Dengue Outbreak Turning to Epidemic

 

Death toll of the Dengue affected patients has exceeded 370.  Infection of the dengue breaks all previous records every day with huge fatality and patients have been suffering severely and creating immense pressure in the hospital gate. This year's maximum infection is 2959 in a day which creates panic among the people. In 2019, the highest number of patients infected by dengue was more than 1 lac, but the dengue outbreak was limited in Dhaka until 2019. Now its infection spread beyond the Dhaka and across the country.

The fatality rate has risen 0.47 percent mirroring the rates seen in 2020. The fatality rate was 0.18 percent in 2019 when the hospitalization cases hit an all-time high record of 1,01354. The fatality rate was 0.37 percent in 2021 and 0.45 percent in 2022 whereas infected patients 62,382 and 281 dengue patients had died and last month of that year (December 2022) number deceases was 27. This year the fatality rate among dengue patients in Dhaka is higher .7 percent while it is 0.2 percent outside of Dhaka according to the Directorate of Health Services (DGHS). The total number of patients 78028 admitted in hospital until 9 august 2023 due to dengue virus.

The fatality rate has risen 0.47 percent mirroring the rates seen in 2020. The fatality rate was 0.18 percent in 2019 when the hospitalization cases hit an all-time high record of 1,01354. The fatality rate was 0.37 percent in 2021 and 0.45 percent in 2022 whereas infected patients 62,382 and 281 dengue patients had died and last month of that year (December 2022) number deceases was 27.This year the fatality rate among dengue patients in Dhaka is higher .7 percent while it is 0.2 percent outside of Dhaka according to the Directorate of Health Services (DGHS). The total number of patients 72225 admitted in hospital until8 august 2023 due to dengue virus.

According to DGHS, the fatality rate among patients aged 21-25 is the highest-around 11 percent; followed by 9 percent among the patients aged 26-30; and 8 percent each among 31-40 and 56-60.

Dengue virus has been causing infection among people in the Bangladesh since 2000.Experts meanwhile have cautioned that the fatality rate is likely to remain high due to the higher rate of the second time infection in different dengue serotypes that led to sever illnesses quickly.

As a result more people are being infected for the second time with different dengue serotypes, leading to severe illness,” DrKhalilur Rahman, Director of Shaheed Suhrawardy Hospital told A renowned English daily on 05 August 2023.

According to the researchers, there are four distinct serotypes of the dengue virus DEN-1, DEN-2,DEN-3, DEN-4. These serotypes are closely related but differ slightly in their genetic makeup, leading to variations in their antigenic properties. When a person infected with one serotype of the dengue virus, they develop immunity to the specific serotypes. However, this immunity does not provide protection against the other serotypes, according to researchers. Different studies show that most people who are infected with dengue will have mild or no symptoms. “This fact has left many dengue patients unaware that they have caught a subsequent infection with different serotypes. So, they develop severe illnesses fast, but come to hospital too late,” physician said. Experts also said coming to hospital late is a main reason behind the higher death rate among young patients. Therefore, they advised that patients have togo to the hospital before developing severe symptoms. And drastic fall of blood pressure is the major sign.

The scarcity of accommodations and medical services patients taking place outside of the hospital. Poor people are staying home without treatment due to leak of enough government healthcare services because low income patients can’t effort the expenditure of private medical services. Mr.Habibur Rahman, Father of a dengue infected patients was  arrested for allegedly engaging in an altercation and subsequently assaulting a doctor while trying to admit his seven-year-old dengue-infected daughter at the capital's Mugda Medical College and Hospital on July 26 morning. (Ref: daily businesspost.com) .Habibur Rahman's wife Sathi Akter alleged that the concerned doctor triggered the whole incident as he behaved very badly with them as they requested him to at least check their daughter before taking her anywhere else. "He behaved very badly with my husband and even slapped him. Hospital people thrashed my husband, starting a scuffle," Sathi said. Later he was allowed bail from DMM Court on a Taka five thousand bond in the case. Which is showing the scarcity of the health service in the country for dengue infected patients.

According to the world health organization (WHO), severe dengue symptoms often come after fever has gone away. According to the physicians, there are seven symptoms of severe dengue: persistent vomiting,intolerable abdomen pain, breathing difficulty, bleeding gums or nose, slurred speech, declining blood pressure and severe fatigue which leaves a patient unable to even walk or stand up.

Different studies show that most people who are infected with dengue will have mild or no symptoms. But for those who do, the most common symptoms are high fever, headache, body ache, nausea and rash and most get better in 1-2 weeks, according to the WHO.

