Published:  04:11 AM, 14 September 2019

Effective management of dengue needed in Chattogram

Effective management of dengue needed in Chattogram

A patient infected with dengue disease died at Chattogram Medical College Hospital on last Thursday afternoon.The deceased was identified as Abu Sayeed, 30, of Tangail. Prof Sujat Paul, head of medicine of CMCH, confirmed the death.

Sayeed was admitted to CMCH on Thursday. He had dengue hemorrhagic syndrome, said Dr Taherul Islam, assistant registrar of medicine department of the hospital.  Sayeed, a foreman of a factory in the port city, went there from Tangail about a week ago.

Meanwhile, a total of 4,409 dengue patients were admitted to different hospitals across the country in the first six days of this month. September is considered a high risk period for dengue fever.

The number of dengue cases was 52,636 last month -- the highest in a single month ever.Though 700-900 patients are being admitted every day to different hospitals since last week, the number of patients are going down gradually.

According to the data of Directorate General of Health Services (DGHS), 75,146 dengue patients were admitted to hospitals across the country. The official number of deaths caused by dengue this year is 57, though the unofficial figure is well over twice of that.

Dengue is a mosquito-borne viral disease that has rapidly spread in all regions of WHO in recent years. Dengue virus is transmitted by female mosquitoes mainly of the species Aedes aegypti and, to a lesser extent, Ae. albopictus. This mosquito also transmits chikungunya, yellow fever and Zika infection. Dengue is widespread throughout the tropics, with local variations in risk influenced by rainfall, temperature and unplanned rapid urbanization.

Severe dengue was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Today, severe dengue affects most Asian and Latin American countries and has become a leading cause of hospitalization and death among children and adults in these regions.

Dengue is caused by a virus of the Flaviviridae family and there are 4 distinct, but closely related, serotypes of the virus that cause dengue (DEN-1, DEN-2, DEN-3 and DEN-4). Recovery from infection by one provides lifelong immunity against that particular serotype. However, cross-immunity to the other serotypes after recovery is only partial and temporary. Subsequent infections (secondary infection) by other serotypes increase the risk of developing severe dengue.

The incidence of dengue has grown dramatically around the world in recent decades. A vast majority of cases are asymptomatic and hence the actual numbers of dengue cases are underreported and many cases are misclassified. One estimate indicates 390 million dengue infections per year (95% credible interval 284-528 million), of which 96 million (67-136 million) manifest clinically (with any severity of disease).1 Another study, of the prevalence of dengue, estimates that 3.9 billion people, in 128 countries, are at risk of infection with dengue viruses.2

At present, the main method to control or prevent the transmission of dengue virus is to combat vector mosquitoes through, preventing mosquitoes from accessing egg-laying habitats by environmental management and modification, disposing of solid waste properly and removing artificial man-made habitats, covering, emptying and cleaning of domestic water storage containers on a weekly basis, applying appropriate insecticides to water storage outdoor containers.

using of personal household protection measures, such as window screens, long-sleeved clothes, repellents, insecticide treated materials, coils and vaporizers (These measures have to be observed during the day both at home and place of work since the mosquito bites during the day).

improving community participation and mobilization for sustained vector control, applying insecticides as space spraying during outbreaks as one of the emergency vector-control measures.

active monitoring and surveillance of vectors should be carried out to determine effectiveness of control interventions. Careful clinical detection and management of dengue patients can significantly reduce mortality rates from severe dengue.

Member States in three WHO regions regularly report the annual number of cases. The number of cases reported increased from 2.2 million in 2010 to over 3.34 million in 2016. Although the full global burden of the disease is uncertain, the initiation of activities to record all dengue cases partly explains the sharp increase in the number of cases reported in recent years.

Other features of the disease include its epidemiological patterns, including hyper-endemicity of multiple dengue virus serotypes in many countries and the alarming impact on both human health and the global and national economies. Dengue virus is transported from one place to another by infected travelers.

