Dengue fever: a lethal outbreak

[By Qurat ul ain Siddiqui]

DENGUE fever, known to health experts for more than 200 years and now turning into a health issue of epic proportions, used to be known as the break-bone fever because of the severe joint and muscle pains it caused which made the patient feel as if his/her bones were breaking.

Dengue isn’t really a novel phenomenon as far as South Asia is concerned, though it is an older one for Africa. More recently, India has also been severely affected by the virus with the death toll from dengue exceeding 100 (more than 30 dead in Delhi only) along with more than 5,000 people admitted to hospitals as “dengue-positive” patients. This initial outbreak eventually turned into an epidemic and it is now expected that the toll may exceed that of 1996 when it claimed more than 400 lives and left more than 10,000 people infected. A similar situation is also developing in Latin America and the Carribean. Cuba and the Dominican Republic are some of the more affected Latin American countries victimised by the infection with thousands of people contracting it (along with the ones suffering from dengue haemorrhagic fever or DHF) during the past few years. DHF is mostly a disease of the tropical and sub-tropical regions and even in those areas it is more likely to be found in the more densely populated places.

Dengue is commonly said to occur in two forms: as dengue fever and as dengue haemorrhagic fever. Dengue fever is an acute flu-like condition which affects people of all ages but is very seldom fatal. On the other hand, DHF is a more dangerous, even lethal form of dengue. The two are essentially forms of Viral Hemorrhagic Fevers (VHFs) – a group of illnesses that are caused by a distinct families of viruses, transmitted to humans by an infected female mosquito Aedes Aegypti, which is commonly known as the Yellow Fever Mosquito. It has the capability and the capacity to host various viruses such as the dengue fever virus (known as the arbovirus that is predominantly transmitted by mosquitoes and ticks), Chikungunya (a much rarer form of viral fever) virus and the yellow fever virus.

One must point out here that it is the mosquitoes that become infected with the virus when they bite infected humans. Oddly enough, this particular mosquito breeds only in clean water containers like barrels, buckets, drums, tanks, flower vases, water coolers, discarded tires, toilet bowls and other such places, including the ones where rainwater collects, which is a practice contrary to that of the malaria-causing mosquito that thrives and procreates in dingy waters.

Dengue is infectious, with the first symptoms occurring during initial five to seven days after being bitten by the infected Aedes Aegypti mosquito. It is characterised by a sudden onset of high fever accompanied by severe headaches, muscle and joint ache, nausea and vomiting as well as rashes. The dengue rash is usually bright red in colour, occurring initially on the lower limbs and the chest and in some cases which then spreads to most of the body. Some cases also involve loss of appetite and the ability to taste things. In certain severe cases, the Sindh Health Department advisory states that the patient may bleed from the mouth, nose, in the vomit or stool, as a result of internal or external bleeding. Symptoms, however, may not be the same for all cases as some cases develop milder indicators which can be misdiagnosed as flu or some other viral infection and later develop into a more serious, even deadly form of the disease. It is for this reason that people may pass on the disease unwittingly until someone with more conspicuous symptoms is discovered, said a local medical practitioner, though dengue patients are usually believed to spread the infection only through mosquitoes or blood products and that too as long as they are feverish.

However, all dengue patients undergo a progressive decrease in their blood platelet count which worsens the condition in cases where bleeding has already started and poses an imminent threat to the ones who aren’t already bleeding, but their condition might worsen. Since bleeding with the low platelet count takes a non-stop turn, an ample supply of platelets and blood is required which may not always be available everywhere all the time. Also, all dengue patients are required to get a blood test done every day to see if the platelets count is getting better.

According to the World Health Organisation (Who), DHF, a more acute form of dengue, has a five per cent mortality rate though this may increase if the cases are not properly handled and treated. On the other hand, with proper treatment and therapy mortality rates may be minimised. Also, according to a Who report, people at a higher risk for dengue transmission are children, travellers and tourists, whereas adults residing in endemic areas are also susceptible to contracting the disease.

There is no vaccine that can effectively and entirely cure dengue, though research is being conducted in this area with the use of biotechnology and genetic engineering. According to a Who document, “a live, attenuated, vaccine for all four types of dengue is now in clinical trials in Thailand,” which is where it was first recognised in the ’50s (along with Philippines) during dengue epidemics, whereas now it has spread to many Asian and Latin American regions.

The only effective and available way of controlling and eventually eliminating the disease is by destroying the mosquito breeding places along with effectively treating patients identified as carriers. These patients can at best be given plenty of fluids and measures should be taken to control their fever. With quick and careful treatment, most patients may survive without having to go through blood transfusion. As for the Aedes Aegypti’s breeding places, they can be eliminated by various means such as by tightly covering water storage containers, draining rainwater regularly and disposing off garbage. Even though the virus may survive without the host as well as within, precautionary measures are advised to be taken as seriously as possible, even required.

