache, pain in the back of the eyes, vomiting, maculopapular rash, weakness, loss of appetite, and swollen lymph nodes. Fever usually lasts for a week, but the whole recovery period may last for another 2 weeks.

Dengue Hemorrhagic Fever (DHF), on the other hand, begins like DF, but is diagnosed using the 4 WHO criteria: fever, hemorrhagic manifestations --- like hemoconcentration (decrease of the fluid content of the blood, with resulting increase in its concentration), low platelet count, and a positive tourniquet test, circulatory failure seen as having low total protein values and fluid accumulation in some organs, and liver enlargement.

There is another dengue variant called Dengue Shock Syndrome (DSS) which is mainly untreated DHF.
DSS is diagnosed using the 4 criteria used for DHF, and presence of symptoms like abdominal pain, vomiting, and restlessness. Evidence of circulatory failure becomes apparent with rapid, weak pulses, cold clammy skin, and an altered mental status.

You should also remember that the Dengue virus has four (4) closely related but distinct serotypes: DEN-1, DEN-2, DEN-3, and DEN-4. This means that if you get infected this year with DEN-1, for example, you get immunity from this serotype. BUT you can get Dengue fever again next year if the mosquito that bites you has any of the 3 other serotypes which you haven't been infected with. Unfortunate, but true. In any given population, lack of immunity to the virus' serotypes contributes to increasing infection rates.

So, how do you solve a problem like Dengue?

There is no Dengue vaccine available....yet. Treatment has always been supportive. This means that hospitalization will see to it that you are given enough fluids to replace whatever was lost should you get DHF or DSS where there is plasma leakage. Meanwhile, it is your body's immunity which will tide you over.

On the preventive side, there are a number of things that can be done. Since you cannot have Dengue without getting bitten by an Aedes aegypti, or an Aedes albopictus mosquito, the one thing you should do is to avoid getting bitten. You must always see to it that whenever possible, you should apply insect repellants, and make sure that there is no stagnant pool of water lying around your house, especially in this time of the year when it rains so often.

The Philippines is an endemic area for Dengue Fever. Not a year will pass that we won't get any infection. It's a fact that existed for more than 50 years already so we have to deal with it on a yearly basis.

Sanitation and refuse control should also be enforced to make sure that mosquito infestation is kept at a minimum or eliminated.

And how about defogging? I invite you to read this interesting perspective of a biologist who visits Cebu City twice a year. Cebu City is a known hot spot for Dengue Fever.

More useful information on Dengue Fever here, here, and here.

6 reactions:

Duke said...

ahh dengue!

a good friend of mine died of dengue a couple of years back and eversince then I realized how deadly dengue can be and that it should be taken seriously. Sometimes if you do not know the symptoms it is hard to distinguish whether you have dengue or just a recurring flu until the doctors starts giving you blood transfusion...

rolly said...

Does the dengue virus mutate just like the others? It doesn't seem like it from my POV based on the reports. Am I correct? Or am I totally wrong?

bayi said...

Many of my staff have been down with dengue at one time or other. From experience, most of the time the doctors were unable to confirm that one is suffering from dengue until a blood test is done. The symptoms are quite similar to some other ailments and suspecting one for dengue the first time symptoms of lethargy, pain in the joints, loss of appetite, etc. are detected may cause unnecessary alarm. This seems to be many of the doctors' view but I think not. By the time the pink rashes appear on the skin, it is a manifestation of hemorrahagic proportions and the condition is already serious. In Malaysia, those who die are usually those who discover their condition too late for supportive care to help mount a recovery.

The health authorities usually fog the surroundings of the patient's residence or work to prevent further cases. Health officers also check residences to see if there are places where mosquitoes breed and the house-owner can be fined up to about Php 500 for each instance of such lapses. The officers also conduct checks after office hours. People are also educated about the dangers of dengue via TV ads.

Dr. Emer said...

Duke: That's correct. That is why people have to be vigilant about dengue's signs and symptoms.

Tito Rolly: What does POV mean? It mutates but not as worrisome as that of the flu virus. What's more significant in Dengue are the closely related but distint serotypes. Read the full post, Tito. It's all there.

Bayi: Hello there, my friend. 'Glad to see you can comment again. The seasonal occurrence of DF/DHF might help in its diagnosis. It's in this time of year when levels of suspicion must be high on the part of the medical authorities. Any flu-like symptoms seen during this period is highly suspect unless proven otherwise. Thanks for sharing the Malaysian picture, Bayi. We almost have the same situation, being close neighbors.

Mec said...

POV is Point of View

at least we know that children cannot infect each other... the thing now to do is how do we get a nation, riddled with corruption and misplaced priorities, to address the issue of sanitation in the country...

jey said...

have you heard about the controversy at pcmc, a patient with dengue died apparently not from the disease, but from negligence of hospital staff?