Dengue

By Pebbles Mendoza

Everyone is consumed with horror thoughts of COVID-19 at present. But let’s not forget there are still many other life threatening diseases out there. They haven’t miraculously disappeared.

Six-year-old Elsa was struck with fever one night after two days of heavy rain. But there was something different; she appeared flushed. She was irritable and had a poor appetite although she never complained about food. Sarah, her mother, observed that her daughter’s flushed skin had some white areas, but she just ignored it.

Sarah thought the fever was just ordinary so she did not bring her daughter to her doctor and instead gave her paracetamol, which she believed would help subside the fever. The fever vanished one day only to return the following day. On the seventh day of on-and-off fever, Elsa experienced what most doctors called as “shock.”

“Elsa was breathing rapidly,” Sarah recalled. “She was restless and her pulse was beating fast. Her skin was cold and clammy and she felt drowsy all the time. She was vomiting and blood was oozing from her mouth. Then, she completely lost consciousness.”

Sarah brought her daughter to the nearest hospital, some thirty minutes away from home. One of the doctors tried to pull Elsa out of shock by replacing the fluids and blood she lost, but it was all in vain. The doctors failed to save her.

Dengue Symptoms

High Fever (40°C/ 104°F) is usually accompanied by at least two of the following symptoms:

• Headaches

• Pain behind eyes

• Nausea, vomiting

• Swollen glands

• Joint, bone or muscle pains

• Rash

Elsa died of what is considered as the most widespread mosquito-viral disease in the world. “After a dengue patient has gone into shock,” the doctor who tried to save her explained, “it is just a matter of time before multi-organ failure occurs and death becomes inevitable.”

Dengue has been known for over 200 years, with the first reported cases arising in 1779 and 1780 from a simultaneous outbreak in Cairo, Egypt; Jakarta, Indonesia; and Philadelphia, United States. It has been in the Philippines since the 1950s, and until now, we haven’t been able to eradicate the disease.

One study on the prevalence of dengue estimates that 3.9 billion people are at risk of infection with dengue virus. Despite a risk of infection existing in 128 countries, the World Health Organization (WHO) reports, 70 percent of the actual burden is shouldered by Asia.

Last year, the Department of Health (DOH) declared a national dengue epidemic when almost a thousand people died of it. “It’s important that a national epidemic be declared so that local government units can use their quick response fund to address the epidemic situation,” said Health Secretary Francisco Duque.

The dengue virus is transmitted by female mosquitoes, mainly of the species Aedes aegypti and, to a lesser extent, A. albopictus. These mosquitoes are also the vectors of chikungunya, yellow fever, and Zika viruses.

The Aedes aegypti mosquitoes live in urban habitats and breed mostly in man-made containers. They are daytime feeders, whose peak biting periods are early in the morning and in the late afternoon before sunset.

Only the female mosquitoes bite as they need to be fed several times between each egg-laying period. Once a female has laid her eggs, these eggs can remain viable for several months, and will hatch when they get in contact with water.

It is only when they become adults that these mosquitoes can infect people. After feeding on an DENV-infected person, the virus replicates in the mosquito midgut, before it disseminates to secondary tissues, including the salivary glands. The time it takes from ingesting the virus to actual transmission is about 8-12 days. Once infectious, the mosquito is capable of transmitting the virus for the rest of its life.

Mosquitoes can become infected from people who are carrying the dengue virus. This can be someone who has a symptomatic infection, someone who is yet to have a symptomatic infection (pre-symptomatic), but also people who show no signs of illness as well (asymptomatic).

A small proportion of cases can progress to severe dengue, which can occur in both adults and children. A rapid deterioration can occur 2-5 days after onset of fever. The complications of severe dengue can lead to collapse and sometimes death.

The recovery phase takes place in the next 48 to 72 hours in which the body fluids go back to normal. The patient’s general wellbeing improves. The white blood cell usually starts to rise soon after defervescence but the normalization of platelet counts typically happens later than that of white blood cell.

Most of those who suffer from dengue are children. Approximately 36 percent of annual dengue infection occur among children aged 1-9 years, and the average age of infection is 12 years old.