A Report On Dengue Fever

Introduction

Dengue is a Spanish word which means “fastidious”, it is derived from “dinga” which means an evil of spirit. Dengue is a viral disease which is caused by the biting of a female mosquito Adese Aegypti. The causative agent of dengue fever is the dengue virus which is an enveloped single stranded RNA virus belongs to the family Flaviviridae. It was first recognized in mid-nineties and now it is wide spread in Asia, mainly in India and Pakistan and is causing a great number of deaths in some regions.

Classification

Dengue virus is classified into four serotypes:

• DEN-1
• DEN-2
• DEN 3
• DEN-4

The antigenically intent but closely related serotypes of dengue show 65% to 70% sequence homology. Each serotype has got different genotype exhibiting comprehensive genetic variability which causes difficulty in vaccine development against all four dengue serotypes. Recovery of dengue infection by one serotype provides long life immunity against selective serotype while cross immunity to the other dengue serotype is temporary. Re-infection of dengue with new serotype can show great risk of developing dengue hemorrhagic due to antibody dependent enhancement, a phenomenon in which virus-specific antibodies strengthen the entry of virus.

Transmission

• The dengue virus is injected in the humans through the bite of mosquitoes. It mainly lives in clean and clear stagnant water and breeds on it. Its biting time is usually dawn and before dusk. It can be found in plants and dark areas as well.
• Infected humans are also the carrier of dengue virus, serving as the source of virus for uninfected mosquitoes.

Symptoms

• Dengue fever is a flu like illness which can cause high fever up to 104° Centigrade.
• Severe headache, pain in joints and muscles, behind the eyes and lower back.
• Nausea, vomiting and rashes on the skin.
• Severe itching on body.
• Rapid decline in blood platelets.
• Severe dengue causes respiratory problems and bleeding.

Symptoms usually last for 6 to 8 days if the patient is treated well he can easily get cured but critical stage of it can be lethal and has the risk of death.

Diagnosis

Dengue diagnosis is redly a challenging matter for any physician because most of its symptoms are similar to other disease such as malaria, rubella, leptospirosis etc. Incorrect and missed diagnosis is the major problem in dengue diagnosis. Atypical clinical appearance of dengue, use of tourniquet test by physicians leads to incorrect dengue diagnosis.

Treatment

• There exist no specific treatment for dengue fever and no such medicine has ever designed to cure this disease but pain relievers with no aspirin can be used as per the direction and recommendation of doctor.
• A very effective natural remedy is drinking papaya leaf juice. Papaya leaves are known to be the natural cure for dengue fever. The leaves have a mix of nutrients and organic compounds which prove helpful in increasing blood platelet count. Papaya leaves also have a high level of vitamin C which stimulate the immune system whereas the antioxidants help in reducing the stress and remove toxins from the body. All you need to do is crush the leaves and stain the juice from the crushed leaves.
• Drinking plenty of water helps a lot. Staying hydrated also reduces the symptoms of headaches, as well as muscle cramps.
• Chew basil leaves. Five, six basil leaves boosts body’s immunity and has been recommended as an effective treatment for dengue fever.
• Citrus juices contain Vitamin C that help in treating the symptoms of Dengue fever by producing antibodies in the body’s immune system, releasing toxins by frequent urination.

Dengue in Pakistan

Dengue was first introduced in Pakistan at Karachi sea port through the importation of tires containing eggs of infected mosquitoes. Dengue is endemic in Pakistan in the post monsoon period for many years and several outbreaks have been reported from Pakistan. The four different serotypes caused disease independently, in different areas of Pakistan, till date. Karachi and Lahore were the main victims of dengue fever and almost all the serotypes caused mini and major outbreaks in both cities.

Dengue being Epidemic in Pakistan: Pakistan is dengue endemic since 1994, and now dengue becomes a public health concern in Pakistan. From 1994 dengue cases have been reported but from 2006, Pakistan faced the worst condition regarding dengue in which thousands of people affected by the disease and hundreds of people lost their lives. In Pakistan there are many factors involved in spread of dengue epidemics. The most important factor is the favorable climate, as the climate of Pakistan is most favorable to the mosquito especially in the post monsoon period in which hot and humid both conditions are available. The increase in temperature is supportive for the female mosquito.

