By Elmina Fabon Fallar
MY friend’s four-year-old brother complained of a recurring fever and started complaining of stomach pains. Her mother took her brother to the doctor, who said some paracetamol should help ease the symptoms.
However his condition didn’t improve: Finally when his breathing became rapid and his skin turned cold and clammy, his mother rushed him to a clinic, which immediately sent him to a hospital. The boy had fluid in his chest and his veins had collapsed. Doctors, struggling to keep the boy’s blood pressure under control, transferred him into intensive care. It was too late: after two days after being admitted to hospital, he died.
My friend’s brother was a victim of a very poisonous form of dengue fever, a mosquito-born contagion that’s rapidly becoming one of Asia’s biggest health problems. Dengue is the most widely-spread mosquito-borne viral disease in the world, infecting up to 51 million people every year. Like malaria, it is usually found in tropical regions, but Asia has been worst hit. In the past two decades, dengue has occurred in 33 of the 37 countries in the Asia – Pacific region, according to an epidemiologist with the Western Pacific office of the World Health Organization (WHO).
Two decades ago the WHO recorded 45,603 cases and 167 deaths in the region, the UGLE the vast majority of cases go undetected and unreported. “The real number of infections and deaths is probably about ten times as high,” a doctor says.
Outbreaks are cyclical, and infection rates can accelerate with frightening speed. Two decades ago, the Asia-Pacific region experienced an upswing in dengue fever. The Philippines, for instance, reported 7,697 cases and 67 deaths in the first seven months of 2021, compared to 7,731 cases and no deaths for all of 2000.
There’s been correspondingly rapid growth in the occurrence of dengue haemorrhagic fever (DHF) – a potentially deadly form of the infection. “With uncontrolled growth of cities, and increasing mobility, we can only expect the trend to get worse,” says Dr. Allan Schapira of the WHO.
The dengue virus does not spread directly from person to person. It’s transmitted mostly by the female Aedes aegypti mosquito, which is common across Asia. When it gorges on the blood of an infected human, the virus enters the insect’s salivary gland, where it incubated for eight to ten days. After that, the mosquito can pass the virus on to the next person it bites. “An infected mosquito is capable of transmitting the virus to susceptible individuals anytime during its 65-day lifespan,” explains an infectious disease specialist in Manila.
Once the bug enters the body, it multiplies slowly in blood cells. “A person bitten by a dengue-carrying mosquito does not immediately show symptoms”, says a pediatrician in Kuala Lumpur. “It takes from five to seven days for the virus to incubate.”
Symptoms vary according to the age and health of the patient. Generally, the sickness starts with a high temperature, rash agonizing headache, and muscle and joint pain. Nausea, vomiting and loss of appetite are common, and a rash usually appears three or four days after the fever starts. The worst symptoms can last up to ten days, and complete recovery can take a month.
In the DHF variant of the infection, cells release chemicals that trigger leakage of plasma from blood vessels. “Fluids accumulate in body cavities, causing profound shock,” explains a professor of UP College of Medicine. “Death often results from bleeding in the brain, intestines or other organs. After a dengue patient has gone into shock, it’s usually a matter of time before multi-organ failure occurs and death becomes inexitable.”
This terrifying scenario is characterized by high continuous fever (40.41 degrees) lasting up to seven days that may be accompanied by loss of appetite, nausea, vomiting, abdominal pain and bleeding from the skin, nose or gums. In worst cases, the patient’s condition may suddenly deteriorate after a few days of fever, and may die within 24 hours.
Many people, including doctors, mistake DHF for influenza and flu-like disease, so it often goes untreated until symptoms become severe and the patient goes into shock. “There’s often a rash in dengue while there’s none in flu. Fever caused by dengue tends to last almost a week, while that of flu disappears after three to five days,” explains Dr. Schapira of the WHO.
Up to five percent of DHF cases are fatal; without proper treatment the rate rises to 15 percent. Most who die are children under the age of 15, but adults are at real risk too. A doctor has seen firsthand the devastating effects of DHF. He was working at a hospital in Cebu City, when an 18-year old construction worker was brought in after suffering from recurring fevers for seven days.
When blood tests confirmed the teenager had DHF, the doctor administered blood and plasma transfusions. On his third day in hospital, the teenager’s condition deteriorated sharply – he started gasping for breath, bleeding heavily from his nose and vomiting blood. The doctor performed an emergency transfusion, but within three hours the teenager was dead.
Patients who recover from dengue develop antibodies that provide immunity. But there are four viruses (DEN-1, DEN- 2, DEN 3 and DEN 4), so a person can develop four infections in a lifetime. Often, infection with a subsequent strain results in a more serious illness, though experts are unsure why this happens.
Epidemiologists blame the spread of dengue largely on Asia’s rapid urbanization. Most Asian cases have been recorded in Kuala Lumpur, Manila, Jakarta, Bangkok and Ho Chi Minh City, where growth has not always been accompanied by the development of well – managed water supplies or waste disposal. Residents must often store water for drinking and washing in open buckets and barrels – good mosquito breeding conditions.
In Baguio City in the Philippines, water shortage have contributed to a surge in dengue cases because suburban residents store water in drums. In other, the intermingling of dense populations and fruit and vegetable cultivation that requires water storage compounds the problem.
The increase in air and sea travel in the region has also aided dengue’s spread. San Fernando in Sibuyan Island, Romblon, Philippines, had never experienced an outbreak, but when an islander visited Manila by boat for a few days, he came back infected. A month later, more than a hundred islanders contracted the fever; two died – a six year-old girl and a 64-year old man.
No specific treatment will “cure” dengue. The best available palliatives are anti-fever pills like paracetamol and plenty of fluids, according to a doctor. Aspirin should not be given to sufferers because the drug can impair blood clothing – paracetamol is better choice. Fruit juice is preferable to water as it gives the patient much-needed vitamins.
Doctors urge anyone who suspects he may be infected to visit his doctor or nearest hospital immediately so that blood pressure and potentially fatal complications like internal bleeding can be monitored, and blood or plasma quickly replaced.
What can be done in the meantime to combat mosquitoes? Experts say is to keep those infected away from mosquitoes so they don’t pass the virus to others. Use mosquito nets if possible. An infected person circulate the virus in his blood at approximately the same time as he has the fever.
Unfortunately, many doctors complain that Asian regional health authorities often act only when outbreaks occur rather than developing preventive programs. Nevertheless, some governments are taking effective actions. In Malaysia, the Ministry of Health organizes ground-level spraying of insecticides in areas where cases are increasing above usual level and in “hotspots” at the beginning of the wet season. In Jakarta, there any open sewers offer mosquitoes excess places to breed, health officials go door-to-door looking for breeding sites.
And in the Philippines, the Department of Health organizes mosquito-eradication campaigns and distributes flyers describing dengue fever’s symptoms and preventive measures. During the rainy months – June to October – the Philippine government and community groups also run a programme mobilizing communities to search out and destroy mosquito larvae (wrigglers”) and breeding sites. Prevention is crucial. Unless we take concerted action to educate our people our people, dengue will continue to take its toll.
Experts agree that government agencies can do only so much, however, “while government has an important role in dengue control, families and communities have a great responsibility,” says an expert. “Mosquitoes breed in our homes. While government reminds, the people should mind.”
“We can control dengue if we work together,” adds the WHO, “Every individual, building administrator, company owner, mayor and barangay captain must ensure that there are no uncovered water containers or receptacles for mosquitoes to breed in. By doing just that we can all save lives.
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