By Henrylito D. Tacio
After two days of rain, six-year-old Jenny came down with a fever. Her mother, Esther, noted that Jenny had lost her appetite and that her skin was flushed, but wasn’t particularly concerned. She gave her paracetamol, which she believed would help the temperature to subside. The fever vanished the following day but returned the next.
Seven days after the symptoms first appeared, Jenny became drowsy. She was breathing rapidly and her pulse was racing. Suddenly, she began to vomit blood. Esther rushed her daughter to the hospital, where a doctor administered blood transfusions, but it was too late. The little girl died soon afterwards.
Jenny was a victim of a virulent form of dengue, a mosquito-borne contagion that’s rapidly becoming one of the country’s health problems.
“Before, we thought that dengue [became rampant only during the rainy season], but this time, dengue is all year round,” Dr Annabell Yumang, the director of the regional office of the Department of Health in Davao Region, told the media during a weekly forum some months ago. “Every month, we now have dengue cases.”
From January to July this year, about 8,681 cases – with 28 deaths! – had been recorded. Davao City had the highest tally with 3,480 cases. Davao del Norte trailed with 1,947 cases, followed by Davao de Oro (1,099), Davao del Sur (909), Davao Oriental (831), and Davao Occidental (415).
Actually, there are two kinds of diseases caused by the dengue virus – the classical dengue fever, which has been known for more than 200 years, and is now having a resurgence it if the rainy season. The other entity, dengue hemorrhagic fever (DHF), emerged in 1953 in Manila, and in 1958 in Bangkok.
More than 90 per cent of the recorded deaths are in children under 15. “Dengue is a big problem among children because it is a major cause of illness and deaths,” says Dr. Lulu C. Bravo, a professor of infectious and tropical diseases.
Approximately 5 percent of all DHF cases are fatal. Without proper treatment, fatality rates may reach 15 percent more. “Although dengue is rarely lethal, its contribution to disease and ill health, especially among young children, should make dengue control a primary public health concern,” says Dr. Dominic Garcia, an infectious disease specialist.
The symptoms of dengue fever are now familiar to most people situated in endemic areas. It usually starts suddenly, with high fever and chills. Headaches, eye pain, back ache, and muscle and joint pains are also common.
“Extreme aching in the legs and joints occurs during the first hours of illness,” explains The Merck Manual of Medical Information. “The temperature rises rapidly to as high as 40 degrees C, with relative bradycardia (heart beating less than 60 beats a minute) and hypotension (abnormally low blood pressure). Fever and other symptoms persist for 48 to 96 hours, followed by rapid dropping of fever with profuse sweating.”
A rash usually appears 3 to 4 days after the start of the fever. The illness can last up to 10 days, but complete recovery can take as long as a month. Older children and adults are usually sicker than young children.
DHF is a potentially deadly complication that is characterized by high continuous fever (40-41 degrees C) lasting 2-7 days, that may be accompanied by loss of appetite, nausea, vomiting, abdominal pain, and subsequent evidence of bleeding such as persistent red spots on the skin, nose or gum bleeding, coffee-ground vomit, and dark stools. The patient can then go into shock (referred to as dengue shock syndrome).
In moderate DHF cases, all signs and symptoms abate after the fever subsides. In the worst cases, parents are advised to watch out for these danger signs: restlessness, cold clammy skin, sudden abdominal pain, having difficulty in breathing, and behavioral change.
Most people equate DHF with influenza and similar flu-like diseases. “There is usually rash in dengue while there is none in flu,” differentiates Dr. Allan Schapira, an epidemiologist. “Fever caused by dengue tends to last almost a week, while that of flu disappears after 3-5 days.”
Both dengue fever and DHF are caused by the same virus. However, there are four distinct viruses that can cause dengue fever, so a person living in a dengue-endemic area can develop four separate kinds of infections during his or her lifetime. Infection with one virus does not protect a person against infection with another.
Dengue viruses are transmitted to humans through the bite of infected Aedes aegypti and Aedes albopictus mosquitoes. The Aedes mosquito is sometimes called the “tiger mosquito,” because of its peculiar white stripes on its legs and back. Its peak biting time is after sunrise and at dusk – especially one hour before sunset. However, only female mosquitoes bite.
The adult female Aedes mates and takes its first blood meal about 48 hours after coming of its pupa stage. To lay eggs, it has to be engorged with blood, which may take two to five days. Each Aedes female can lay up to four batches of eggs – at least 40 eggs per batch – during its life cycles. The eggs hatch into “wrigglers” in two days, and after four days become “tumblers.”
Not all tiger mosquitoes, however, are carriers of the dengue virus, but only those that have bitten people infected with dengue fever. It takes about 8-10 days to multiply in the female mosquito’s salivary gland before the insect can transmit the virus to human beings.
The breeding sites of Aedes mosquitoes are never far from human habitation. They may live in tree holes, bamboo stumps, earthen jars, discarded bottles and tins, old rubber tires, rain barrels for collecting rainwater, clogged roof gutters, coconut shells and husks, and canoes and small fishing boats.
Inside the house or office buildings, the potential sites for the mosquito larvae are “any container than can accumulate water for up to seven days,” according to Dr. Enrique Tayag, one of the country’s foremost experts on dengue. These include uncovered water storage tanks, flower vases, saucers for ornamental plants, soft drink bottles, and metal and plastic pails for water storage.
Dr. Yumang urged every Dabawenyos to strengthen the 4S campaign to further avert dengue cases from escalating. The strategy includes searching and destroying mosquito breeding places, seeking early consultation, self-protection methods, and support to fogging operations in areas where an increase in cases is recorded for two consecutive weeks.
Some health officials are recommending using the so-called “three A’s” – asin (Tagalog term for salt), alcohol, and aceite (oil) – to kill the wrigglers. All a person has to do is pour any of the three into the clean stagnant water where wrigglers live.
“We can control dengue if we all work together,” believes Dr. Schapira. “Every individual, every family, every builder, every building administrator, every company owner, every mayor and every village head have to make sure that there are no, absolutely no, uncovered water containers or receptacles that mosquitoes can breed in. By doing this, we might be able to save someone from death.”
While there is currently no specific treatment for dengue, early detection and appropriate healthcare for case management can significantly reduce mortality.
According to the World Health Organization, the focus is on treating pain symptoms. Acetaminophen (paracetamol) is often used to control pain. Non-steroidal anti-inflammatory drugs like ibuprofen and aspirin should be avoided as they can increase the risk of bleeding.
For patients with dengue fever, they may be brought to the hospital for admission or may stay at home. If not admitted, they should be given plenty of fluids (water or juices). Should any of the severe symptoms appear, they should be brought immediately to the hospital.
“For DHF, admission is necessary and the patient is subjected to regular blood test monitoring until stable,” Dr. Bravo says. “Fluids are carefully computed and monitored plus as soon as needed, blood or blood components are transfused.”
Meanwhile, the mosquitoes are in the shadows, waiting for sunrise to strike. – ###
