Dengue Epidemic in 2004?

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The National Epidemiological Center reported that nationwide, there were 7,541 cases of dengue fever (with 80 deaths) from January 1, 2003 to August 17, 2003, an increase of 6.6% compared to the same period in 2002. Metro Manila had the highest (1262), followed by Central Visayas (944), Southern Visayas (862) and Northern Mindanao (834).

Dr. Socorro Entera, Region 7 coordinator of the dengue program in the Philippines, predicted in August 2003 that the dengue fever cases will reach "an epidemic proportion" in year 2004, based on the number of cases the past eight years. According to her, the life cycle of the dengue virus averages 3 to 5 years. The previous epidemics were in 1998 and 2001. Those who were infected before are expected to get the infection again, the second time around with a more severe course. It is possible for an individual to get dengue infection four times in his/her lifetime. Learning all we can about dengue can help in its prevention.

What is Dengue Fever?

Dengue Fever, which is on the rise again, is a severe, potentially fatal, hemorrhagic febrile disease caused by dengue viruses. The three clinical types include simple Dengue Fever, the Philippine, Thai or Singapore Hemorrhagic Fever or Acute Infectious Thrombocytopenic Purpura, and the Dengue Shock Syndrome.

When was the first case of Dengue Fever reported?

In 1956, Hammon established the relation of dengue infection to Dengue Hemorrhagic Fever, but report of this condition in Australian children was made as early as 1897. In 1981, Cuba had a large outbreak of this disease affecting more than 100,000 children and adults (with shock syndrome), 158 of whom died. In the Philippines, the 1997 first outbreak of dengue nationwide has been reported to have reached 13,024, with 236 fatalities, as of September 14, 1998.

How many recent cases in Cebu?

In the first quarter of year 2000, there were only 200 cases nationwide, compared to the 946 cases reported the first quarter in 2001. That year, there were 2148 cases in Cebu City alone. In 2002, there were 863 cases of dengue fever in Cebu City. As of June 15, 2003, the total cases for the year was 558, with 3 deaths. This was a more than 50% increase compared to the preceding year. Ninety-five percent of the patients were children below 14 years of age. Dengue fever, which is endemic in Cebu, can victimize any person of any race, age, gender, or socio-economic standing. Next to Metro Manila, Central Visayas ranks second highest among the various regions in the country.

How does one catch this disease?

Dengue virus is an arbovirus, meaning the virus is (arthropod-borne) carried and transmitted by an insect, in this case, by Aedes aegypti (daytime-biting) female mosquitos. These vectors or carrier mosquitos permanently inhabit and rapidly breed in stagnant pools of water or in tanks of drinking or bath water in the backyard of homes, which makes the situation more dangerous. The disease is more widespread during the rainy season. It is not transmitted directly from person to person. Only a deliberate timely, systematic, strategic, and simultaneous nationwide fogging (fumigation) program by the national government to eradicate these Aedes aegypti vector mosquitos could have a realistic chance of ending this dreaded and fatal disease once and for all. Of course, public support and compliance, to achieve environmental sanitation, is essential in eradicating this vector, and Dengue.

What are the symptoms of Dengue Fever?

While it can happen to adults, children (one to 9 years old) are the major victims of Dengue Hemorrhagic Fever. It starts as a relatively mild first phase, with an abrupt onset of fever (38-40 degrees) two to 7 days duration, skin rash, malaise, pain behind the eyes, headache, joint and bone pains, anorexia, vomiting, nose and/or gum bleeding, easy bruising, coffee-ground loose stools, and cough. This is followed, after 2 to 5 days, by rapid deterioration in the patient's condition and collapse. In this second phase, the patient usually has cold, clammy, extremities, warm body, flushed face, sweaty, restlessness, irritability, and upper mid-abdominal pains. There are dot-like bleeding under the skin in the forehead and palm and sole of the feet, and the patient bruises easily. In some cases, there may be convulsions, confusion and coma, and muscular spasm. The liver may be enlarged. In less than 10%, there is bleeding in the intestines and shock. The Dengue Shock Syndrome, which is a fatal stage, can sometimes happen in a day.

Has there been any disease which the Philippines has totally eradicated?

Yes, the Philippines, as a nation, can take pride in stating that, through its effective health program, was able to totally eradicate Small Pox, which epidemic used to kill thousands people daily in the 1800s and early 1900s. Hopefully, our government, in partnership with every family in the entire Philippines, could embark on an effective preventive program against Dengue, soon, and eliminate this disease forever, like what we did to the deadly Small Pox.

Is it true that local physicians can diagnose Dengue faster than physicians in the U.S.?

As a general rule, yes this is true. This is because our physicians in the Philippines and those in our neighboring countries are more familiar with Dengue Fever, which is common in these regions. Physicians in North America see Dengue Fever cases very rarely, if at all. Our physicians in the Philippines are more experienced in Dengue than the American physicians.

Where are the "Hot Spots" of Dengue Fever?

According to the National Epidemic Sentinel Surveillance System of the Department of Health, the "Hot Spots" are areas where there is an increasing number of cases of Dengue Fever for at least two consecutive weeks. These "Hot Spots" include Kalookan (Bagong Silang, Dagat dagatan, Grace Park, Maypajo), Las Pinas (CAA Compound), Manila (Pandacan, Sampaloc, Sta. Cruz, Tondo), Taguig (Western Bicutan), and Valenzuela (Karuhatan, Malinta, Marulas, Paso de Blas and Ugong).

What can I do to prevent catching Dengue Fever?

Prevention is the best, as far as illnesses are concerned. Dengue Fever is no exception. The most prudent strategy is to eliminate all possible breeding places of the Aedes aegytpi mosquitos, which carry the virus. These mosquitos love stagnant water and dark places. Eliminate pools of stagnant water (in tanks for drinking or bathing, or pools of water in the ground, in discarded auto tires, etc.) in your backyard. Cover your tanks of drinking or bath water. Use mosquito nets if you live in a house that is not totally mosquito-proof. Use mosquito repellant sprays, Katol, etc., if needed. But first, remove all stagnant pools of water by your home, and maintain a clean surrounding environment. Vaccines for the prevention of the different types of dengue fever are now available. The final elimination of the mosquito breeding sites, which is a function of the Department of Health and its regional centers, in cooperation with the people, will eradicate and prevent the infection.

If my child has symptoms of Dengue, what should I do ?

The first thing to do is to take your child to see your physician or to the health center, and do it right away. Do not delay this consultation. The earlier you see a physician, the earlier the diagnosis is made, and the earlier treatment could be started. The prognosis (final outcome) could depend on how early the diagnosis is made and the appropriate treatment started. And even if you doubt your own "diagnosis," the most prudent step to take immediately is to bring your child to a physician. It is better to err on the safe side.

©2003Raoul R. Diez, M.A.O.D.