Dangerous dengue

Published On: November 21, 2017 12:30 AM NPT By: Dr Sher Bahadur Pun

Dengue is spreading fast in Nepal, in what could be the worst and most explosive epidemic since 2010.

A few days ago, a patient diagnosed with dengue virus was airlifted to Sukraraj Tropical and Infectious Disease Hospital (STIDH) for treatment. Another patient was brought to Kathmandu after she was confirmed to have contracted dengue virus. These two representative cases reflect panic among patients who are currently experiencing dengue-like symptoms, especially in the worst dengue-affected areas. 

Dengue is spreading across the country at the moment—in what could be the worst and most explosive epidemic since 2010. After it was first detected in 2004, Nepal has experienced dengue epidemics almost every year. And it is expanding across the country, which is a matter of grave concern. But there have been limited studies on causes of the spread of this virus. Available studies suggest rapid urbanization, trade and human movements, inadequate water storage and climate change are responsible for spread of dengue virus worldwide. 

A study conducted in Kathmandu showed that poor waste management allows virus-carrying mosquitoes to breed. Discarded tires, drums and plastic things are perfect harbors of mosquito larva in Kathmandu. A few years ago, the Epidemiology and Disease Control Division (EDCD) found that aedes mosquitoes are already established in Kathmandu. Thus dengue outbreak may occur in Kathmandu anytime and it will be the worst outbreak, as Kathmandu is a city with the largest population as well as highest human mobility. 

For the first time this year, at least four patients have been confirmed to have dengue virus in Kathmandu. They contracted the virus after being bitten by infected local aedes mosquitoes. When they come to Kathmandu they bring with them the virus.
Nearly 200 patients with dengue virus have already been treated at STIDH. The majority of these patients were in early stages of infections, which means local mosquitoes are acquiring viruses from these patients. The virus may rapidly spread in Kathmandu.

Poor awareness 

Many people in Kathmandu are unaware of aedes mosquitoes, the carriers of dengue virus. The mosquitoes they are familiar with, of anopheles family, are carriers of malaria parasite, are most active at night and usually breed in polluted waters. 

The patients claim to be sleeping inside mosquito nets during the night, and as such they should have been immune to such insects. But aedes mosquitoes are day biters and breed wherever there is clean standing water. It shows that there is a huge knowledge gap among people regarding mosquitoes. This needs to be promptly addressed. 

The government seems unwilling to deliver timely and right information to people so as to better educate them on dengue epidemic. Rather it has a “mosquito search and destroys” policy, usually started only after massive outbreaks are reported. 

Hundreds of dengue patients are being referred to Kathmandu for treatment. But there is no specific medicine to treat dengue infections. Platelets in our blood help with clotting. Platelet count may decrease drastically following a dengue infection, its patients are at high risk of hemorrhages. 

Using social media

According to the Indian dengue guidelines, if the platelet count goes below 10,000/cumm, transfusion is warranted. But most health workers refer dengue patients to Kathmandu only after the count gets below 100,000/cumm. Health workers should be able enough to determine who requires admission and who does not. For this, we need to develop dengue treatment and prevention guidelines based on our own resources and researchers. Guidelines for prevention and control should be published in Nepali language as well in order to keep local communities informed. 

Mass media can be effective to spread awareness of dengue. Studies in other countries suggest knowledge on dengue fever can be effectively disseminated via mass media such as television, radio, newspapers and social media networks. 

The number of social media users is increasing in Nepal. Spreading this message through social media sites can thus be effective in educating people on prevention measures. This will also help control the outbreak early. 

As dengue outbreaks are being reported, it has sent people, especially those living in dengue-affected areas, into a state of panic. Preparedness and timely education can dispel such fear and anxiety.  

The author is coordinator of Clinical Research Unit at Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu.

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