Another component is the unregulated and unplanned urbanization which provide intense breeding sites to female mosquito due to incapability of environmental sanitation to cop up with the plethora of waste containers. Other factors as improper sanitation facilities, over population, lack of fresh drinking water, inadequate mosquito control, air traveling, poor socioeconomic conditions, absence of public health support and awareness related to health effects are all play crucial role in dengue outbreaks.

Dengue Today in Pakistan

“As many as 9,000 dengue cases have been reported from across the country, while 16 people lost their lives during the current year. Twin cities of Islamabad and Rawalpindi have been badly hit by the disease, while 43 cases were notified in Punjab from other provinces. Chief of Disease Surveillance Division at the National Institute of Health (NIH) Dr. Rana Safdar said that within Rawalpindi, clustering of cases had been observed in Airport Housing Society, Gulzar e Quaid Scheme, Wakeel Colony, Dhoke Munshi and Kot Jabbi, while in Islamabad cases were reported from Mohra Nagial and UC Kirpa”.

A Comparison: Comparing current year from the past few years, a massive in increase in number of patients of dengue fever has been reported. This represents a poor management of epidemic control by current government as compared to the previous government who considered this epidemic a serious factor for the state and did their best in managing it as can be seen in year 2012.

Prevention: Control of vector borne diseases including dengue is very challenging in Pakistan due to lack of trained entomologist. By implementing following steps, dengue prevention can be better in future.

At Individual level:

• The best way to prevent the disease is to prevent bites by infected mosquitoes.
• Use mosquito repellents, outdoors as well as indoors.
• When outdoors, wear full sleeved shirts and long pants which should be tucked into socks to leave a very little chance for mosquitoes to bite.
• When indoors, use air conditioning if available as it also help the environment to become mosquito free.
• Make sure windows and door screens are secure and free of holes. If sleeping areas are not screened or air conditioned, sleep inside mosquito nets.
• Get rid of places where mosquitoes can breed. These include old tires, cans, or flower pots that collect rain water, directly.
• If someone gets dengue fever, be vigilant about efforts to protect yourself from mosquitoes. As mosquitoes that bite the infected person could spread the infection to others as well.

At Public and Government Level:

• In Pakistan, poor health care system may be responsible for high mortality rate from dengue in previous years. The rate of mortality can be decreased by implementing timely and appropriate clinical management, which involves early clinical and laboratory diagnosis, intravenous rehydration, staff training and hospital reorganization.
• Health Ministry of Government of Pakistan should plan health promotion campaigns for spreading awareness in community to eliminate the breeding sites of mosquitoes. Improved hygienic practices, use of personal protective measures, encourage using of larvicides, surrounding cleanliness and treatment of undesired stagnant water should be the objectives of on spot awareness campaigns.
• The crucial part of dengue prevention is the environmental management and it remains applicable where dengue is endemic. Environmental management refers to the modifications in environment to reduce man-vector contact and consequent transmission hazard. Solid waste management, source reduction, unproved and proper water supply system, proper drainage system, covering of domestic water-storage containers, cleaning of flower vases and recycling of old tyres all are included in environmental management.
• Environmental management should be unproved by government to control dengue. Sanitation is the major issue in Pakistan and government should focus on street cleaning, better drainage system and removal of stagnant water.
• Prior to dengue transmission and during outbreak, cleaning and other public hygienic campaigns should be organized on regular basis in all community settings.
• Chemical control is one of the key components in dengue prevention. Dengue vector can be controlled chemically by using larvicides and space sprays.

An idea to root out dengue. Vaccines are the most effective tool to control infectious diseases. A secure, efficient and inexpensive dengue vaccine against all dengue serotypes would characterize a major advancement in dengue control. Pakistan has neither vaccine development program nor any international vaccine get authorization yet. So working on this idea will arise positive results and environment where no more fear of deaths by dengue will exist.