Friday, September 25, 2015

Dengue, the menace which it is not!

Friday, September 25, 2015

There is a very thin line between increasing awareness and generating panic. Most of the discussions,especially on electronic media, on epidemics of diseases of larger public interest manage to cross this line. And like in so many discussions the anchor forgets his role and assumes the role of dictating the discussion rather than moderate it. There is such a forceful attempt to force personal views that the spirit of discussion is the casualty.

For most of the epidemics of infectious diseases, the end point of delivering health services that a doctor is cannot be held responsible for everything. Availability of beds, manpower, and infrastructure in government sector is not in the hands of a treating doctor.

Logically a civic body should be held responsible for diseases related to poor sanitation, unsafe drinking water, festering sewage lines, inefficient disposals of wastes. Diarrhea, Hepatitis, Malaria and Dengue are prime examples of these. For every death related to diarrhea and alike illnesses the authorities must be questioned and grilled, instead, the poor doctor has to bear the brunt. He is the easy target and it is so much easier to assault him and ransack his setup.

The discussion on these diseases should focus on the preventive aspects, on dissemination of information of red flag or danger signs as they are called, to make people aware and report in time for a proper management that could stall the interminable progress of the disease and prevent deaths. It is too much to expect from a doctor sitting in primary and secondary care setup to be able to provide intensive care to needy ones. The moot question is how many really need such a care? Here is the need to put things in right perspective, which is lost in the rhetoric and dramatics of discussions.

Perspective on dengue!

Dengue is a viral illness and like any other viral illness is vastly a self limited and minor illness. The symptoms are so nondescript and non specific that a clinical diagnosis is well nigh impossible. And like so many viral diseases there is no specific medicine (Or ANTIDOTE, as people will certainly love to have one!) against the viruses (there are 4 of them) causing this.

Today about 2.5 billion people, or 40% of the world’s population, live in areas where there is a risk of dengue transmission. Dengue is endemic in at least 100 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean. The World Health Organization (WHO) estimates that 50 to 100 million infections occur every year, including 500,000 severe cases and 22,000 deaths, mostly among children. If I translate it in terms of probabilities, you have 40% risk of contracting dengue if you are in the elite at risk group, you have only 0.5% risk of developing a serious form of the disease which is now called serious dengue, and those of us who are unfortunate to not to recognize the march of events and allow the relentless progress, a 3-4% risk of dying. The proportion case fatality is 220 per million cases of dengue, 0.022%! Each death is important, I shall say each life is important, and more so if the death is preventable to a large extent, but to subject millions of people to the terror of what in the end is a trivial, self limiting disease is a gross exaggeration in trying to make people aware.

The focus should be on what are the red flag signs!

Dengue fever causes moderately high grade fever, rash with severe aches, mostly severe backache (colloquially called back breaking fever) pain behind the eyes. Following this there is an apparent phase of improvement and in severe forms there will be vomiting, pain in abdomen, some red spots appearing, and reduction in urine output, change in alertness and in some bleeding. The biggest problem in serious dengue is a leak in our minute blood vessels, the capillaries. The fluid starts leaking out in to various tissues, effectively reducing the volume that is in the circulation and causing a drop in blood pressure and its entire attendant sequel.

The erroneous emphasis has shifted on to platelet drop in Dengue. Everyone seems obsessed with the numbers. The blood donation camps send the signals that this is the most important aspect of management which is life saving! NO IT IS NOT! Platelets are required in only a very few cases of severe dengue, they may do more harm than good. When a patient has serious bleeding he may require other things than platelets.

The central theme is basically fluid management in severe dengue, monitoring patient’s urine output, blood pressure and his hemoglobin level.

The message should be loud and clear, do not panic! If you are suffering from dengue, take plenty of water and keep count of how many times you void. In case of any thing that bothers you see a doctor sooner than later. Do not get platelet count every day, do not worry about numbers.

Preventive tips

There is no vaccine available against dengue, and there are no specific medications to treat a dengue infection. This makes prevention the most important step, and prevention means avoiding mosquito bites.

The best way to reduce mosquitoes is to eliminate the places where the mosquito lays her eggs, like artificial containers that hold water in and around the home. Outdoors, clean water containers like pet and animal watering containers, flower planter dishes or cover water storage barrels. Look for standing water indoors such as in vases with fresh flowers and clean at least once a week.

The adult mosquitoes like to bite inside as well as around homes, during the day and at night when the lights are on. To protect yourself, use repellent on your skin while indoors or out. Proper application of mosquito repellents containing 20% to 30% DEET as the active ingredient on exposed skin and clothing decreases the risk of being bitten by mosquitoes. When possible, wear long sleeves and pants for additional protection. Also, make sure window and door screens are secure and without holes. If available, use air-conditioning. The risk of dengue infection for international travelers appears to be small. There is increased risk if an epidemic is in progress or visitors are in housing without air conditioning or screened windows and doors.

Let us focus on generating awareness in true perspective, understand the warning signals, report early to health care facilities and contribute our bit to the preventive measures. Only such distant vision can be answer to short sighted discussions. One obsession that we have to get rid of is platelets and the number game!


  1. Dr Sanjeev Aggarwal25 September 2015 at 19:30

    Very nicely explained intricacies of dengue. must be shared widely at all available forums for the benefit of masses.

  2. Very precise n informative sir...thanx fr sharing๐Ÿ™๐Ÿป๐Ÿ™๐Ÿป