News Features  


DENGUE Urgent prevention the only medicine

By Tharindu Prematillake
2009 recorded the most number of people infected by the dengue virus (35,007) and the most number of people killed by it (346). Unfortunately, today, the chance of being infected by this deadly virus is a reality. This article explains the spread of the dengue virus over the past couple of years, thoughts from experts as to why the virus has taken such a dramatic turn for the worse, and finally, gives some of the basic facts about the dengue virus, that may help you avoid being bitten by the deadly dengue mosquito Prompt Action Needed
Graph A shows that the number of dengue cases in 2009 is dramatically high, when compared with previous years. In 2008, only 6,555 dengue cases were reported. However, in 2009, that number has risen to 35,007 cases. When looking at the data for 2010, the situation is even graver. The first 45 days of this year has reported 6,638 cases, compared with around 1,800 cases for the same period in 2009. If the number of cases continues at the current rate, there will be approximately 53,000 cases by the end of 2010. However, after looking at the weekly distribution of dengue cases for the last few years (Graph B), one thing that is apparent is that, the number of cases spike up between the months of May and August. If this spike between May and August is also accounted for, the actual number of dengue cases for this year could be well over 53,000.

Dr. Nimalka Pannilahetti, Coordinator National Dengue Prevention Unit
Coordinator- National Dengue Prevention Unit, Dr. Nimalka Pannilahetti acknowledged that there was a sharp rise in the number of cases over the past year. She said that lack of proper waste management has played a major role in the dengue virus being on the rise. “In certain areas, there is very poor waste management. There is so much waste in which mosquitoes can breed in. Such places have accumulated for a while and have assisted dengue mosquito breeding”.

She also said that improved reporting has ensured that more cases have been recorded unlike in the past. Dr. Pannilahetti also said that the increase in the number of people travelling to and from the North and East, has also resulted in the dengue virus spreading across the country. “You won’t see symptoms of the virus immediately. After the war ended, people have been travelling much. So, if a person infected with the virus travels to several places before the symptoms show, there is a high likelihood that he will be bitten by mosquitoes that will in turn carry the virus to another person.”

When questioned on what new steps were being taken to combat the virus, Dr. Pannilahetti said that, they have started programmes to educate the public on how the dengue mosquito breeds and the importance of destroying such breeding places. “There is only so much we can do. It is really up to the people to take responsibility and destroy places that breed mosquitoes. Some people don’t realise the role they have to play in this, until a family member gets the dengue virus. You can’t wait for that to happen”. Furthermore, she added that, special instructions have been given to Medical Officers of Health (MOH), Public Health Inspectors (PHI), doctors and nurses, on the role they can play in curbing the spread of dengue.

It was recently reported that Sri Lanka is the first country in the Asia Pacific region to successfully eliminate Malaria. The Nation queried from Dr. Pannilahetti why it was not possible to achieve the same success in fighting dengue. “There are medicines for malaria, which will completely cure the patient. On the other hand, there is no direct medication for dengue. All we can do is treat the symptoms. The other reason is the malaria spreading mosquito rests in open areas such as walls, so it is easier to kill them by using the necessary sprays. However, the dengue mosquito is harder to kill in that manner, because they prefer to lay on clothes, and other hard to reach dark corners. This is why we haven’t been able to combat dengue as successfully as we did malaria”, she explained.

Dr. Nihal Jayathilaka, Secretary- Ministry of Health & Nutrition
Acting Secretary- Ministry of Health & Nutrition, Dr. Nihal Jayathilaka said that fighting dengue are two pronged. He explained that, on one hand, the government is trying to assist people already infected by dengue, by giving special instructions to doctors and nurses on how to deal with dengue patients. “The other aspect of combating dengue is mosquito control. We need multi disciplinary action, in order to combat dengue properly. So, we are in the process of setting up a special task force to address this issue. The papers are prepared and we are now awaiting Cabinet approval. I will head the task force and it will comprise the Secretary or a representative from the Education ministry, Environmental ministry, Media ministry, representatives from the provincial and local governments, the Director General of Health Services, chief of the Epidemiology Unit, the Coordinator of the Dengue Control Unit and a representative from the WHO,” Dr. Jayathilaka said. He also added that the ministry intends to significantly increase funding to combat dengue.

Saliya Chandrakumara, Secretary- Health Inspectors Union
PHIs are responsible for inspecting dengue breeding grounds, advising the public on ways to prevent the spread of dengue, and taking legal action against those who do not destroy dengue breeding grounds. Secretary- PHI Union, Saliya Chandrakumara said, “We inspect areas that are known to be infested with dengue mosquitoes. If we see mosquito breeding grounds, we advise the owners to destroy such locations. If they don’t take any action, then we send them an official notice. If still no action is taken, then we take legal action.”

However, Chandrakumara noted that they face several serious drawbacks when performing their job to safeguard the public from the dengue menace. “One of the major problems is that we don’t get enough support when we try to pursue legal action. The Prevention of Mosquito Breeding Act was introduced in 2007. We saw some major flaws in the Act and informed the necessary people several times about these deficiencies. However, in 2009, the Act came into force, and no one had even considered the amendments that we suggested. There are several adverse consequences of our suggestions being ignored. One such consequence is that, if we decide to take legal action against someone who has not taken steps to destroy mosquito breeding places, that person can easily get away from litigation, if he has a good lawyer who has read this Act properly. There are loopholes in this Act. If the officials are serious about reducing the spread of dengue, they need to plug these loopholes”.
Chandrakumara also pointed out that funds received for dengue prevention are not being properly allocated. He said that in certain areas, even the travel costs of PHIs has not been paid. He queried how proper inspections can be carried out under such circumstances.

Facts about Dengue Symptoms
The first symptoms of dengue fever are headaches, chills, vomiting, aches and pain in joints, low back pain that may be followed by a spread of bright red spots around the body. These symptoms become apparent three to 15 days after being stung by the virus carrying mosquito. The temperature can rise to an uncomfortably high 40 degrees Celsius within a few hours, after the initial display of symptoms. Glands in the neck and groin will swell, followed by reddening of the eyes. These initial symptoms will last two to four days, after which the fever will drop rapidly.
After the fever drops to normal, the patient will enjoy one or two days of feeling completely normal. However, this ‘lull’ is again followed by high fever and a rash that spreads all over the body, except on the face.

As of yet, there is no antibiotic or medicine to specifically cure dengue, because it is a virus. The medication done when you are diagnosed as a dengue patient, is to reduce the symptoms that accompany the virus. Doctors stress on the importance of constant intake of fluids to keep the body hydrated.
Non-steroidal medicine and aspirin should be avoided, because they will exacerbate any internal bleeding.

The Dengue Mosquito
(Aedes aegypti)

The dengue virus does not spread from person to person. It can only spread by being bitten by a mosquito that is already carrying the virus.
The Aedes aegypti mosquito that has stripes and black spots on its legs spreads, the dengue virus. This mosquito usually bites people during the daytime, it lives indoors and likes to hide under dark furniture, within dark clothes and pots. It usually bites people’s ankles and feet, it is harder to catch because it moves very quickly, the bite is usually painless, therefore, people may not even feel the sting.

Unlike most other mosquitoes, Aedes aegypti does not breed in dirty swaps and drains. The usual breeding grounds are places that collect rain and run off water such as plant pots, jars, open cans, tires, blocked roof gutters, boats, buckets and unused wells.