It was 2006 when people of Pakistan fell prey to a new disease spreading through mosquitoes. People suffering from this virus complained about intense fever, searing muscle and joint pain, in severe form blood seeping through the skin and possibly leading towards death. It was dengue which was once rare and considered only a topical disease but now threatening 50 to 100 million people across the globe and it is now endemic in more than 100 countries of the world. The first dengue case was reported in Karachi and it is said that the virus came in Pakistan through tyres imported from infected countries. Onward, the number of patients kept increasing every year and 2011 became worst when dengue attack was on its peak and the number of cases reported was highest in the world. The severest form of dengue fever inflicted unspeakable miseries and it haunted the mind of everyone especially Lahories.
It is the peak season for growth of dengue virus and its patients are also being reported in media these days. What is this disease and what it will take to stop are the common questions which I asked from Dr. Khalid Mahmud Khan, a member of Dengue Expert Advisory Group (DEAG), the body which gives training to doctors and also provides medical assistance to other provinces asks for.
“Dengue fever has earned many geographical names across the world. It is known as ‘Break Bone Fever’ and in East Africa it is called ka-dinga pepo, a disease of the devil.”
“It is a disease caused by a family of viruses that are transmitted by mosquitoes. It is an acute illness that usually follows with symptoms such as headache, fever, exhaustion, severe muscle and joint pain, swollen glands and rash. Other signs of dengue fever include bleeding gums, severe pain behind the eyes, and red palms and soles,” Dr. Khalid was saying as we were passing by different rooms and wards moving and heading towards his office in Ganaga Ram Hospital. He is treating dengue patients for the last seven years which has given him exposure to different complexities of this disease.
“The virus of this disease is transmitted by a striped Aedes aegypti mosquito that flourishes during rainy seasons but can breed anywhere in water like in flower pots filled with water or buckets or anything which can hold water. One female mosquito on average lays 100 eggs at one time and at least three times in her life. These eggs can survive years conditionally in favourable environment and hatch as get water,” the man in white gown was explaining as he was walking by my side in the long corridor.
“One mosquito bite can cause the disease and after being bitten it is usually five to eight days when the signs and symptoms of dengue appear in stages and if not treated on time can prove worse. However, the virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito-to-another-person pathway. It can affect anyone but people with compromised immune systems are easy prey,” he said as we entered a room within a room which was small but neat and looked tidy. There was already a doctor present in that room, greeted us.
‘Let’s have a seat and discuss it in detail,’ the doctor said as he dragged his chair near the table.
“Can we not get rid of this endemic forever,” I asked curiously and he responded with a smile on his face. “My dear it is not that easy. The prevention of dengue fever requires control or eradication of the mosquitoes carrying the virus that causes dengue and you know in our society it is not easy because our atmosphere is favourable for mosquito growth. Only through prevention we can save ourselves.”
“There are four different viruses that can cause dengue fever, all of which spread by that certain female mosquito. So any person may fall prey to dengue for multiple times but with different type. An attack of dengue produces immunity for a lifetime to that particular type to which the patient was exposed. If anyone is infected again and become ill, there is a greater risk of developing a harsher form of the disease but this is very unusual because, normally, previous exposure to a virus causes the body to carry antibodies that allow the body to fight off the virus more easily the second time,” Dr Khalid continued.
While I was listening to the doctor and taking notes, I was also contemplating that why there is no vaccine of this virus which is infecting humans from decades and when it is expected to be made and available in markets?
The doctor started explaining the recovery process. He was speaking and removing the misinformation about this disease in the society. “The majority of people suffering from dengue fever get better within two weeks. However, some individuals can suffer fatigue and depression for months after the infection,” he paused as if he had read my face that I had something to ask; and I put my question about its vaccine.
“Currently, there is no vaccine for dengue fever. There is a vaccine undergoing clinical trials, but it is too early to tell if it will be safe or effective. It is expected through clinical trials that vaccine may be available in next two years. The best way to prevent the disease is to avoid being bitten by mosquitoes. There is no specific medicine or antibiotic to treat it. For typical dengue, the treatment is purely concerned with relief of the symptoms. Rest and fluid intake for adequate hydration is important. But Aspirin or any other such medicine should only be taken under a doctor's supervision because of the possibility of worsening bleeding complications,” he answered.
The second doctor who was already present in the room and was listening to everything broke his silence and became the part of this discussion. He said that there were many patients in the hospital undergoing malaria treatment who came supposing that they were suffering from dengue fever. This led discussion towards the difference between malaria and dengue because the both are related to mosquitoes.
Dr Khalid having vast experience of treating these patients said, “The signs of dengue fever are similar to typhoid fever and malaria, which sometimes complicate the diagnosis. So to clarify we have to take some blood test to determine the real disease.”
There are lot of people who are living far-off areas of country and do not get medical assistance on time. What such people should do as general treatment, was a must question.
Dr Khalid advised that there are things that patients or the families can do to help, depending on the severity of the disease. These tips could be fruitful only for milder forms of dengue till the patients did not reach or get some good doctor.
The patients should drink maximum clean water, ideally bottled water rather than tap water, because high fever and vomiting can dehydrate the body and they should protect themselves from mosquitoes.
At the end the doctor also showed some dengue patients being treated in the hospital and how they are being protected from any wondering mosquito. He also lauded the role of the Punjab Government who assisted in every way medically to treat the patients and launched awareness campaigns to curb this devil’s disease from spreading.