LIVING DENGUE-rously

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2010 is the year of living “dengue-rously”. Dengue did not make it in the Top 10 list of health news last year, but it came back this year and zoomed to No. 1 as cases have rose to an all-time high, peaking in August. The Department of Health reported 98,934 dengue cases with 644 deaths (case fatality rate of 0.65) from January 1 to September 25, 2010. This is a huge surge compared with 57,819 cases were reported for the entire year in 2009.

The World Health Organization considered dengue as one of the fast-emerging infections in the world. Among the estimated 2.5 billion people at risk globally, more than 70% reside in the Asia Pacific countries, with the Lao People’s Democratic Republic, Malaysia, Vietnam and the Philippines among those particularly badly affected.

Dengue fever, a flu-like illness spread by Mosquitoes, often emerges when the insects are able to breed in large numbers in locations exposed to still water such as containers, improperly managed garbage, building sites and flower pots. The disease is particularly prevalent in substandard housing areas with poor sanitation. However, even the rich and famous are not exempted having the disease, just like Kris Aquino’s sons, Joshua and Baby James, who got dengue in 2009. This year, Kris involved herself in dengue awareness activities, particularly in schools.

There is currently no treatment or vaccine for dengue. Early recognition and prompt supportive treatment can substantially lower the risk of developing the severe disease. The principal symptoms of dengue fever are high fever, severe headache, severe pain behind the eyes, joint pain, muscle and bone pain, rash, and mild bleeding (e.g. the nose or gums). However, in severe cases, death from dengue shock syndrome can occur in a minority of persons, especially if early treatment is not sought.

DOH spokesperson, Dr. Eric Tayag said that the first episode of infection causes the body to develop antibodies to a particular type of strain. However, if infection occurs again, the antibodies may not be able to neutralize the new strain, which may cause the immune system to overreact resulting in more severe and more virulent dengue infection like dengue hemorrhagic fever or dengue shock syndrome. “The circulation of four dengue strains (DEN-1, DEN-2, DEN-3, and DEN-4) made things worse for public health experts,” Tayag further explained. He added that if a person becomes infected of DEN-1, he/she becomes immune to the DEN-1 strain but not to the three remaining strains.

Meanwhile, Health Secretary Enrique T. Ona issued an order to all DOH hospitals to activate their dengue express lanes to facilitate patient admission for severe dengue cases. He also announced the new D.E.N.G.U.E strategy to educate the public in home treatment on mild dengue cases. This will aid in decongesting tertiary hospitals by assuring the public that not all dengue cases require hospital confinement but can be managed at home using the said strategy.

“Instead of confining patients in a hospital facility, parents and caregivers can practice the D.E.N.G.U.E. strategy. D.E.N.G.U.E stands for D – daily monitoring of patient’s status, E – encourage intake of oral fluids like oresol, water, juices, etc., N – note any dengue warning signs like persistent vomiting and bleeding, G – give paracetamol for fever and NOT aspirin, because aspirin induces bleeding, U – Use mosquito nets and E – early consultation is advised for any warning signs include severe abdominal pain or persistent vomiting, red spots or patches on the skin, signs of bleeding, black stools, drowsiness or decreased consciousness, and pale or cold clammy skin,” Ona said.

And in the light of the rumors of the medicinal value of the herb tawa-tawa, durian fruit and other plants as cure against dengue, health professionals maintain that there is still no evidence confirming such.

The DOH reiterated that the effective way to prevent and fight dengue is still by practicing the DOH’s 4-S strategy consisting of Search and destroy Self-protective measures, Seek early treatment and Say no to indiscriminate fogging. The strategies must be done throughout the year because dengue is no longer a seasonal (rainy season) disease in the country.

In a statement released in September, the WHO said that the increase in dengue cases can be attributed to a number of factors. These included higher temperatures and rainfall in many parts of the region this year, growing population densities, and greater international travel. Higher awareness levels and better surveillance systems were also probable factors in some countries.

Even though there was no firm evidence yet that the increase in cases was tied to global warming, climatic change plays an important role in the spatial and temporal distribution of dengue. Mosquitoes are now being found in areas where they were once not common, including the Republic of Korea and the highlands of Papua New Guinea.

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