An air of despondency has once again infiltrated Pakistani towns and cities, more so in the North-West. The August of 2017 saw five lives being lost to the deadly dengue fever. Hospital wards across Khyber Pakhtunkhwa (KP) province present a familiar setting, with dozens of patients admitted due to sudden-onset fever, body aches, rash and/or bleeding.
According to World Health Organisation (WHO), “since 2010, Pakistan has been experiencing an epidemic of dengue fever that has caused 16,580 confirmed cases and 257 deaths in Lahore and nearly 5000 cases and 60 deaths reported from the rest of the country.” These figures expose our inherent lack of capacity in tackling this preventable disease.
Dengue fever is an acute viral infection. The virus penetrates the human body when a bloodthirsty Aedes Aegypti mosquito, having characteristic white markings on its legs, takes its fateful blood meal. Interestingly, only the female mosquito population causes dengue fever while the males are incapable of even biting. The early signs of this mosquito, which has now become a perennial misery for thousands of people worldwide, can be traced back to 15th century Africa.
Usually, the first exposure of the human body to any virus results in the formation of antibodies, which not only fights off the current virus but also counters any subsequent viral attack. However, this natural defense mechanism falls short in case of dengue virus because it has four distinct variations (serotypes).
Infection with a single serotype results in what is known as simple dengue fever, which is free of hemorrhagic manifestations. With infection involving double serotypes, the tendency to hemorrhage increases and falls under the category of Dengue Hemorrhagic Fever (DHF). The third stage is Dengue Shock Syndrome (DSS) where most vital organs are damaged. Unfortunately, antibodies formed against one viral serotype are ineffective against the others.
Every year after enduring the sweltering Pakistani summer and relishing the pleasant rainfalls of monsoon, we are forced to face dengue outbreaks which unfortunately will always remain a distinct possibility as our homes, neighbourhoods, poor drainage system and potholes containing stagnant rain water provide ideal breeding grounds for this contagion.
The treatment modalities for dengue fever are quite limited and incorporate supportive measures like fluid replacement and use of Paracetamol for fever and body aches. Aspirin should be avoided as it might aggravate the risk of bleeding. Owing to the patient’s low platelet count, some physicians transfuse platelets but this strategy remains unsupported by evidence. Instead, packed red-blood cells or whole blood is recommended.
Prevention indubitably outweighs the narrow treatment spectrum. The two most effective preventive techniques include ‘wire gauze screening’ of windows and doors of buildings opening to the outside, and installation of ‘air curtains’ at entrances of public facilities like restaurants, malls, hospitals and offices to block the entry of mosquitoes.
Owing to our care-free lifestyle, practices such as sleeping under mosquito nets, using insect repellents, wearing clothes which fully cover the extremities, have not achieved the popularity they deserve. Properly covering drinking water containers and appropriate disposal of empty bottles and cans should be ensured, along with regular fogging of localities with insecticide spray. Besides dengue fever, these measures also help keep other diseases like Zika fever, yellow fever and Chikungunya at bay, which are transmitted by the same mosquito.
Every year after relishing the pleasant rainfalls of monsoon, we are forced to face dengue outbreaks — which unfortunately will always remain a distinct possibility, as our homes, neighborhoods, poor drainage system and potholes containing stagnant rain water and provide ideal breeding grounds for this contagion
Benefitting from the 2011 training program by an eleven member team of Sri Lankan experts, some progress with regards to the treatment of dengue has been made especially in Punjab province. Medical teams sent by Punjab government to KP will further enhance the efforts to counter dengue in the northwestern province. International researchers have focused their attention on the development of a vaccine named CYD-TDV, which is in clinical trials and may soon surface to the relief of many in Pakistan.
The writer is a full-time medical doctor and a part-time freelance writer based in Islamabad. He tweets @rajakhalidshab
Published in Daily Times, August 29th 2017.