ABOUT DENGUE

Dengue is transmitted by the bite of an Aedes mosquito infected with any one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 3—14 days after the infective bite. Dengue fever is a febrile illness that affects infants, young children and adults.
Symptoms range from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash. There are no specific antiviral medicines for dengue. It is important to maintain hydration. Use of acetylsalicylic acid (e.g. aspirin) and non steroidal anti-inflammatory drugs (e.g. Ibuprofen) is not recommended.
Dengue haemorrhagic fever (fever, abdominal pain, vomiting, bleeding) is a potentially lethal complication, affecting mainly children. Early clinical diagnosis and careful clinical management by experienced physicians and nurses increase survival of patients.

By World Health Organization

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A Sri Lankan man stands near garbage piled on a street in the capital Colombo on June 26, 2017. Sri Lanka has suffered a record number of deaths from dengue fever this year, which the health minister blamed on a garbage disposal crisis.

Story highlights

  • More than 77,000 infections have been registered this year

  • The health minister blames a garbage crisis in the country's capital

 

(CNN)A deadly outbreak of dengue fever has ravaged the island nation of Sri Lanka, killing at least 227 people and infecting tens of thousands.

Experts worry the death toll could yet increase, as the country's health infrastructure struggles to cope with the virus' rapid spread.

"Dengue will get worse as flood waters recede further," Health Minister Rajitha Senaratne said in comments made to state-owned media outlet Daily News.

The government has deployed 450 troops in a bid to help combat the spread of the disease.

"We are assisting health inspectors to search for dengue breeding areas and have also set up temporary wards at the Negombo Hospital on the outskirts of Colombo to tackle the issue," Sri Lankan Army spokesman Brigadier Roshan Senevirathana told CNN.

Families are now struggling to find adequate care for affected individuals, with overcrowded hospitals turning away patients in need of urgent assistance.

Dengue is endemic in Sri Lanka. The last major outbreak in 2009 saw 25,000 infections and 249 deaths.

Dr. Priscilla Samaraweera, at the Sri Lankan National Dengue Control Unit, told CNN that healthcare workers are struggling to combat the virus, which is more infectious and fatal than other strains that have hit the Asian nation in previous years.

A Sri Lankan health worker sprays a neighborhood with a fog used to ward off mosquitos in January.
 

Rising threat

More than 79,000 infections have been registered since the start of the year, more than three times the number recorded in 2009.

Among those infected, the 5-year-old nephew of a man named Prasad.

Prasad, who goes by one name, told CNN his family called everyone to get his spot in a government hospital, to no avail.

They settled on an expensive spot in the Intensive Care Unit at a private facility.

"It is difficult to get doctor appointments. Almost all the hospitals are full in the Colombo area," Prasad said. "Two to three kids -- and even adults -- are sharing a bed meant for one person."

Delayed medical attention has been the leading cause for deaths arising from dengue, Dr. Ali Akram of the National Hospital in Colombo told CNN. The inability to find spaces in hospitals and long waits to get checkups has led to anger and frustration in families like those of Prasad.

Dr Fernando of Negombo Hospital told state media, "We have a problem about insufficient number of beds. There are only 17 beds in our High Dependency Ward where the blood pressure and cardiac status of each patient can be monitored continuously as each bed is equipped with a multi para monitor. However, in the past three weeks, we have had over 100 patients a day."

Overwhelmed

The current outbreak comes amidst large scale floods in the country earlier this year, which had raised fears of a dengue epidemic amongst vulnerable communities.

"We're particularly worried we could start seeing a further increase in the number of dengue cases because of the stagnant water that the floods will leave in their wake, which is the last thing needed by families and communities that have already lost so much," warned a statement released by UK-based charity Save the Children in May.

It also follows a continuing garbage disposal crisis in the capital Colombo, which recently saw a garbage dump collapsing onto dozens of homes.

The Sri Lankan Cabinet has approved a proposal put forward by the Prime Minister on a program "to have disposal of waste to recognized lands under environmental laws, take judicial action to prevent public protests on waste disposal, waste to be disposed only by grading, provide necessary tools for local government authorities and increase awareness of the public with regard to waste".

However, the health minister said that the government cannot work alone to solve the crisis. "One ministry alone cannot do this, all should come together and waste management should go hand in hand here".

Prasad blamed authorities for not doing enough to resolve the situation.