Karachi presently has, according to official estimates, more than 800 people suspected of being dengue-positive. About 100 new cases were reported last week in different hospitals of the city, whereas more than a hundred people have been discharged during the past few days. However, the average number of dengue case registration has gradually increased over the past few weeks and is still on the rise. One of the first reported deaths this year (in early October), however, was that of a man in his ’40s from Karachi’s Akhtar Colony.

It is hard to determine, let alone tell, who was the first infectee and from where it all started as far as Karachi is concerned, though a young doctor working at a local government hospital spoke of another doctor who died of DHF no less than six months ago, which indicates that the dengue that we see today is, possibly, no sudden phenomenon. It has been there for the past few months, though rather sporadic in its appearance.

A medical practitioner from Liaquat National Hospital, who requested anonymity, said that a terminal case of DHF was registered at this hospital about six months ago. The patient was rejected admission at another reputable hospital for the very reason that his condition had worsened to the point of incurability. Despite continuous insistence on the part of health experts and the provincial advisory issued with regard to DHF – not transferable from one person to another – the doctor is also of the opinion that DHF patients should be kept in quarantine instead of an open ward as droplets or any secretion from a dengue-positive’s body can infect another person. However, now that the city is dreading the growing dengue threat, hospitals are hopefully going to try and live up to their reputation and perform their duties in this seemingly precarious situation.

A medical operative at a local government hospital revealed (on condition of anonymity) that the doctors were not even properly briefed about handling the cases as they began to increase in number. She was also uncomfortable with the fact that dengue patients were not being kept in a separate ward. “In fact,” she said, “you can find dengue patients’ wards that deal or at least are supposed to deal with something entirely different.” When asked whether she thought the situation was turning into an epidemic, she felt that “it already has become one, and if not, then it will, because things don’t seem to be changing around here, and in that case we shouldn’t expect different results.” When asked about ways to prevent dengue from spreading further, she said that other than keeping and treating the dengue-positive patients in isolation, the city administration, apart from the “fumigation spree” that it is on these days, should also deal with the city’s sewerage system along with regularly checking up on abandoned construction sites as well as various potholes and dilapidated streets throughout the metropolis.

The virus, it appears, cannot be prevented from spreading and the dengue-infected mosquitoes from breeding if these aspects which, according to her, are in fact the problem, go unattended. “The dengue problem in Karachi, if considered with some insight, leads to a Pandora’s box which I don’t think anyone here would want to open,” she said.

Things have become better with regards to the diagnostic facilities available to the people. Earlier, it was only one other private hospital along with Liaquat National Hospital, that had the equipment for conducting diagnostic tests for dengue, whereas government hospitals would send blood samples of suspected infectees to the National Institute of Health, Islamabad, which took three to four days to send its report on the samples. However, the health department’s recent announcement that all patients hospitalised either at private or public hospitals can get their tests done at the Sindh Services Hospital, Blood transfusion Centre without charge, is a much desired development given the current crisis.

The government is trying to do its bit by assisting patients with laboratory facilities for diagnosis; however, the aerial and ground sprays that began a few days ago give more of an unorganized, helter-skelter picture and are not believed to be as effective as desired by various health experts around the city.

At the same time, the number of people wanting to be tested for dengue is gradually increasing; an indicator that the average Karachiite is taking the threat rather seriously. Paranoia, one may say, but it is not without good cause. A lab operative at a local private hospital informed that contrary to prior practice, tests can be administered without a medical prescription which was also one reason people would show up more frequently for a test. He informed that an average number of 20 people were getting tested every day, out of which 20-25 per cent would turn out to be carriers of the virus.

Many hospitals however portray a rather dismal picture when it comes to dealing with dengue. At one of the most crucial medical facilities in Karachi, the “information” section operative did not know whether the hospital housed a specific ward for dengue-positive patients, let alone for those suffering from DHF. This chaotic scenario was seen at a renowned medical facility which has admitted possibly the largest number of dengue cases in Karachi. Dengue-positive cases are also being identified in some areas of Punjab and, therefore, it is a matter of growing concern that it is gradually spreading to different parts of the country.

The use of biological weapons against certain groups of people comes as nothing new to the human world. The use of smallpox-contaminated blankets by the colonising British against the Native Americans and the Russian attack on Swedes with plague-infected corpses are examples. In the current context also, the spread of dengue fever is a cause for speculation and inquiry, considering that it spread extremely quickly. Who knows whether the disease known as dengue fever is an actual disease or just one of the many biological weapons that are being developed around the world.

The writer is a freelance contributor

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