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As numbers rise, NS1 antigen test a priority in times of dengue – Dr. Fernando
Dengue is on the rise with numbers jumping up. The weekly update issued by the Health Ministry’s National Dengue Control Unit showed a rapid rise in the week November 1 to 7 (826 cases) from the previous week (759 cases).
The danger districts as usual were Colombo with 295 cases and Gampaha with 188 cases for that week, with the overall infection number for the year being 22,795. These, however, are the notified numbers and the actual numbers could be much higher.
“If a person or child has fever above 100°F or 37.8°C for over 24 hours, it is important to get a Dengue NS1 Antigen test, a full blood count (FBC) and a C-Reactive Protein (CRP) test done,” urges Consultant Paediatrician Dr. LakKumar Fernando who is the Clinical Head of the CentreforClinical ManagementofDengue & Dengue Haemorrhagic Fever (CCDDHF), Negombo.
Explaining his thinking, he says dengue is endemic in the country and this is the need of the hour when there are signals that we are heading for a dengue epidemic like right now. If people living in an area which has dengue or there is dengue in their neighbourhood get fever, the dengue antigen test is a priority. This, however, would change in non-dengue times.
“What we need is to get a head-start about dengue before it takes control of a patient. This is why even if someone cannot afford all three tests – dengue antigen, FBC and CRP – the first priority should be the dengue antigen because dengue can quickly go down the slippery slope and end in severe disease and death,” he reiterates.
He points out that the antigen test would provide an accurate answer – whether positive or negative for dengue – in over 95% cases after the first 24 hours of fever. This is very early in the disease and something not seen with regard to many other conditions. It is also helpful to clinicians.
Commending Sri Lanka’s management of dengue in the past decade or more, he says in 2009, the country’s track record was not that good – 35,000 dengue infections with 1% deaths (346 deaths). But good management has brought down the death rate to 0.05%. Now the need is to cut that down further and save, if possible, all the lives of patients who fall victim to dengue.
“The saving of 325 of 345 people from death (20 times less) is a ‘major achievement’ for Sri Lanka and now we should strive to stop the other 20 from dying and bring it down to zero,” says Dr. Fernando, urging people whose FBC indicates the platelets dropping closer to 100,000 to get themselves admitted to hospital. When the platelets begin the downward trend from 150,000, there is a need for scanning for fluid leakage and close monitoring.
He says: “This can be done by being more proactive and arming ourselves with knowledge, through the dengue antigen test (the results of which come in 15-20 minutes), whether the patient is having dengue or not, whereas the FBC result would come in after several hours or longer. By that time, a patient who may be having Dengue Haemorrhagic Fever (DHF) may be in serious trouble.
“Arguments whether some dengue antigen test kits are good and some are bad should not prevent this vital test being performed. We must ensure that the people have quality test kits, like the right types of face-masks against COVID-19.”
When a patient is brought to hospital, there is a need now to think of dengue as a culprit. Therefore, doctors also need to perform an ultrasound scan to spot the leakage of fluid if the platelets are down to 100,000 or less which indicates the critical stage of DHF, says Dr. Fernando, adding that there needs to be constant monitoring by staff after that.