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Killer dengue
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Over the past few months, 135 cases of dengue have been reported in the city. Five deaths have, so far, been reported. The victims of this killer disease are younger and healthier, indicating an increased level of lethality.
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The world of Venu and Lakshmi came crashing down this past week, when their nine-year-old son, Arjun, succumbed to dengue fever.
"On Thursday, my grandson came back from school, with fever. My daughter, Lakshmi, a staff nurse at the S.A.T Hospital, took him to the hospital. The routine blood test revealed nothing; the blood count was normal. The doctor prescribed the Paracetamol tablet. His fever temporarily subsided only to shoot up later. On Monday, he was taken back to the hospital and a few more tests were conducted. The doctors suspected my grandson had dengue. While under treatment, Arjun went into a bout of fits; his temperature soared to 106 F. He later developed complications that ended in cerebral oedema. Within a few hours of being admitted to the intensive care unit, he collapsed," says Arjun's grandmother, Omana Amma (resident of Kumarapuram), a former staff with the Sree Avittom Tirunal (S.A.T) Hospital.
"Now the Corporation and health staff come here, fog and spray all kinds of pesticides to destroy vectors. But what is the use of doing all this now? Our child is no more... ," she breaks down. Venu, employed in Saudi Arabia, flew down to Thiruvananthapuram after being informed about his son's demise.
The victims of dengue are younger and healthier, indicating an increased level of lethality. According to A. Ghosh, health inspector, crisis management cell, "Over the past few months, 135 cases of dengue have been reported here, out of which, five persons have succumbed to dengue while four cases are suspect. Four deaths have been confirmed this month. In Thiruvananthapuram, most of the dengue reports have come in from within the city limits."
"Around 56 dengue cases have been reported from within the city corporation limits," says Dr. Abdul Rashid, District RCH Officer.
Statistics of the Directorate of Health Services paint a grim picture: the report, dated June 24, has confirmed 442 new cases of dengue fever, 668 new cases of leptospirosis, 433 new cases of Typhoid and 876 new cases of malaria. However, the unofficial figures far exceed the official ones. Cases of diseases such as dengue (`break bone' fever), leptospirosis (rat fever), typhoid, malaria and viral fever, have, over the past few months, reached epidemic proportions in the State.
The suddenness, with which cases of dengue have cropped up in the State, has alerted the Health authorities. Dengue, transmitted by the (female) mosquito, Aedes aegypti, is a febrile disease caused by a flavivirus with four distinct serotypes namely DEN-1, DEN-2, DEN-3 and DEN-4. These are four distinct but closely related viruses that cause dengue. A person infected with say, serotype 1, acquires lifelong immunity against that serotype, but has only partial or transient protection against subsequent infection by the other three serotypes.
"When a person who has recovered from dengue serotype I gets infected with Serotype 3 or 4, it is likely to prove fatal," observes Dr. V. K. Rajan, director of Health Services.
He points out that medical evidence and research indicate that sequential infection increases the risk of more serious disease resulting in dengue haemorrhagic fever (DHF), which is found to be a leading cause of death.
The onset of dengue is characterised by sudden rise in temperature and subsequent reversal, severe headache, appearance of rashes, severe pain in the joints, nausea and vomiting. The blood cells are crippled, often leading to bleeding of gums.
Lack of timely and proper clinical diagnosis and treatment aggravates the patient's condition. Similarly, lack of adequate infrastructure in primary healthcare centres and hospitals proves to be a stumbling block in effecting early and effective measures to control epidemics. A patient diagnosed with dengue or DHF has to be put on support treatment, which includes fluid replacement and correction of electrolyte imbalances apart from medication. In certain cases of severe DHF, gastrointestinal bleeding may also occur.
"Most people mistake dengue for common cold, and pop in a few tablets to bring down the fever," says Dr. Rajan.
Test for dengue infection include detection of antibodies in blood samples using IgM ELISA. The most common test used for the confirmation of an acute dengue infection is the enzyme immunoassay for dengue specific IgM.
Simultaneous detection of specific IgM and IgG antibodies to dengue virus in the serum and plasma helps ascertain the severity of dengue. However, doctors point out, IgM antibodies usually develop after the fifth day; therefore, obtaining accurate diagnosis is difficult. "This is what happened in my grandson's case. The final tests were conducted on the third day after he contracted fever," adds Ommana Amma.
"We have taken all precautionary measures and intensified steps to check the epidemic and control vectors. The District Medical Officers across the State are doing their bit. The Agriculture Department, NGOs and local agencies have been directed to step up awareness programmes on dengue, leptospirosis, malaria and other communicable diseases. Funds have been allocated to local hospitals. `Fever clinics' have also been set up at district hospitals. Routine blood test has been mandatory for all patients diagnosed with fever. Public laboratories and health centres have facilities for diagnostic tests," says Dr. P. K. Sivaraman, additional director, Health Services, Kerala.
The endemic areas have been mapped out. "The districts," says Dr. Sivaraman, "which have borne the brunt of the epidemic are Thiruvananthapuram, Kottayam, Ernakulam, Malappuram, Kannur, Kozhikode and Idukki."
"Awareness programmes are in full swing at the block, taluk, panchayat and district levels in the State. Monetary assistance to the tune of Rs. 10 lakh each has already been provided to the districts. An additional sum of around Rs. 140 lakh will be disbursed," adds Dr. Rajan.
"Now that so many people have fallen victim to dengue, malaria and leptospirosis, money is being spent and officials are talking about cleanliness and destroying vectors. Once the furore dies down, things will be back to square one," says V. Narayankutty, a septuagenarian.
SMITHA SADANANDAN
Photo: S. Gopakumar
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