Monday, September 19, 2011

News report Daily Times

Panic the enemy of dengue management

Rashed Rahman
Editor, Daily Times

LAHORE: Epidemics, particularly if they are new and unknown, tend to produce panic. Dengue has been on everyone’s mind in recent days. Reacting to the scare stories of this being an inevitably fatal affliction, thousands of citizens have crowded the hospitals in recent days for fear of having contracted the dreaded disease. So far, according to the Punjab government’s statistics, there have been around 6,000-6,500 confirmed cases of dengue fever. The rest of the crowds thronging the hospitals have been found to have other, perhaps more familiar and less scary problems. The ratio of dengue sufferers to other afflictions amongst those crowding the hospitals is around 16 percent. Panic set in largely because public awareness about dengue has been conspicuous by its absence.
To remedy this gap in public knowledge and perception, the Punjab government arranged a briefing for editors, anchors and commentators in Lahore on the issue of the dengue problem. The briefing was chaired by the Chief Minister, Mr Shahbaz Sharif, and conducted by the Sri Lankan dengue experts’ team graciously dispatched by Sri Lankan President Mahinda Rajapaksa to help Pakistan cope with the epidemic. Sri Lanka has decades of experience in the field since the country has been suffering from the disease for at least four decades.
Dr Risintha Premaratne, the Consultant Epidemiologist leading the Sri Lankan team revealed a few hitherto unknown facts and put the issue in perspective. First, some myth busting. The common belief that the dengue mosquito only breeds in clean stagnant water was debunked by showing photographs and a video made by the team in and around Lahore. This clearly showed female dengue mosquitos laying eggs in dirty stagnant water, and the larvae, which take about a week to mature, thrashing about. This implies that all kinds of stagnant water, whether in utensils, bins, and even crevices in trees and plants, in short any place where water can accumulate and remain undisturbed for some time is a potential breeding ground for the dengue mosquito. This obviously translates into a huge potential.
The team therefore suggests that unless all sources and sites of stagnant water are either drained or filled up with sand, the problem can only get worse. This is a task beyond the capacity of any government or even the state. It is necessary therefore to mobilise the whole community or society to make a contribution in homes, work and public places, in tandem with government efforts, to eliminate first and foremost the potential breeding grounds. This can and should be accompanied by spraying and other measures to kill the larvae and the grown mosquitos. As the argument implies, without mobilising the whole of society, the worst may be yet to come.
On the curative side, the team explained that since dengue is a virus, there is no cure known to modern medicine so far. However, in the overwhelming majority of cases, conservative management yields positive results. This includes the use of paracetamol or Panadol to bring down the fever and relieve joints pain. Aspirin must not be administered, only Panadol, because aspirin has deleterious side effects on the stomach and intestines. Patients suffering from the high fever and joints pain symptomatic of dengue fever are administered saline solution intravenously to correct the imbalance in the body’s enzymes, etc, that is an accompanying outcome of the disease. Blood tests are meant to establish the platelet count, which tends to fall after the onset of the fever. Normally, conservative management and treatment helps the body recover from the fever and pain and the restoration of enzymal, etc, balance in the body allows the body to produce platelets naturally. Platelet transfusion is only used in extreme cases. In Sri Lanka's experience, administration of unrequired platelets led to a few deaths. Caution and conservative treatment are the watchwords.
Fatalities are associated more with dengue haemorrhagic fever, transmitted by a different virus, which causes internal bleeding. In Sri Lanka, the proportion of this kind of fever amongst dengue sufferers is 35 percent. Fortunately, in Pakistan it is still only 5 percent. That implies that 95 percent of simple dengue fever patients can and do recover.
The Sri Lankan team was impressed by the response of the health regime in Punjab to the epidemic. They praised the system in place and the manner in which our doctors were coping with the workload, but stressed the need to make medical practitioners as well as the public aware of the true nature of the threat. This would help to allay the panic that has set in of late and allow the authorities to better control the epidemic. The media has been called upon by the authorities to help the public awareness campaign required to reassure people and mobilise them to combat dengue by eliminating its potential and actual breeding grounds all around us, in our homes, workplaces and common public spaces.

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