In Bangladesh there were Dengue outbreaks in 2000 (5,555 cases and 93 deaths); 2001(2,430 cases and 44 deaths) and 2002 (6,104 cases and 58 deaths). Thanks to improvements in management protocols and dissemination of knowledge among the general public, deaths related to Dengue outbreaks have decreased. But it is good to remember that second or third attacks might easily result in Dengue Hemorrhagic Fever or Dengue Shock Syndrome; conditions which require hospitalization and invasive therapy.   The following FAQs summarized below are commonly asked in relation of Dengue Fever in our country.

 How we can prevent the spread of Dengue Fever in urban areas of Bangladesh?

The dengue virus is a vector borne organism which has two life cycles one inside a specific species of mosquito known as Aedes Aegypti (endemic for Bangladesh) and second life cycle which propagates inside the human body. Our aim of intervention must be to stop the viral life cycle by mosquito eradication during rainy season. This may be achieved by centering our attention towards environmental sanitation whereby Aedes Aegypti is no more capable of finding ample breeding grounds and secondly we should try to protect our city dwellers from this mosquito, the most vulnerable population being children.

Disorganized urbanization is a key factor in the rapid spread of this virus. Due to the increasing number of slums in Dhaka City, mosquitoes are able to breed at astronomical rates. Although the Aedes mosquito reproduces in relatively cleaner water, factors like loitering, lack of proper waste disposal initiatives and practices have helped Dengue to spread. For example every time we have a coconut in the street where do we dispose the husks and shells; do we ever try to crush the can or cup after having a soda?

The answer is inevitably ‘No’ and these wastes of everyday life serve as breeding grounds for dengue virus during rainy season. I believe it is customary to dispose water which accumulates in our pot plants and in the hollow of trees regularly during this season. The water which accumulates as a result of refrigerator use, serve as ample sources of clean water, should either be cleared or reused for other household purposes. This clearance of refrigeration water should be done at least two to three times a week.

Due to unplanned urbanization and scarcity of water, city dwellers often need to hold water in pitchers and buckets. Under such circumstances the buckets must be covered. The same goes for water tanks on roof tops. In more developed countries around the world, research into sterilizing male mosquitoes and changing their genetic makeup to lessen their capacities as vectors is going on with full fervor.

Time has come for Bangladesh to escalate such research efforts in our country.   Now we must discuss how to protect our families from the Aedes mosquito. Children are the ones who are most vulnerable to Dengue Fever; mosquito nets must be used wherever and whenever babies and small children fall asleep. Often, mosquito nets are not used when children sleep during the day.

It is important to remember that the Aedes mosquito can and will bite in morning and evening. Windows must have netting to prevent mosquitoes from flying into homes as much as possible. Self protection is beneficial. Use of mosquito repellents and aerosols has always proven useful in preventing mosquito bites. Children should be clothed with full sleeved dresses during monsoon season.

What is dengue hemorrhagic fever and how dangerous is it from a public health perspective?

Dengue hemorrhagic fever (DHF) is a specific syndrome that tends to affect children under 10 years of age. It causes abdominal pain, hemorrhage (bleeding), and circulatory collapse (shock).

In DHF, there is bleeding with easy bruising, blood spots in the skin (petechiae), spitting up blood (hematemesis), blood in the stool (melena), bleeding gums, and nosebleeds (epistaxis). Pneumonia is common, and inflammation of the heart (myocarditis) may be present. Patients with DHF must be monitored closely for the first few days since shock may occur or recur precipitously (dengue shock syndrome). Cyanotic (bluish colored) patients are given oxygen. Vascular collapse (shock) requires immediate fluid replacement. Blood transfusions may be needed to control bleeding.

Dengue fever is a manifestation of the metropolis only. Is there any news of outbreaks outside cities or in rural areas elsewhere in the world?

Dengue fever is common in cities mostly but as the city throws its tentacles into the countryside, there is an upsurge of pollution both indoor and outdoor. This allows the virus to claim new ground and its spread gains new momentum.

Another contributing factor is urban and international migration. This is especially true for the Chikungunya virus known for producing symptoms very similar to dengue. This virus has already affected many in West Bengal.How can we be sure that this has not passed into Bangladesh? Research should be pursued to check Chikungunya outbreak in our country. We must cease this opportunity to express our gratitude to our Bangladesh Government for the commencement of observation and quarantine measures to prevent ebola virus epidemic.

Will a dengue vaccine become available anytime soon?

The dengue virus has four strains. This fact compounds the manufacture of vaccines greatly as the vaccine should be effective against all four strains. Another sad fact is; if one strain has caused infection a consequent infection by another strain may cause dengue hemorrhagic fever.

Thus recurrent dengue is much more dangerous than primary infection. Infection after vaccination may be equally life threatening. The greatest impediment to vaccine development has been the emergence of a fifth and newer strain of Dengue Virus. Therefore prevention remains the key.

It is known that the afebrile (fever free phase) phase of Dengue Fever may be more dangerous than the febrile stage. Is there any advice caregivers should follow during this period?

Parents and caregivers must know of the seasonal variation of different types of fever. For instance, if it is monsoon season, dengue fever is a common diagnosis in big cities.

Parents must not administer any Non Steroidal Anti Inflammatory Drugs to treat fever except paracetamol. The afebrile phase usually occurs 4-5 days after febrile phase. Caregivers should be wary of skin changes like rashes, nose bleeds and gum bleeds which maybe a reflection of bleeding problems, abdominal swelling or ascitis and undue fatigue. Due to a fall in blood pressure, fluids may accumulate in the chest cavity (known as pleural effusion); this will cause breathlessness, cough and confusion in the child although he/she maybe afebrile. Adequate fluid replacement is important in all stages of Dengue fever but over hydration may lead to circulatory overload.

Physicians and pediatricians must always provide reassurance and counseling, as chances of dengue hemorrhagic fever or dengue shock syndrome is less in our country’s context. Confidence is key in treating dengue but complacency may proof fatal.(Reprint)