Some time ago, I received a weeping call from my sister. In a choked voice, she said that her nine-year-old kid had been admitted to a private nursing home and a provisional diagnosis of dengue was made by the consultant paediatrician based on clinical symptoms. Worried, I called up my paediatrician-friend to garner more information about the disease, and its recent outbreak, especially in Tamil Nadu.

I was startled at the revelation that a large number of deaths due to dengue/dengue haemorraghic fever (DHF) occur every year but many cases go unnotified. This can be attributed partly to the health care facility fearing unnecessary queries and partly to the public health authorities' reluctance to register cases.

Every year, after the onset of monsoon the incidence of dengue is annoyingly high, but the Public Health Department fails to acknowledge it until there is intense public outrage and agitation after the death of a child/patient. Under the National Vector Borne Disease Control Programme, fogging/focal spray should be carried out within a 100-metre radius of residence and the workplace of the patient, that too only if a dengue fever case is confirmed by a serological test (a blood test).

Spraying operations are not efficacious, owing to the increased resistance offered by the winged vectors.

Records show only a very small number of reported cases, though the actual incidence is disturbingly high. This is attributable to the fact that the department takes into account only confirmed cases. How can one expect the figures to escalate in the records when most of the government hospitals are lacking diagnostic kits?

Viral fever

It's a type of viral fever transmitted by the bite of a particular group of mosquitoes (Aedes aegypti). The disease, affecting infants, young children and adults incapacitates the patient with the abrupt onset of high fever, severe headache, pain behind the eyes, muscle and joint pains, and skin rash.

DHF is a potentially deadly complication that is characterised by high fever, abdominal pain, often with enlargement of the liver and bleeding tendencies and, in severe cases, it causes circulatory failure and death.

There is no specific treatment or vaccine for dengue fever. Treatment is only supportive care, but prevention is possible by preventing mosquito bites.

The mosquito bites during the day and breeds primarily in water storage containers, water collected in used old tyres, flower vases, plastic cups, broken earthen and glass wares in and around human dwellings.

The right to health guaranteed by the Constitution includes the right to safe environment and the onus lies with the government to provide a safe living environment to its citizens. Just thrusting a few pills into the patient's hand free of cost doesn't complete health care. Not only dengue, but malaria, Japanese encephalitis, lymphatic filariasis, kala-azar, and chikungunya are transmitted by mosquitoes.

With the slackness shown by the government in implementing routine mosquito control measures, the mosquito repellent industry has grown into gigantic proportions.

The market size of mosquito repellents (mats, coils, vaporisers or as liquids) in India is placed at a whopping Rs. 8.25 billion, and is expected to grow exponentially in the coming years. But these repellents are not totally safe. Burning a mosquito coil in a closed room is equivalent to smoking 20 cigarettes and the smoke is carcinogenic, besides causing exacerbations of asthma, COPD (chronic obstructive pulmonary disease) and allergic rhinitis. Similar are the side-effects of vaporisers but the intensity is less. Mosquito repellent creams cause severe allergic rashes in susceptible individuals. Doesn't the government help tycoons indirectly in this lucrative business?

Alexander the Great and his powerful army were deterred by Indian mosquitoes. It's almost 2,500 years down the lane that we are still unsuccessfully battling against this lethal-winged minuscules, despite our being armed with all scientific advancements. Besides the government, every citizen has the responsibility to keep his environment clean to get rid of this deadly little dragon.

(The writer, a consultant pulmonologist, can be contacted at drpdorai@yahoo.com)

Keywords: dengue fever