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Monday, 11 September 2006

Being clean is dengue deterrent
By Maan Lopez de Leon

One of the most prominent, and feared illnesses in our country is dengue fever. This disease, though dreadful, is one of the most easily preventable diseases. The key to its prevention is simply cleanliness of both self and surroundings.

Before we go into the details of what we can do to prevent this disease, let' s take a brief look into just what dengue fever and dengue hemorrhagic fever (DHF) are. The culprit behind this health menace is the dengue virus, carried by an infamous mosquito called A. aegypti.

Dengue fever is the clinical manifestation of an infection by dengue virus. DHF results in an individual's second infection with the virus, but with a different viral serotype from the first exposure. DHF is accompanied by severe shock. There are four different serotypes (1-4), all of which are present in the Philippines. There are no specific differences among the four serotypes in terms of clinical course, treatment and prevention.

An infection with one serotype does not protect against a repeat infection with another serotype, and as already explained, and the virus, as a repeat offender, may cause a more severe illness.

The average incubation period for dengue fever is 2 to 7 days, during which an infected patient usually experiences sudden high-grade fever, headache, pain around the eyes, accompanied by backache and muscle pain. During the first day of infection, rashes may appear along with enlarged tonsils, vesicles on the roof of the mouth and red eyes. The disease, on average, lasts a week, with the victim experiencing loss of appetite, nausea and vomiting. The skin is very sensitive during this time. Once the fever breaks, rashes may appear, starting from the trunk then spreading to the arms, legs and then the face. Nosebleeds and scattered pinpoint hemorrhages may also be present in uncomplicated cases.

According to the Department of Health's Consensus Guideline on Dengue Case Management, the presence of the following signs on an outpatient consult should make the physician suspect dengue fever:

1. history or presence of fever for 2-7 days
2. skin flushing or rash, and/or positive tourniquet test

8 with no danger signs

(A tourniquet test is performed using a BP apparatus. The cuff is inflated to the patient's mean arterial pressure for three minutes. It is then released, and the presence of pinpoint hemorrhages at the angle of the elbow on the patient's forearm is a positive test.)

For these cases, the patient is usually sent home and asked to return daily to their physician for follow up until two days after the fever has disappeared.

On the other hand, patients already in hospital, the following are danger signs:

• spontaneous bleeding
• persistent abdominal pain
• persistent vomiting
• listlessness
• changes in mental status
• restlessness
• weak rapid pulse
• cold and clammy skin
• difficulty of breathing
• seizures
• low blood pressure
• platelet count (100,000 cells per cubic millimeter)
• hemoconcentration
• prolonged bleeding time

The usual management involves adequate hydration, medical support of blood pressure and transfusion with platelets if necessary. Antibiotics are not routinely given and have no role in treating the primary infection. The patient can be sent home they have 2-3 days of complete recovery from shock, is symptom free without any danger signs, has good appetite, good urine output and no signs of bleeding, has a rising platelet count, normal bleeding time, with no cardiac or central nervous system involvement or other complications.
Local infection statistics

According to Dr. Lyndon Leesuy from the Infectious Diseases section of the Department of Health, there were a total of 16,162 dengue cases in the Philippines in 2002. Of these cases, there were 183 deaths. Seventy percent of the dengue cases involved children usually from congested areas, with most of the cases occurring during the rainy season. At present the number of cases is already slowly rising with the approaching rainy season. He expressed the importance of a clean environment in the prevention of dengue fever. Dengue, according to him can be avoided by preventing its vector, Aedes aegypti from being able to breed, and this can only be done by keeping our surroundings clean. In Dr. Leesuy's words, "No mosquitoes, no dengue."

Much of the Department of Health's efforts on preventing dengue are centered on dengue awareness, especially on educating the Filipino people about the various preventive measures that can be done. This preventive program is called "Goodbye Kiti-kiti, Goodbye dengue" and presents the following measures:

1. Keep drums, pails, and other water containers well-covered so as not to serve as Aedes aegypti breeding places.
2. Clean and scrub the sides of water containers well at least once a week. Mosquito eggs usually attach to these.
3. Old tires should be disposed of. Those used to keep roof in place should be punched with holes to prevent these from collecting water.
4. Change the water inside flower vases at least once a week.
5. Keep spouts and drains clean to prevent water from collecting in them.
6. Throw away used cans and bottles that may collect water and serve as breeding places.

It is not really difficult to prevent dengue as these preventive measures propose. Keeping our surroundings clean is crucial in making our country dengue-free. All it takes is an open mind, a love for health, respect for the environment, hunger for awareness and lastly vigilance in keeping the dengue-free campaign a constant action. In the end, the environment is clean and lives are saved.

For those who have questions on dengue, you can call the National Center for Disease Control and Prevention of the Department of Health's hotline at 743-8301.

Special thanks to Dr. Lyndon Leesuy of the Department of Health.

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