Dengue Fever Prevention and Cure.
Although I am not a doctor but based of my experience in the field of medical health insurance some literature review and interaction with some patients I feel to highlight some useful information for the public awareness about Dengue Fever. Dengue Fever is a disease caused by viruses that are transmitted to people by mosquitoes. Dengue Fever causes high grade fever (about 104 F-105 F) skin rashes severe headache muscle and joint pains. Unfortunately the disease occurrence seems to be increasing due to several factors:
Due to increased urban crowding with more sites for mosquitoes to develop
Travelers who carry the disease to areas where mosquitoes have not been previously infected
Local and world environmental changes that allow mosquitoes to survive in the winter months
History and Statistics:
It is one of the leading causes of death in Pakistan as well as in the world. Dengue fever is estimated by the WHO (World Health Organization) to cause about 50-100 million infections per year worldwide. Dengue is common in Pakistan with its usual peak occurrence in the post monsoon season. In children under 16 years of age it was reported for the first time in Pakistan as an undifferentiated fever in year 1985. During 1995 in Hubb Baluchistan 75 cases and 57 deaths were reported. In 2003 Dengue occurred in Haripur in which 1000 patients were infected and 7 deaths registered. The same year in Khushab Nowshera 2500 cases reported and 11 died. In 2004 only 25 cases were reported from Islamabad and Karachi. In 2005 Karachi witnessed death of 13 patients out of 500 cases. In 2006 dengue was reported from Karachi Sukkar Nawabshah Rawalpindi and Islamabad with about 5400 cases and 55 deaths.
In 2007 Karachi Hyderabad Mirpurkhas Lahore Haripur Rawalpindi and Islamabad were affected resulting in 24 deaths out of 2700 reported cases. In 2008 Lahore got 1800 positive cases. In 2009 overall 570 cases were reported. In 2010 5000 positive cases were documented. Study conducted in Lahore Sheikhpura and Gujranwala on 320 patients while in federal capital Islamabad 35 cases with one death reported. In Khyber Pakhtunkhwah 25 cases and 3 deaths and in Azad Jammu Kashmir 5 cases were reported. In 2011 Pakistan had the worst strike of dengue in which more than 20000 cases and 300 deaths were reported officially which according to experts reflect under reporting. Lahore was the epicenter with maximum number of cases followed by Faisalabad Rawalpindi and Sargodha. In Karachi Sindh 196 cases were reported. (Ref: Journal of the Dow University of Health Sciences Karachi 2011 Vol. 5)
Symptoms of Dengue Fever:
The symptoms of dengue begin about three to 15 days after a mosquito bite. It transfers a virus to a person earlier unexposed to the viruses. Fever pain in muscles and joint aches can occur during the first few hours of symptoms when headache chills rash and swollen lymph nodes first appear. Pain behind the eyes is also a common symptom. These symptoms usually last about two to four days and then reduced only to reappear again with a rash that covers the body and spares the face. The rash also may occur on the palms of the hands and the bottom of the feet. The symptoms may last about one to two weeks with complete recovery. However some people can develop more severe symptoms and complications such as hemorrhagic areas in the skin gums and the gastrointestinal tract. This clinical problem is called dengue hemorrhagic fever (DHF). The majority of DHF is seen in children under the age of 15 years but it can occur in adults.
Another clinical variation of dengue fever is termed dengue shock syndrome (DSS); DHF usually precedes DSS. The patients eventually develop severe abdominal pain heavy bleeding and blood pressure drops; this syndrome if not treated quickly may cause death.
Causes of Dengue Fever:
Four closely related viruses cause dengue fever. The viruses are transmitted from Aedes aegypti and Aedes albopictus mosquitoes to humans in a viral cycle that requires both humans and these mosquitoes. There is no human-to-human dengue fever transmission. Once a mosquito is infected it remains infected for its life span. A human can infect mosquitoes when the human has a high number of viruses in the blood (right before symptoms develop).
Diagnosis of Dengue Fever:
Dengue Fever is diagnosed by a medical practitioner by the relatively specific sequence of high fever rash appearance and other symptoms in a person who has a history of recent travel to dengue endemic areas and recalls mosquito bites while in the endemic area. However if not all of the symptoms or history is complete; the medical practitioner is likely to take a number of tests to obtain a definitive diagnosis. Other diseases may yield similar symptoms (i.e. typhoid fever yellow fever scarlet fever meningococcemia and several others) if the patient has severe symptoms; or if the medical practitioner does not have enough information to make a presumptive diagnosis the patient is likely to undergo a number of other tests (i.e. CBC Dengue IgM Antibody Dengue IgG Antibody and PCR etc.) to definitively distinguish dengue fever from other diseases.
In general the more serious the symptoms such as fevers at or above 104 F hemorrhages or shock syndrome the more tests are likely to be done.
Treatment of Dengue Fever:
This viral disease is usually self- limited and usually adequate hydration and pain control will help the person through the infection. However for dengue fever a caution is given by most doctors in home treatment. Nonsteroidal anti- inflammatory agents (i.e. Aspirin Ibuprofen and other NSAIDs) should be avoided because of the tendency of the dengue viruses to cause hemorrhages. The NSAIDs may add to the hemorrhage symptoms. Other medications such as Acetaminophen (Tylenol) codeine or other medicines that are not NSAIDs may be used. More severe conditions of dengue fever (hemorrhagic and shock syndrome) usually require hospitalization. IV hydration Isolation blood transfusions platelet transfusions blood pressure support and other intensive-care measures may need to be utilized in these patients.
Prevention of Dengue Fever:
Dengue fever can be prevented by stopping mosquitoes from biting because they are the vectors the dengue viruses require for transfer to humans.
We can minimize areas of exposed skin by wearing long-sleeved shirts long pants boots and hats. Tucking in shirts and wearing socks and closed shoes instead of sandals may reduce dengue fever's risk. Mosquito repellents (i.e. Mospel Mortien Mosquit etc.) can be used for added protection.
When accommodations are not adequately screened or air conditioned bed nets are essential to provide protection and to reduce discomfort caused by biting insects. Bed nets are most effective when they are treated with an insecticide or repellent.
Aerosol insecticides vaporizing mats and mosquito coils can help to clear rooms or areas of mosquitoes. Insecticides should always be used with caution avoiding direct inhalation of spray or smoke.
Cover all water tanks barrels and storage container with tightly fitted covers or with wire mesh. Flower pots saucers and vases should be emptied and scrubbed at least once a week to destroy mosquito eggs. Eggs can hatch into larvae in 3-6 days. Cut down all bushes and clear overgrown lots that can hinder mosquitoes.
Aedes mosquitoes typically live indoors and are often found in dark cool places such as in closets under beds behind curtains and in bathrooms. The risk of being bitten is highest during early morning several hours after daybreak and in the late afternoon before sunset. However mosquitoes may feed at any time during the day.
As per my findings the awareness among general public about Dengue Fever is insufficient and people should be given awareness about Dengue Fever prevention risk factors importance of medical checkup for early detection of Dengue Fever and availability of treatment in Pakistan. Dengue Fever awareness programs are needed especially for rural population through electronic and print media (TV Newspapers Literatures and Social Media) health / medical insurers and hospitals. Ministry of Health must play its active role in prevention of Dengue Fever from Pakistan. Although Department of Health Government of Punjab has made SOPs for Prevention and Control of Dengue but proper implementation is required because Punjab Province is mostly affected by Dengue Fever in past years. Tests for Dengue Fever should be available free of cost nearer in the urban and rural basic health centers and it should be compulsory for the people to undergo those tests on regular bases.