The Aedes aegypti mosquito is the primary vector of dengue. The virus is transmitted to humans through the bites of infected female mosquitoes. After virus incubation for 4-10 days, an infected mosquito is capable of transmitting the virus for the rest of its life.

Infected symptomatic or asymptomatic humans are the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes. Patients who are already infected with the dengue virus can transmit the infection (for 4-5 days; maximum 12) via Aedes mosquitoes after their first symptoms appear.

The Aedes aegypti mosquito lives in urban habitats and breeds mostly in man-made containers. Unlike other mosquitoes Ae. aegypti is a day-time feeder; its peak biting periods are early in the morning and in the evening before dusk. Female Ae. aegypti bites multiple people during each feeding period. Aedes eggs can remain dry for over a year in their breeding habitat and hatch when in contact with water.

Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. Warning signs occur 3-7 days after the first symptoms in conjunction with a decrease in temperature (below 38°C/100°F) and include: severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness and blood in vomit. The next 24-48 hours of the critical stage can be lethal; proper medical care is needed to avoid complications and risk of death.

For severe dengue, medical care by physicians and nurses experienced with the effects and progression of the disease can save lives - decreasing mortality rates from more than 20% to less than 1%. Maintenance of the patient's body fluid volume is critical to severe dengue care.

The first dengue vaccine, Dengvaxia® (CYD-TDV) developed by Sanofi Pasteur was licensed in December 2015 and has now been approved by regulatory authorities in 20 countries for use in endemic areas in persons ranging from 9-45 years of age.

In April 2016, WHO issued a conditional recommendation on the use of the vaccine for areas in which dengue is highly endemic as defined by seroprevalence of 70% or higher. In November 2017, the results of an additional analysis to retrospectively determine serostatus at the time of vaccination were released.

The analysis showed that the subset of trial participants who were inferred to be seronegative at time of first vaccination had a higher risk of more severe dengue and hospitalizations from dengue compared to unvaccinated participants.
The live attenuated dengue vaccine CYD-TDV has been shown in clinical trials to be efficacious and safe in pers

ons who have had a previous dengue virus infection (seropositive individuals), but carries an increased risk of severe dengue in those who experience their first natural dengue infection after vaccination (seronegative individuals).

For countries considering vaccination as part of their dengue control programme, pre-vaccination screening is the recommended strategy. With this strategy, only persons with evidence of a past dengue infection would be vaccinated (based on an antibody test, or on a documented laboratory confirmed dengue infection in the past).

Decisions about implementing a pre-vaccination screening strategy will require careful assessment at the country level, including consideration of the sensitivity and specificity of available tests and of local priorities, dengue epidemiology, country-specific dengue hospitalization rates, and affordability of both CYD-TDV and screening tests.

Vaccination should be considered as part of an integrated dengue prevention and control strategy. There is an ongoing need to adhere to other disease preventive measures such as well-executed and sustained vector control. Individuals, whether vaccinated or not, should seek prompt medical care if dengue-like symptoms occur.

At present, the main method to control or prevent the transmission of dengue virus is to combat vector mosquitoes through, preventing mosquitoes from accessing egg-laying habitats by environmental management and modification, disposing of solid waste properly and removing artificial man-made habitats, covering, emptying and cleaning of domestic water storage containers on a weekly basis, applying appropriate insecticides to water storage outdoor containers.

using of personal household protection measures, such as window screens, long-sleeved clothes, repellents, insecticide treated materials, coils and vaporizers (These measures have to be observed during the day both at home and place of work since the mosquito bites during the day).

improving community participation and mobilization for sustained vector control, applying insecticides as space spraying during outbreaks as one of the emergency vector-control measures.

active monitoring and surveillance of vectors should be carried out to determine effectiveness of control interventions. Careful clinical detection and management of dengue patients can significantly reduce mortality rates from severe dengue.


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