Dengue Deadly Fever in Indian Context

 

Chetan S. Patali¹, Susheel Kumar V. Ronad², Suvarna S. Pinnapati³

¹Principal, Dhanush Institute of Nursing Sciences. Bagalkot.

²Lecturer/Assistant Professor. Department of Psychiatric Nursing DIMHANS Dharwad.

³Vice-Principal, Dhanush Institute of Nursing Sciences, Bagalkot.

 

ABSTRACT:

Dengue fever, also known as breakbone fever, is a mosquito-borne infection that can lead to a severe flu-like illness. The Aedes aegypti mosquito is the main vector that transmits the viruses that cause dengue. The viruses are passed on to humans through the bites of an infective female Aedes mosquito, which mainly acquires the virus while feeding on the blood of an infected person. . Today it affects Asian and Latin American countries and has become a leading cause of hospitalization and death among children and adults in these regions. Symptoms vary depending on the severity of the disease, it can be divided in to Mild dengue fever, Dengue hemorrhagic fever and Dengue shock syndrome on the basis of severity of the patient classification of the dengue will be considered. Treatment will fall in so many classified areas accordingly their severity first comes Preventing dehydration, Painkillers, such as Tylenol or paracetamol and Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, are not advised, as they can increase the risk of internal bleeding. Prevention can be done by Clothing Reduce the amount of skin exposed by wearing long pants, Mosquito repellents, Mosquito traps and nets, Door and window screens.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INTRODUCTION AND BRIEF STATISTICS OF DENGUE:

Dengue is fast emerging pandemic-prone viral disease in many parts of the world. Dengue flourishes in urban poor areas, suburbs and the countryside but also affects more affluent neighbourhoods in tropical and subtropical countries. Dengue is a mosquito-borne viral infection causing a severe flu-like illness and, sometimes causing a potentially lethal complication called severe dengue. The incidence of dengue has increased 30-fold over the last 50 years. Up to 50-100 million infections are now estimated to occur annually in over 100 endemic countries, putting almost half of the world’s population at risk. Severe dengue (previously known as dengue haemorrhagic fever) was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Today it affects Asian and Latin American countries and has become a leading cause of hospitalization and death among children and adults in these regions. Member States in three WHO regions regularly report the annual number of cases to the Secretariat.

 

Figure 1 shows the number of dengue cases (suspected or confirmed) notified to WHO since 1990. The actual numbers of dengue cases are underreported and many cases are misclassified.

 

One recent (2013) estimate indicates that 390 million dengue infections occur every year (95% credible interval 284–528 million), of which 96 million (67–136 million) manifest clinically (with any severity of disease).¹ Another (2012) study, of the prevalence of dengue, estimates that 3.9 billion people in 128 countries are at risk of infection with dengue viruses.

 

The full life cycle of dengue fever virus involves the role of mosquito as a transmitter (or vector) and humans as the main victim and source of infection.

 

Dengue cases and deaths due to the disease have been rising across the southern states of Kerala, Karnataka and Tamil Nadu in the post-monsoon period.

 

India had reported a total of 87,018 dengue cases and 151 deaths until 15 October. Of this, the highest number was reported by Kerala at 18,908 cases, followed by Karnataka at 13,235 and Tamil Nadu at 12,945. The number of deaths was also the highest in Tamil Nadu at 40, followed by Kerala at 35 and Uttar Pradesh at 24. Karnataka has reported five deaths so far.

 

Dengue cases in Tamil Nadu have risen nearly seven times and deaths due to the disease 10 times compared with last year. The state recorded 1,895 cases and four deaths in 2016 till 31 October. In Kerala, the total number of cases was 6,725 and 13 deaths while Karnataka reported 5,230 cases and eight deaths. The worst affected districts in Kerala due to dengue are Thiruvananthapuram (8,324), Kollam (2,752), Alappuzha (1,293), Kozhikode (1,292) and Thrissur (841). Huge cases in Karnataka are from Mandya (824), Kalaburagi (770), Davanagere (756) and Mysuru (757). Similarly, Thoothukudi (1191), Chennai Corp. (1,177) and Sankarankoil (1,084) are recording maximum cases in Tamil Nadu.

 

Apart from these states, West Bengal (5,389 cases) and Delhi (5,220 cases) also continue to remain affected with dengue. “In West Bengal, there was an overcrowding due to Durga Puja recently due to movement of people. The viruses DENV 2 and DENV4 of dengue are circulating in West Bengal and the clinical manifestation is different and concerning this time because there is an organ involvement during the diseases.

 

The city has seen 4,280 dengue cases since January this year. That's 36.9% of the total dengue cases reported across Karnataka -11,610 as of August 16, 2017. Alarmed by the spurt in dengue cases, a team of experts from the Union health ministry is currently on a visit in the state. They are taking stock of the public health scenario, especially that of vector-borne diseases and their control measures. The team visited a private hospital in north Bengaluru on Saturday and had been to Tumakuru on Friday.

 

The numbers, however, haven't shaken the BBMP even a bit. According to BBMP chief medical officer (public health) Dr Lokesh MN, the number of dengue cases in Bengaluru should be analysed in the context of the city's population. "Detecting 4,280 dengue cases for a popu lation of one crore in eight months is not an alarming data. We have taken precautions to prevent mosquito breeding through household surveys and the same has been explained to the central team. There has been an increase in the cases of dengue and the Vijayanagar Institute of Medical Sciences, Bellary, is treating 80 people, out of whom 50 are children, from the districts of Bellary, Raichur and Koppal, according to the latest reports. Such is the situation in the three districts, especially Koppal and Raichur, which have vast open farm land. “With an increase in the number of patients coming to VIMS, we are using the facilities of other departments to accommodate these patients,” official sources in the hospital told The Hindu. According to available statistics this year, 1,901 cases of dengue have been reported in the hospital since January to the first fortnight of September. Of them, 320 cases have been positive.

