Preventing dengue

The treatment of dengue is symptomatic and its approved vaccine exists only in some countries with restricted recommendations. In Pakistan, health authorities must adopt preventive measures on individual and national levels to reduce the annual spikes in dengue cases.

Dengue is considered as a risk in various parts of Asia and the Pacific Islands. Infected Aedes species mosquito bite spreads dengue virus among people. Hundreds of deaths are reported every year due to dengue in South Asian regions where healthcare facilities are not sufficient to combat this infectious disease and it is estimated that about 4 billion of the world’s population resides in areas carrying increased chances of dengue virus growth. Among those Asian countries, Pakistan, India, Sri Lanka and Bangladesh report higher than usual numbers of dengue cases. An inclined trend in the number of dengue fever cases has recently been reported in all provinces of Pakistan and health authorities fear an outbreak of this deadly disease in the future.

Recovery from mild dengue virus infection usually takes two to seven days but severe dengue virus infection is a medical emergency that generally requires hospitalisation. Uncontrolled bleeding, extreme low blood pressure, organ failure and death are reported as a result of severe dengue infection. The risk of death among people with severe dengue infection is 0.8% to 2.5%. With extreme low blood pressure this risk increases to 26%; in children less than five years of age, this risk is four times higher than younger adults; and in those with adequate symptomatic treatment, this risk is less than 1%. Hence it is the need of time to strengthen health facilities for diagnosis and treatment of dengue patients at all the primary, secondary and tertiary care hospitals of Pakistan to prevent complications and deaths.

Although the symptoms of dengue virus infection can be controlled by pain killers and febrifuges with excess consumption of water, the dengue virus itself carries no specific anti-viral treatment. Dengue fever vaccine has been approved and is commercially available in some countries but this vaccine is only recommended in previously infected individuals or those with a higher rate of prior infection by age nine. So, the mainstay of dengue control lies in its prevention with precautionary measures at individual and national levels. The United States Centers for Disease Control and Prevention (CDC) has instructed all the travelers and residents of risk areas to prevent mosquito bites by using insect repellent registered by the Environmental Protection Agency (EPA), wearing fully body-covering clothes, and sleeping under an insecticide-treated bed net.

The Ministry of Health must co-ordinate with provincial health departments to initiate dengue awareness campaigns all over the country to educate the population about precautionary measures. District administrations must carry out fumigation drives to reduce the alarming rise in the number of Aedes mosquitoes. Stagnant water from all the areas must be drained to prevent breeding of mosquitoes and further open collections of water must be reduced through environmental modification. Analysis of current environmental situation and healthcare parameters for dengue, guidelines for quality-assured interventions, capacity building for healthcare providers, dengue surveillance, and logistics support for dengue control must be focused on by healthcare authorities. Cleanliness is regarded as half of faith and these hygiene practices can prevent people from this deadly infectious disease. Dengue Outbreak Emergency Plan of Action (EPoA) needs a thorough review by the Ministry of Health to amend and implement it according to the prevailing dengue situation in Pakistan. Mobile health teams must be formulated and sent to the rural areas of Pakistan to specially educate the mass on protecting vulnerable populations such as pregnant women, children less than five years of age, and the elderly, against dengue.

Preventive measures must be ensured because the situation may turn worse in the coming years as no effective vaccine or any proper alternate treatment against the deadly dengue virus is so far available in Pakistan.

Published in The Express Tribune, November 4^th, 2021.

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