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Fight against ‘debilitating’ dengue is long and arduous

Fight against ‘debilitating’ dengue is long and arduous

Dengue is the most prevalent vector-borne viral infection. Plus, recurrences of the infection tend to be even more severe
Photo by Anantha Subramanyam K

Mysuru-based artist Wishvaa Winyaas first got dengue 10 years ago. Three years ago, he again contracted the disease. On both occasions, dengue left him weak for several weeks.

“The fever and the accompanied chills were hard to forget,” says the 56-year-old artist. “I still get a shudder whenever I think about those days. I had lost around six-seven kilos both times.

“Thankfully, I was not admitted to hospital on either occasion. I was on complete bed rest. My platelet count had also reduced. Along with medicines, I was eating healthy food, consisting of fruits, vegetables and meat.”

Winyaas now makes sure to eat healthy and on time. “As an artist we lead a very hectic schedule,” he says. “Earlier, I used to skip meals. I had become weak and my doctor told me dengue becomes debilitating if the host is weak. I follow a fixed routine, especially when it comes to my meals. I eat my breakfast, lunch and dinner on time.”

Dengue, which is transmitted by Aedes mosquitoes, is the most prevalent vector-borne viral infection. More than 3.9 billion people in over 129 countries are at risk of contracting dengue, with an estimated 96 million symptomatic cases and an estimated 40,000 deaths every year, according to the World Health Organization (WHO).

Can dengue fever recur?

Like Winyaas, many patients might get dengue again. “Dengue infection doesn’t usually give protection against future recurrences,” says Dr TR Hemkumar, consultant, internal medicine, Sakra World Hospital, Bengaluru. “There are chances of dengue infection recurring in patients. Usually, second or third recurrences of dengue infections tend to be even more severe than the initial one.”

How to keep the disease at bay?

Dengue has been suspected of increasing in frequency due to rapid urbanization, according to Dr Hemkumar. Now, the question is how to keep the infection at bay.

“Dengue prevention is primarily a question of environmental cleanliness,” says Dr Hemkumar. “Mosquito breeding can be prevented by avoiding stagnant water in or around the house. People should use mosquito nets, repellents and wear long-sleeved clothing to avoid mosquito bites. The Aedes mosquito, which transmits dengue fever, is more active during the day. As a result, keeping the environment clean is the most fundamental form of prevention against dengue.”

Don’t take dengue lightly

Vector-borne diseases — such as malaria, dengue, schistosomiasis, human African trypanosomiasis, leishmaniasis, chagas disease, yellow fever, Japanese encephalitis and onchocerciasis — account for more than 17 per cent of all infectious diseases, causing more than 70,0000 deaths every year, as per the WHO. Also, vector-borne diseases are most prevalent in tropical and subtropical areas. They disproportionately affect the poorest populations.

Bengaluru-based activist Nagasimha G Rao got infected with dengue two months ago in December last year, just before the third wave of Covid-19 induced by Omicron. Rao, who is still recovering, had four days of high fever before test results showed he was suffering from dengue symptoms. “As I am an asthma patient, my wheezing problem worsened,” he says. “I was immediately shifted to a private hospital in Bengaluru, where I stayed for eight days.”

In the hospital, he was treated for both dengue and asthma. Along with dengue, his sugar and blood pressure levels rose considerably. Now his vitals are normal again. But he has lost around 14kg. “I have become very weak,” he says. “I am still having a constant cough because of the antibiotics. I also did an RT-PCR test for Covid-19, but it is negative.”

Rao is dealing with other health-related issues post-dengue. He developed rashes on his body, but they have reduced with the passage of time. He is also feeling mentally weak because of his illness. “I am yet to see a mental health counsellor but will do so soon if things get bad,” says Rao. “I am still recovering and my doctor told me it would take a while. I have rejoined work as I can’t afford to miss it any more.”

Dengue treatment

Experts say no specific treatment exists for dengue fever. Over-the-counter (OTC) drugs like acetaminophen or Tylenol and others do help reduce muscle pain and fever in patients. But experts warn that patients with dengue fever should avoid other OTC pain relievers like aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) since these could increase the risk of bleeding complications of dengue fever. Patients with severe dengue symptoms generally need hospitalization, intravenous (IV) fluid and electrolyte replacement, blood pressure monitoring and transfusion to replace blood loss.

“The diet for dengue fever is the same as for any other acute febrile illness caused by another virus,” says Dr Hemkumar. “It is critical to keep the patient hydrated with plenty of water, coconut water, electrolyte powder or other glucose solutions. The patients need to consume easily digestible rice or wheat-based foods that may be steamed or boiled, in little quantities, on a regular basis to maintain a high energy level.”

Last year, Karnataka recorded about 5,500 dengue cases. At least five persons died due to the disease in 2021. Delhi, a hotspot for the disease, has already recorded 23 cases of dengue this year. At least 9,613 dengue cases were recorded in Delhi last year. It is the highest number of cases of the vector-borne disease since 2015. Around 23 people died due to the disease last year, as per reports.

“Dengue cases are mostly seen during the monsoon months,” says Dr Hemkumar. “The cases start increasing somewhere around May, peak during August and starts declining by October and November. We also witness dengue cases in other periods. The number of cases at Sakra World Hospital can vary between 200 and 400 per week during the peak seasons and can decline to less than 10 patients per week during the off-peak seasons.”

A subcontinental problem

Dengue is proving to be a challenge across the border too.

In 2021, a total of 48,906 cases of dengue, including 183 deaths, were reported in Pakistan, according to ‘Dengue virus cases surge amidst Covid-19 in Pakistan: Challenges, efforts and recommendations’, a report published in Dove Medical Press.

Dengue is now endemic in Pakistan, circulating throughout the year. The highest prevalence is in the post-monsoon season and all the four provinces of Pakistan are majorly affected, says the report.

“Pakistan is currently facing two outbreaks, dengue and COVID-19; both have strained its healthcare system resulting in multiple concerns including the co-diagnosis of two,” it says. “Due to poor healthcare capacity, low vaccination rate, increasing COVID-19 variants, socioeconomic disparities, and misinformation, it is inevitable that implications will prove to be damaging to both healthcare workers and civilians.

“Among these challenges, it is important to note the need for stronger epidemiological surveillance for both COVID-19 and dengue and the implementation of public health measures without endangering sources of livelihood. To sustain this, cooperation between WHO and Pakistan’s government must continue through smart lockdowns, dengue awareness campaigns, and double laboratory procedures.”

Awareness is key

Experts say awareness about dengue has increased in the recent past. However, there are a lot of misconceptions and fear among the population. “Though patients experience a lot of pain and discomfort during the illness, most recover without much problem,” says Dr Hemkumar. “Unnecessary testing like frequent platelet counts, platelets transfusion and serological testing way too early than the onset of symptoms causes confusion among clinicians. The ideal way is to consume paracetamol and rest at home for one or two days. If the fever on the third or fourth day doesn’t settle down, it is necessary to consult a family physician for further diagnosis.”

If a patient is experiencing either decreased urination or few or no tears or dry mouth or lips or lethargy or confusion and or cold or clammy extremities, then it is a must to see a doctor.

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