When 15 year old Ashani (not her real name) came down with fever, her parents were not overly concerned. But a few days later she was in hospital urgently requiring blood transfusions. She had been infected with the Dengue fever virus. Several days of high fever suddenly took a turn for the worse and the young girl began hemorrhaging. Her condition was quite serious, but yet her parents had to go through quite an ordeal to obtain the blood she needed, from the Central Blood Bank. Today, Ashani is doing fine, but those close to her will not forget the trauma of those weeks of hospitalization.
Dengue fever (pronounced Dengie) has been raging through the city of Colombo at an alarming rate after the recent monsoon showers. Four years ago it was only found in Colombo but it is now quite common in other cities like Negombo, Kalutara, Kurunegala, Gampaha and Kandy. Every year the reported incidence of Dengue has increased, reaching near- epidemic proportions during the last two months - July and August. Spread by a tiny black and white speckled mosquito called Aedes, which is as active during the day as at night, Dengue fever has several states of manifestation. Most of us would be infected without any external symptoms or signs of a disease. Others could merely have fever with severe body aches. The hemorrhagic fever and Dengue shock syndrome which are the serious stages, have a potential death rate of about two percent.
The disease is an urban one- because the mosquito prefers to feed on humans . It affects all age groups but children, ironically, better nourished children fall prey to the disease more often than others. Statistics were difficult to obtain as they were still scattered over various hospitals- government and private. In the Lady Ridgeway hospital for children alone there were some 182 cases of Dengue in these two months. Four children aged 5 to 9 died of the disease in the hospital. Private hospitals too reported several patients suffering from symptoms associated with Dengue. Nawaloka Hospital recorded some 30- 40 cases of Dengue.
According to Health sources the disease begins to raise its ugly head after monsoon rains because the infection carrying mosquito breeds in clear water that is stagnant. That means the breeding grounds of this mosquito are in rainwater filled tyres, pots, vases, ant traps and birdbaths. The mosquitoes find breeding places in the tyres and barrels used as security barricades in the city . The larvae of the parasite can survive dormant for months until rains arrive - which is one way that the disease is spread to the out stations.
The danger in dengue is that its early symptoms say nothing of the deadly disease that it is. The initial symptoms of fever and body aches could be easily mistaken for a flu. This could be fatal for the patient , especially if he is not rushed to hospital in time to deal with the hemorrhaging.
“One way of identifying dengue is that the disease would not show signs of influenza as would a normal flu,” Dr. Maxi Fernandopulle , Senior Pediatrician at Lady Ridgeway Hospital said. According to Dr. Fernandopulle, the fever and aches should be treated at home . The time to enter a hospital is when the patient shows signs of bleeding, external or internal.
Hemorrhaging or bleeding in a Dengue patient could be seen as flushing of skin, red blotches on skin, red, brown or black substance in vomit or faeces. If any of these signs are apparent then the patient should be taken to hospital for proper care, before the bleeding gets out of hand and the patient enters what is called the Dengue shock state, which is a result of blood losing fluid. Sometimes blood transfusions are necessary for the patient to recover from the blood loss. “But often, IV fluid is enough to restore the blood composition,” Dr. Fernandopulle said. Dengue patients bleed because the virus causes weakness in the blood vessels resulting in the loss of fluid through the vessel wall.
“What we see as Dengue hemorrhagic fever is just the tip of the ice berg,” Dr. Fernandopulle said. There are so many who have been infected with the virus, but our bodies have developed the antibody and fought the virus without the symptoms becoming apparent. But the danger is that Dengue can recur- upto four times, because the virus has four types . Each succeeding attack would be more ferocious than the preceding one.
“We have seen that the majority of those who hemorrhage from Dengue are suffering from a second or third attack,” Dr. Nalini Vithana, Virologist at Medical Research Institute said.
There are no drugs to fight the Dengue virus. The only recourse for those infected with Dengue is to get sufficient rest and control symptoms like fever, so that the body can build its own antibodies to fight the virus. It is also not a disease that is confirmed by blood reports. Blood testing is done, of course, but the tests are more useful for epidemiological work than for the patients to get treatment.
Tests for the Dengue antibody in blood are done by the Medical Research Institute once a week. For this two blood samples are necessary- one taken at the outset of the illness and another after two weeks. According to Dr. Vithana, the MRI tests some 250 samples every week - not all test positive- for viral antibody . This test can also determine whether the patient is suffering from a first attack or secondary infection. MRI provides this service free of charge for hospitals and charges Rs. 50 per test for others. “Be warned of private clinics offering Dengue tests for exorbitant prices,” Dr. Fernandopulle said.
Parents also complained of the difficulties they had to undergo when trying to obtain blood for their children hemorrhaging due to Dengue “The private hospital where my child was warded asked for two donors of the same blood type if they were to release the quantity needed for the transfusion. When I went to the Central Blood Bank , they were lethargic and came up many excuses as to why they could not supply the blood,” an angry and frustrated father told The Sunday Times. When we contacted the Blood Bank, we were told by the Director, Dr. Bindusara that she would not speak to the press without permission from higher officials at the Ministry of Health.
During the past four years when Dengue has hit the country with a vengeance, the incidence of the disease has been continuously on the rise. Doctors agree that this year the number of cases were extraordinarily high. “This could be because of the rainfall pattern of intermittent showers or maybe because of some different virus,” Dr. Vithana said.
She said that the numbers are still on the increase this year. “Every month we have more cases than last,” she said.
Dengue is here to stay,” Dr. Maxi Fernandopulle said. “With the next monsoon it will rise again. The only way to prevent the disease is to keep ones neighborhood clean.”
Preventing Dengue cannot be an individual effort, people must make it a community effort . Since the mosquito can fly almost a kilometer, you could easily be infected by your neighbours mosquitoes even if your own compound is free of the speckled horror.
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