Wednesday 21 September 2011

Sri Lankan experts give serious advice on dengue


Sri Lankan experts give serious advice on dengue
 
ISLAMABAD: Amid mounting deaths caused by dengue fever, a team of Sri Lankan experts, specialized in treating and controlling the disease, says fumigation, being done officially or unofficially, can help overcome the spread of ailment by just 15 per cent while preventive measures taken by the community at homes can defeat it by 85 per cent.
They have told worried Chief Minister Shahbaz Sharif that the dengue fever was basically a "domestic problem" that citizens would have to deal with. "If clean water is kept uncovered at homes, the disease cannot be curbed," one of them said.
The team comprises doctors, clinical experts, epidemiologist, physicians and communication specialists that is visiting Pakistan on the invitation of the Punjab government to make suggestions on treating and controlling the dengue fever as Sri Lanka has an excellent experience of defeating it.
The experts said Sri Lanka has successfully grappled with the disease over the past thirty years mainly by creating 100% public awareness. Additionally, it has introduced legislation that penalizes citizens who do not implement precautionary measures in their homes.
They said that the incidence of tremendous drop of platelets in patients struck by the dengue fever is highly negligible, just 0.12 %, and prompt making up of the deficiency is at times counter-productive. The experts said that Sri Lanka treated at least 35,000 dengue fever patients in 2009. Of them, there were only 350 deaths.
They explained that patients were afflicted by dengue fever or dengue hemorrhage fever. They said that the panic created in Pakistan has led to most deaths because some affected who are already suffering from diabetes or heart problems can't physically and psychologically bear the pressure of the disease and collapse having cardiac arrest. The experts said that the ratio of those hit by dengue hemorrhage fever, which was very serious disease, was just 0.1 percent. They said that the best treatment for the dengue fever patient was to keep checking his or her temperature for three days and then treat him by the use of only Paracetamol in the next ten days to make him recover from the disease.
The experts said that last year Sri Lanka had 3,500 such patients but only one died. They said that hospitals were meant to treat many more serious patients, who deserved immediate attention.
They said fumigation could not be very helpful because the disease spreads from homes. He said that in Sri Lanka public awareness has been achieved by 95 % and the rest of the 5 % are prosecuted and jailed for not adhering to the law.
The experts said that even if a small minority of citizens did not take precautionary measures at their residence, several others living in the neighbourhood are affected. The Sri Lanka team told the chief minister that it would stay in Pakistan till the time the problem was overcome. It said that it would carry out tests of all water triggering dengue fever. An official, who was present in the briefing, said that the Sri Lanka experts were also taking preventive measures to avoid the disease because they were tremendously exposed.
End.


Your Guide to Dengue Fever




Dengue Fever is a major global health threat and a leading cause of mortality in the tropics and subtropics. It is caused by infection with any one of four serotypes of dengue virus transmitted by the bite of the Aedes mosquito. This mosquito species breeds around habitations and feeds during the day. As many as 100 million people are infected annually, of which about 25,000 die of the disease.

Presentation

Once inoculated into the human body, dengue has an incubation period (during which the virus multiplies) of 3-14 days. Thereafter, in the typical form of the disease, a five- to seven-day acute fever ensues. Recovery is usually complete by 7-10 days.
It is important to appreciate that about half of all dengue infections go completely unnoticed. Some patients have isolated fever while others may produce the typical symptom complex of classic dengue fever (DF). Fever may be as high as 106°F. The fever presents in a nonspecific manner and may not be distinguishable from other infectious illnesses. The fever in DF is often preceded by chills, red speckles on the skin, and facial flushing. It typically begins on the third day of symptoms and lasts five to seven days. The other symptoms associated with DF include headache, which is usually generalised, pain in the back of the eye, nausea or vomiting and a rash that begins on day three and persists for about three days. DF can also be associated with muscle aches, joint pains and generalised fatigue. Abdominal pain when present can be a heralding sign of a more serious form of the disease, known as dengue hemorrhagic fever (DHF).
DHF is characterised by bleeding. This may be as mild as small amounts of oozing from the nose or gums or serious enough to present with copious bloody vomiting, an abnormally heavy period or excessive blood in the stool. Abdominal pain, excessive restlessness, confusion, decrease in body temperature, and a drop in the platelet count are indicators of imminent DHF.
Patients who have previously had DF (over half of which go unnoticed) are specifically at risk for development of DHF. It is also important to keep in mind that it is at the time when the fever is receding that DF patients are at greatest risk for DHF. This is the time to watch for the warning signs mentioned above and seek emergency care. If not properly taken care of, DHF complications (particularly gastrointestinal bleeding) can worsen and induce shock. This most severe and fatal form of dengue is known as Dengue Shock Syndrome (DSS). DSS is characterised by cold-clammy skin, a fast heart rate, decreased blood pressure, delirium, difficulty breathing and damage to the internal organs specifically the liver and kidney. DSS can lead to multiorgan failure and death.

Outcome

Most patients achieve a complete recovery from dengue. Even patients with DHF and DSS usually recover with proper resuscitation. Infection with one dengue serotype confers lifelong immunity against that particular serotype, but still leaves the individual susceptible to the other three serotypes. As mentioned above, a subsequent infection by a different serotype is a major risk factor for the development of DHF and, as a result, DSS.

Prevention

No vaccine is currently available to prevent contracting the dengue virus. Consequently, the most effective protective measures are those that avoid mosquito bites. Repellants and protective clothing are simple effective measures to take. Even better, eliminate mosquito breeding grounds: ensure no water is left standing in flower vases, old tires, etc. Since the Aedes is a day-biting mosquito, mosquito nets are not useful. (Read about some alternative solutions to protecting your home here.)

Diagnosis

DF is diagnosed clinically, based on the patient’s presenting symptoms and signs. A complete blood count might reveal a low white cell and platelet count. Serological testing and PCR are not only very costly but are unhelpful in the initial stages of the disease.

Treatment

Dengue fever is usually a self-limited illness, and only supportive care is required. No specific antiviral medication currently is available to treat dengue infections. Paracetamol should be used to manage the fever. Other agents including aspirin should be avoided, especially in children.
Patients may become dehydrated from fever, vomiting or lack of adequate dietary intake. Patients who are able to tolerate oral fluids should be encouraged to drink oral rehydration solution, fruit juice or water to prevent dehydration. Patients should also have their blood counts measured daily from the third day of illness until one to two days after the fever abates.
Patients who improve can continue to be monitored in an outpatient setting. Patients who do not improve should be admitted to specialised camps or a hospital for hydration. Patients with dengue shock syndrome are treated in intensive care units.
No specific diet is necessary for patients with dengue fever. Bed rest is advised.
When the patient’s fever is going away, watch for the warning signs mentioned above (taken from the CDC site here). If any of them appear, take the patient to the Emergency department of your nearest hospital immediately.

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