Uptick in dengue cases

93 cases reported to the government in Sindh so far this year, with up to 20 cases reported directly after the rains.

KARACHI: The monsoons have always been welcomed by the people of Karachi but the pleasant showers have a flipside - a sharp rise in dengue fever cases.

Ninety-three cases have been reported to the government in Sindh so far this year, with up to 20 cases reported directly after the rains, said Dr Shakeel Malik, who is in charge of the Dengue Surveillance Cell. The cell was activated on Tuesday given the rise in numbers. Out of this year’s patients, 70 tested positive for the virus and were treated. Only one of them was from Thatta and the rest of them were from Karachi.

As with most information-gathering in Pakistan, however, these numbers are only the official statistics. Haematologist Dr Tahir Shamsi, who is the director of National Institute of Blood Diseases (NIBD), warns that the government’s data is incomplete as the dengue cell isn’t receiving numbers from all of the hospitals in the city. “[The NIBD] alone received nine patients in the last 24 hours,” he said to prove his point. “There have been a total of 21 cases reported this month.” Most of the NIBD patients are from Gulistan-e-Jauhar and Shah Faisal Colony.

According to data from the Sindh health ministry, Aga Khan University Hospital reported 58 dengue cases so far, out of which 44 were admitted. Many of them were discharged, and according to Dr Bushra Jamil, who is an associate professor of medicine at the AKUH, 12 people are being treated at present.

Other hospitals - Abbasi Shaheed, Anklesaria Nursing Home, Civil Hospital, Karachi Seventh Day Adventist, Qatar and Civil Hospital, Hyderabad have also reported to have treated patients.

What it feels like

Kamraan Iqbal Allahwala, 23, felt the initial symptoms of dengue on the second of Ramazan. “It started with fever but the worst part was the body ache, especially in the back,” he said. Since his fever was in its initial stages, his platelet count had not dropped as much. A platelet count is a test to measure how many platelets you have in your blood. Platelets help the blood clot or give it thickness. Normal counts should be in the range of 150,000 to 450,000 per microlitre of blood. In dengue patients, doctors start to worry if it’s 80,000. “Besides the pain, the body becomes extremely weak and any previous injuries suddenly start hurting a lot,” he said, while referred to a dislocated joint. He has managed to control his fever with panadol and by drinking lots of fluids.

Given the regular yearly outbreak of the fever, most of the major private and government hospitals in the city have the expertise for clinical and laboratory diagnosis of the life-threatening break-bone fever, nicknamed after the symptom of extreme pain in the body of the dengue patient.

How it spreads

Accumulated stagnant water is a popular breeding ground for the vector that spreads this infectious disease.

“Urban areas, with their high-rise buildings, make a better breeding ground for the virus,” he explained. This is because the higher the building, the cooler and more humid it is.

The Aedes Aegypti mosquito, which is a vector for the virus, is a clean water mosquito and breeds in clean, stagnant water pools. “This make the city of Karachi an ideal target” informed Dr Malik. It mostly bites at sunrise and sunset, he added.

Dr Tahir Shamsi of the NIBD adds that collected water of an air conditioner, places inside cupboards, water collected in plant pots and open tanks for buildings and houses are also risky.

Similarly, Dr Bushra Jamil of the AKUH, said that the months between May and October are peak months for the outbreak of the viral fever. “We get patients in the hundreds during this time every year but fortunately the mortality rate is not very high,” she said. While the disease is not communicable, it is vector borne, meaning it can move from one place to another and thus spread easily. The precautions are fumigation, cleaning up stagnant pools of water and covering water vessels. “Anyone from any locality and condition can become a patient,” she warned.

Floods and Dengue

Dr Shakeel Malik, who is currently in Thatta to see the health situation and to distribute relief goods arranged by Civil Hospital, Karachi, told The Express Tribune that for now the flood survivors are not under threat as the water is still flowing. “Once this water stagnates, then the people of interior Sindh will be at risk,” he warned. Meanwhile, there is also the potential threat of malaria, he added. This was backed by Dr Shamsi, who said the threat of dengue fever may extend to other areas in Sindh.

Dr Jamil also warned that there has been an outbreak of the Japanese B Encephalitis in India, another vector- or mosquito-borne disease. She said that it could reach Pakistan and is more dangerous than dengue.

Published in The Express Tribune, August 30^th, 2010.