Pakistan Issues Dengue Fever (DF) in Pakistan

Dengue Fever (DF) in Pakistan

Dengue is a widespread mosquito-borne infection in human beings,
which in recent years has become a major international public health concern. Symptomatic dengue virus infections can present with a wide range of clinical manifestations, from a mild febrile illness to a life-threatening shock syndrome. Both viral and host factors are thought to contribute to the manifestations of disease in each infected. It is important to understand its burden on health care, morbidity and mortality. Early diagnosis and suspicion of DF in primary care might reduce the complications if handled properly. We must understand the depth of the problem in terms of its transmission, clinical presentation, diagnosis, management and prevention.

Protection from Dangi Virus

With the arrival of the monsoon season, the dengue virus has also returned with a vengeance. In fact, stagnant water, which accumulates in plenty during the rainy season, offers a breeding ground for this particular type of the mosquito. It is especially active around dawn and sunset. The situation becomes more alarming owing to poor sewerage system and the laidback attitude of WASA to remove garbage heaps and fix leaking water supply pipes. Reportedly, 526 cases of dengue patients have been confirmed in Punjab alone, out of them 466 happen to be from Lahore, which of course shows the lack of precautionary measures. It is some relief to know that special isolation wards have been set up in hospitals and vaccines ordered. Although the vaccine does not completely cure the patient, they reduce the chances of death. The only precaution is regularly spraying pools of waters around public places and residential areas. This is something that the provincial government has been found wanting. Last year, we had seen that not much precaution was taken as a result of which, many people had fallen prey to dengue and many had to lose their lives. It has also been observed that while spray squads are sometimes active in elite localities, they are nowhere to be seen in less developed areas. The virus must be controlled before it gets out of control.

Dengue Fever Symptoms:

After being bitten by a mosquito carrying the virus, the incubation period ranges from three to 15 (usually five to eight) days before the signs and symptoms of dengue appear in stages. Dengue Fever starts with:

• chills,
• headache,
• pain upon moving the eyes,
• and low backache.
• Painful aching in the legs and joints occurs during the first hours of illness.
• The temperature rises quickly as high as 104 F (40 C), with relatively low heart rate (bradycardia) and low blood pressure(hypotension).
• The eyes become reddened.
• A flushing or pale pink rash comes over the face and then disappears.
• The glands (lymph nodes) in the neck and groin are often swollen.
• A characteristic rash appears along with the fever and spreads from the extremities to cover the entire body except the face.
• The palms and soles may be bright red and swollen.
• Fever and other signs of dengue last for two to four days, followed by a rapid drop in body temperature (defervescence) with profuse sweating. A second rapid rise in temperature follows.

Because dengue fever is caused by a virus, there is no specific medicine or antibiotic to treat it. Also, there is currently no vaccine available for dengue fever.

The prevention of dengue fever requires control or eradication of the mosquitoes that are carrying the virus that causes dengue.

Expansion of Epidemic Dengue Viral Infections in Pakistan

In Pakistan, an outbreak of DHF was first reported in Karachi in 1994. From September through December 2005, at least 3 major hospitals in Karachi had a sudden increase in the number of patients with signs consistent with that of Dengue Viral Infections.

Today the Epidemic of Dengue Viral Infections has spread severely throughout the country. According to Dr. Javed Akram, the Head of Jinnah Hospital Lahore and chairman of dengue expert committee: Until date, officially more than 3,500 people have been infected and over a dozen have died from the recent dengue virus in Pakistan outbreaks

“These are the official figures but I think the number of unreported dengue patients is more than 500, 000.”

This recent outbreak of dengue fever in Pakistan confirmed the presence of all four types of dengue viral infections in Pakistan. Two of these were reported in previous outbreaks in Karachi city, while a third has been reported in the Lahore outbreak of 2008. Now all four types of dengue serotypes have been confirmed in Punjab.

Hospitals Dealing with Dengue Viral Infections in Pakistan:

Heavy monsoon rains in Punjab has provided ideal conditions for dengue-carrying mosquitoes to thrive in stagnant waters. The number of Dengue Patients is constantly increasing. Seven patients lost their lives on 15th September 2011, while 5,500 Dengue cases have been confirmed in Punjab only. Out of 29 people who died of Dengue in Punjab, 25 were from Lahore, Geo News reported Friday, 16th September 2011.

According to District Health Officer Dr Khalid Randhawa, there are more than 30 private hospitals in the city. He said the number of private clinics with 20 beds was over 1,000.

Dr Farooqi said the government hospitals had accepted the challenge to cope with the situation but in case of increase in the number of patients, the services of private hospitals would be utilised. He said private hospitals would treat the dengue patients free of cost.

Ahmed Medical Complex, Sadiqabad, and Aziz Nursing Home had offered 30 beds each. While other hospitals including: Bilal Medical Centre offered 15 beds, Social Security Hospital 100 beds, Railway Hospital 16 beds and Islamabad International Medical College Hospital set aside 10 beds for the investigation and treatment of dengue patients.

Dengue Fever Treatment Costs:

A 15 days treatment of Dengue fever in Pakistani Hospitals can cost you around Rs. 102000. One mega unit of platelets, provided free at the public sector hospitals, costs Rs 15,000 to Rs 20,000 at private clinics.

Transfusion of more than one unit further increases the expenses of a private patient. Treatment of a dengue patient at a private hospital costs from Rs 50,000 to Rs 1 million depending upon the number of platelets kits.

Prevention of Dengue Viral Infections:

Dr. Akram stressed the need of an integrated vector control strategy. He said that mosquito sprays are not sufficient as we need a multiple approach for mosquito eradication, such as biological control, Larvicide, mass awareness, quarantine for patients and travel advisory. Guppy fishes are the best agent for the biological control of dengue mosquito.

There is also a need for larger clinical studies in Pakistan and other South Asian to better understand the range of infections, endemic patterns and genetic susceptibility of different populations to the dengue virus.