"If we wait like this, it will increase for sure. The government should declare an emergency," he said

Article sourse : http://edition.cnn.com

Dengue Fever Symptoms

Dengue Haemorrhagic Fever is a mosquito-borne viral infection endemic in the tropical and sub-tropical regions. The female Ae.aegypti (the most important vector) mosquito is semi-domesticated, preferring to lay its eggs in man-made water containers, resting indoors and feeding in the early morning or late afternoon. There are 4 serotypes of Dengue virus. Dengue usually occurs as epidemics in Sri Lanka following monsoon seasons.
According to data from epidemiology unit of Sri Lanka, the number of total cases recorded for year 2009 is 32713. Most affected district was Kandy. Colombo, Gampaha and Kaluthara districts which have been susceptible in the past have also recorded a high rate of infection and deaths.
Dengue virus; There are 4 serotypes of the single-stranded RNA virus (flaviviridae).
Patients become infected once bitten by mosquitos. The virus passes to lymph nodes and replicates which is followed by spread to the circulation and other tissues. It is thought that infection with a secondary serotype is what leads to severe haemorrhagic disease.
Disease varies in severity
- Incubation period is 2-7 days.
- All haemorrhagic fever syndromes begin with abrupt onset of fever (39.5–41ºC) and myalgia.
- Fever is often biphasic with two peaks.
- Fever is associated with frontal or retro-orbital headache lasting 1–7 days, accompanied by generalised macular, blanching rash.
- Initial rash usually fades after 1–2 days.
- Symptoms regress for a day or two then rash reappears in maculopapular, morbilliform pattern, sparing palms and soles of feet. Fever recurs but not as high. There may be desquamation.
- DF cases experience severe bony and myalgic pain in legs, joints and lower back which may last for weeks (hence breakbone fever).
- Nausea, vomiting, cutaneous hyperaesthesia, taste disturbance and anorexia are common.
- Abdominal pain may occur and if severe suggests DHF pattern.The signs of dengue fever/ Dengue haemorrhagic fever are- High fever, rash, hypotension and narrow pulse pressure, poor capillary refill.
- There may be hepatomegaly and lymphadenopathy.
- A tourniquet placed on an arm may induce petechiae in early DHF cases. DHF sufferers exhibit a bleeding tendency as evidenced by petechiae, purpura, epistaxis, gum bleeding, GI haemorrhage and menorrhagia. There may be pleural effusion, ascites and pericarditis due to plasma leakage.
- Petechiae are best visualised in the axillae.
- Flushing of head and neck.
- Tender muscles on palpation.
- Periorbital oedema and proteinuria may be present.
- Maculopathy and retinal haemorrhages may also occur.
- DSS pattern cases progress through DHF until profound shock due to severe hypotension is present.
- CNS involvement e.g. encephalopathy, coma, convulsions.

- Hepatic failure: Means failure of the liver
- Encephalopathy: Means damage to the brain causing fits, loss of consciousness and confusion- Myocarditis – Inflamation of heart muscles
- Disseminated intravascular coagulation - Damage to blood vessels and blood cells causing problematic bleeding and clottingDengue can cause death
- FBC - low platelets and high packed cell volume if haemoconcentrated. Usually white cell count will fall
- Infection may be confirmed by isolation of virus in serum and detection of IgM and IgG antibodies for Dengue by ELISA, monoclonal antibody or haemagglutination
- Molecular diagnostic methods such as reverse-transcriptase-PCR are increasingly being used.
- Chest X-ray may show pleural effusion.
- Bed rest
- Nutritious diet and lot of liquids, But avoid red and brown foods and drinks like coffee, chocolate, grapes etc as it may misinterpret vomiting as blood stained vomitus.
- Fever control with paracetamol, tepid sponging and fans. Aspirin should be avoided.
- Need to seek advice from a qualified medical practitioner if fever lasts for more than 2 days
- Hospital managemnt includes intravenous fluid resuscitation with close monitoring. Haemorrhage and shock will require Fresh Frozen Plasma, platelets and blood. Intensive management with inotropes of the shock syndrome may be required in severe DHF/DSS cases.
- Vaccines are being researched
- Anti-mosquito public health measures such as reducing breeding sites ( flower pots, fish tanks,tires, coconut shells, tins, water collecting plants, gutters which can collect water) and good sewage management
- Insecticides to destroy the larvae
- Mosquito nets can be used during day time as the Aedes mosquitoes is day-biting.
- Mosquita repellents
- There is a bacteria called Bacillus thuringiensis which destroy the mosquito larvea

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