Prof Dr Saif Ullah Munshi a virologist at a Bangabandhu Sheikh Mujib Medical University, said that the four five day following the patient’s report of “no Fever” are crucial.This is because patients may go into shock (or may develop severe symptoms) at any time during this period. So taking caution is crucial at this time, “Prof Saif Ullah Munshi told the Daily Star earlier.According to different studies, the mortality rate among patients with severe symptoms is 1 percent if treated. When untreated, the mortality rate is 5 percent.

This year, the number of dengue cases started surging early on due to weak mosquito containment efforts and other relevant factors, leaving the hospital under pressure.As of yesterday morning total of 9334 undergoing treatment at different hospitals countrywide, which is around 15 percent of all dengue cases this years Dengue’s virus is spread to peoples through the bites of infected Aedes mosquito (Ae Aegypti or Ae Albopictus).These are the same type of mosquito that causes the spread of Zika and Chikungunya viruses.

The vector mosquitoes under genus Aedes breed mainly in the manmade water containers including buckets, mud plots, discarded containers, used tyres, storm water drains etc. Aedes deposits eggs singly on a damp surface just above the water line.It prefers to breed in clean, stagnant water easily found in our home.

Under the optimal conditions, the egg of an Aedes mosquito can hatch into a larva in less than a day. Then the larva takes about four days to develop into a pupa. From which an adult mosquito will emerge after two day. The entire life cycle of Aedes from egg to adult is 7-8 Days and life span for adult Aedes is around 2-3 weeks, by this time it can spreading infection among the residents of the city drastically. Specially from June to September Aedes spread infection due monsoon weather.

Most of the observations show that neither dweller of Dhaka city did clean and cover the garbage cans nor city authority operated the right monitoring operation to establish healthy and clean premises. If anyone visits the different areas of the Dhaka city corporation except Dhanmondi, Gulshan and Banani , they will find that the maximum premises is covered with garbage and dirty stagnant water. Besides, house owners are very careless about producing Adedelarva; they have developed unplanned rooftop gardens and pet farms everywhere on their premises until infections. Although, publishing huge reporting and awareness program, neither city authority nor city dweller didn't take any right measure to clear the city premises and removing water before they infected by dengue..

Rather they feel comfortable throwing the garbage bags near and here. They are also unaware of changing water of the swimming pool, flower tube, bird-drinking trough regularly that causes of breeding Aedes mosquito drop eggs.

We need to get rid of stagnant water, because Aedes mosquitoes can lay their eggs in stagnant water. Besides, the courtyard of the house should always be kept clean. Mosquito repellants should be used, insecticides should be sprayed in the house and corners of the house, camphor should be used to repel mosquitoes, basil leaves and lavender oil can be used as mosquito repellants.

Although first case of dengue recognized in 2000 in Dhaka but not spread panic.In 2002 dengue shown in alarming stage due increasing Aedes in the Dhaka city but not outside of Dhaka.

Due to the indifference of the authorities, the dengue outbreak gradually spreading outside Dhaka after 2019. Only in 2019 did dengue infect more people than it did in the first 20 years. Then the dengue virus gradually moves from city to suburb to village level due to careless travel of infected carriers. Which would not have taken such a prominent shape if it had been maintain with due sincerity and truthfulness from the beginning.

At present dengue outbreak is spreading almost equally in Dhaka and outside Dhaka. Last Sunday (August 7), a source said that 37 thousand 722 people were infected with dengue in the capital and 34 thousand 503 people outside the capital, by this time almost 62422 patients token clearance from the hospital. There are patients facing huge scarcity in the hospital to take admission.

In such a situation, the health department and the city authorities have to take appropriate action to control the alarming dengue situation with an honest, skill and dedicated team under supervision of expert team leader. Besides, the city authorities should apply the necessary drugs to destroy Aedes eggs and larva in and deployed emergency team to clean the city premises to prevent dengue, as well as take disciplinary action against those residents who pollute their own area and urban environment. Otherwise, it is only a matter of time before this dengue outbreak turns into a pandemic.

Dengue’s virus is spread by Aedes mosquito. It prefers to breed in clean, stagnant water easily found in our home. Under the optimal conditions, the egg of an Aedes mosquito can hatch into a larva in less than a day. Then the larva takes about four days to develop into a pupa.

There are seven symptoms of severe dengue: persistent vomiting, intolerable abdomen pain, breathing difficulty, bleeding gums or nose, slurred speech, declining blood pressure.

According to DGHS, the fatality rate among patients aged 21-25 is the highest-around 11 percent; followed by 9 percent among the patients aged 26-30; and 8 percent each among 31-40 and 56-60.


Md. Al-Amin Chowdhury is
Publisher of The Asian Age
and an ICT entrepreneur.