Dengue Fever

Dengue Fever

Health

Dengue is a virus that is transmitted via mosquito bites resulting in either a mild dengue fever or hemorrhagic fever. Mild dengue fever is accompanied by development of rashes and muscle and joint pain. Hemorrhagic fever results in severe bleeding, sudden drop in blood pressure and if not treated, death.

These mosquitoes thrive in areas with standing water, including puddles, water tanks, containers and old tires. Lack of reliable sanitation and regular garbage collection also contribute to the spread of the mosquitoes.

Dengue is a viral infection caused by four types of viruses (DENV-1, DENV-2, DENV-3, DENV-4) belonging to the Flaviviridae family.

Image Source: The Daily Star

Risk

Risk of Dengue exists in tropical and subtropical areas of Central America, South America, Africa, Asia, and Oceania. All travelers are at risk during outbreaks. Long-term traveler’s and humanitarian workers going to areas where Dengue is endemic are at higher risk. Dengue occurs in urban and suburban settings with higher transmission rates happening during the rainy season.

Symptoms

Early symptoms for dengue are similar to flu or malaria and may include:

  • Sudden and high fever
  • Headaches
  • Muscle and joint pain
  • Pain behind the eyes
  • Nausea and vomiting
  • Rash

In case of hemorrhagic fever, these symptoms worsen to include

  • Rapid breathing
  • Bleeding gums
  • Persistent vomiting
  • Abdominal pain

Dengue is related to Zika Virus, Yellow Fever, West Nile Virus, and Japanese Encephalitis. It can be misdiagnosed for Chikungunya, Zika Virus, or Yellow Fever.

Image Source: International Global Health

Tests and diagnosis

Dengue is primarily diagnosed by a blood test to detect for strains of the virus in your bloodstream. Due to its similarity in symptoms with other diseases such as malaria, dengue is usually difficult to diagnose early.

Treatment and Services

There is no direct treatment for dengue. Initial measures include bed rest and high intake of fluids to counteract dehydration from vomiting. Normal painkillers such as aspirin are to be avoided as they lead to complications. Acetaminophen may be taken instead to reduce fever and decrease muscle pain. In severe cases of dengue fever you may require supportive care at the hospital where you will be monitored for:

  • Dehydration and replacement of electrolytes
  • Platelets count and transfusion in case of blood loss
  • Blood pressure monitoring

Prevention

Traveler’s should take meticulous measures to prevent mosquito bites during the daytime.

  • Use a repellent containing 20%-30% DEET or 20% Picaridin on exposed skin. Re-apply according to manufacturer’s directions.
  • Wear neutral-colored (beige, light grey) clothing. If possible, wear long-sleeved, breathable garments.
  • If available, pre-soak or spray outer layer clothing and gear with permethrin.
  • Get rid of water containers around dwellings and ensure that door and window screens work properly.
  • Apply sunscreen first followed by the repellent (preferably 20 minutes later).

A vaccine is available for people living in some Dengue endemic countries, but is not commercially available for travelers.

Dengue Virus History

Dengue is the most common mosquito-borne viral disease in the Americas and the most suspected in patients with fever. However, the recent introduction of two new arboviral diseases (chikungunya virus in late 2013 and Zika virus in 2014) has created a new challenge for public health in the Americas. The three arboviral diseases (dengue, chikungunya, and Zika) can produce very similar clinical symptoms, mainly during the acute phase (the first days of the disease), hindering clinical diagnosis by health workers, creating problems for appropriate case management, and sometimes triggering fatal events. Serological diagnosis has presented further difficulties, due to the cross-reaction between IgM/IgG antibodies of the dengue and Zika viruses, complicating laboratory confirmation and compromising epidemiological surveillance.

Dengue Virus In Pakistan

Dengue fever is an important infectious disease in Pakistan with increasingly frequent epidemics. Despite the efforts of the Government of Pakistan, especially in Punjab, the high cost of prevention has limited the ability of Pakistan to control epidemics. In Pakistan, in the summer of 2011, more than 300 people died of Dengue fever. The prevalence of the disease was over 14,000. The outbreaks occurred mostly in the Lahore area, Punjab, Pakistan.

2011 epidemic

Morbidity and mortality

In November 2010, more than 21,204 people were diagnosed with dengue fever. Those infected were mainly from Punjab, Pakistan. Patients were admitted to dedicated wards in government hospitals. The severity of the epidemic was greatest in Lahore.

The secretary of the Punjab Mineral Development Corporation, Ataullah Siddiqui and Ghiasuddin, a member of the Punjab Public Service Commission died as a result of the dengue fever. On 30 September 2011, the Punjab MPA Mumtaz Jajja also died of dengue fever. Eight Chinese engineers were taken ill.

International response

In 2011, the Government of Sri Lanka gave medicines and staff to Punjab. A group of 12 doctors from Sri Lanka came to Lahore to assist. The Indonesian government dispatched a medical team of twenty to assist the Pakistani authorities. The World Health Organization provided technical guidance along with support for provincial and territorial dengue monitoring and coordination committees.

WHO support to Pakistan on dengue fever?

The WHO country office in Pakistan is providing technical support to the Government of Pakistan in its response to the epidemic of dengue fever. The current epidemic has caused to date 16 580 confirmed cases and 257 deaths in Lahore and nearly 5000 cases and 60 deaths reported from the rest of the country.

WHO provides technical support, guidelines and capacity-building for planning and implementation in all three areas of prevention and control of dengue fever: vector control, case management and community awareness? This support is being provided to all three provinces facing the epidemic, namely Khyber Pakhtunkhwa, Punjab and Sindh.

WHO is fully committed to improving the health of the population of Pakistan? It will continue in its efforts to assist Pakistan’s dengue response by providing situation analysis, guidelines for quality-assured interventions and capacity-building for health planners and care providers at all levels and in all provinces in Pakistan.

An estimated 400 million dengue infections occur worldwide each year, with about 96 million resulting in illness. Most cases occur in tropical areas of the world, with the greatest risk occurring in:

  • The Indian subcontinent
  • Southeast Asia
  • Southern China
  • Taiwan
  • The Pacific Islands
  • The Caribbean (except Cuba and the Cayman Islands)
  • Mexico
  • Africa
  • Central and South America (except Chile, Paraguay, and Argentina)
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