 

 

 

 

 

 

 

 

 

STATISTICS OF DENGUE:

Daily Report of Dengue in Karnataka State - 2017

SL NO	District	Total No. Of blocks (Taluks) in the District	Total Dengue affected
			Taluks	PHC	Villages (areas)	Population of affected Villages
1	Bangaluru (U)	4	1	1	1	2876
2	Bangaluru (R)	4	1	1	1	1154
3	Ramanagar	4	0	0	0	0
4	Kolar	5	3	7	7	11367
5	Chikkaballapura	6	2	3	3	3406
6	Tumakuru	10	4	7	8	3372
7	Chitradurga	6	6	30	36	52330
8	Davanagere	6	3	15	20	35030
9	Shivamogga	7	3	11	15	11977
10	Belagavi	10	5	12	14	95553
11	Vijayapura	5	2	4	4	35977
12	Bagalkote	6	6	19	27	113958
13	Dharwada	5	4	41	91	182150
14	Gadag	5	5	18	26	105462
15	Haveri	7	3	5	6	38702
16	Uttara kannada	11	0	0	0	0
17	Kalaburagi	7
18	Yadageri	3
19	Bidar	5
20	Ballari	7
21	Raichur	5	2	3	3	88173
22	Koppal	4	4	18	28	275004
23	Mysuru	7	7	20	30	58723
24	Chamarajanagar	4	3	10	12	43650
25	Mandya	7	6	24	30	68315
26	Hassan	8	8	4	4	3960
27	Dakshina Kannada	5	4	8	10	5526
28	Udupi	3	3	45	110	151905
29	Chikkamagaluru	7	5	5	6	1593
30	Kodagu	3	2	12	29	30022
*	Bangalore City
Total		176	92	323	521	1420185

 

 

 

 

 

Fig 1.

 

 

DENGUE:

Dengue Cases and Deaths in the Country since 2010

Sl.No.	Affected States/UTs	2010		2011		2012		2013
		C	D	C	D	C	D	C	D
1	Andhra Pradesh	776	3	1209	6	2299	2	910	1
2	Arunachal Pradesh	0	0	0	0	346	0	0	0
3	Assam	237	2	0	0	1058	5	4526	2
4	Bihar	510	0	21	0	872	3	1246	5
5	Chattisgarh	4	0	313	11	45	0	83	2
6	Goa	242	0	26	0	39	0	198	2
7	Gujarat	2568	1	1693	9	3067	6	6272	15
8	Haryana	866	20	267	3	768	2	1784	5
9	Himachal Pradesh	3	0	0	0	73	0	89	2
10	J and K	0	0	3	0	17	1	1837	3
11	Jharkhand	27	0	36	0	42	0	161	0
12	Karnataka	2285	7	405	5	3924	21	6408	12
13	Kerala	2597	17	1304	10	4172	15	7938	29
14	Madhya Pradesh	175	1	50	0	239	6	1255	9
15	Meghalaya	1	0	0	0	27	2	43	0
16	Maharashtra	1489	5	1138	25	2931	59	5610	48
17	Manipur	7	0	220	0	6	0	9	0
18	Mizoram	0	0	0	0	6	0	7	0
19	Nagaland	0	0	3	0	0	0	0	0
20	Odisha	29	5	1816	33	2255	6	7132	6
21	Punjab	4012	15	3921	33	770	9	4117	25
22	Rajasthan	1823	9	1072	4	1295	10	4413	10
23	Sikkim	0	0	2	0	2	0	38	0
24	Tamil Nadu	2051	8	2501	9	12826	66	6122	0
25	Tripura	0	0	0	0	9	0	8	0
26	Telangana	0	0	0	0	0	0	0	0
27	Uttar Pradesh	960	8	155	5	342	4	1414	5
28	Uttrakhand	178	0	454	5	110	2	54	0
29	West Bengal	805	1	510	0	6456	11	5920	6
30	A and N Island	25	0	6	0	24	0	67	0
31	Chandigarh	221	0	73	0	351	2	107	0
32	Delhi	6259	8	1131	8	2093	4	5574	6
33	D and N Haveli	46	0	68	0	156	1	190	0
34	Daman and Diu	0	0	0	0	96	0	61	0
35	Puduchery	96	0	463	3	3506	5	2215	0
	Total	28292	110	18860	169	50222	242	75808	193

** Provisional till 24th Dec. 2017                        * Report upto 04th Oct. 2017, # Report upto 09.11.2016               C=Cases | D=Deaths

 

Contineued

Sl.No.	Affected States/UTs	2014		2015		2016		2017**
		C	D	C	D	C	D	C	D
1	Andhra Pradesh	1262	5	3159	2	3417	2	4776	0
2	Arunachal Pradesh	27	00	1933	1	13	0	15	0
3	Assam	85	0	1076	1	6157	4	5016	2
4	Bihar	297	0	1771	0	1912	0	1875	0
5	Chattisgarh	440	9	384	1	356	0	433	0
6	Goa	168	1	293	0	150	0	257	0
7	Gujarat	2320	3	5590	9	8028	14	4564	4
8	Haryana	214	2	9921	13	2493	0	4411	1
9	Himachal Pradesh	2	0	19	1	322	0	453	0
10	J and K	1	0	153	0	79	1	485	0
11	Jharkhand	36	0	102	0	414	1	703	5
12	Karnataka	3358	2	5077	9	6083	8	17018	5
13	Kerala	2575	11	4075	25	7439	13	19912	37
14	Madhya Pradesh	2131	13	2108	8	3150	12	2585	6
15	Meghalaya	0	0	13	0	172	0	42	0
16	Maharashtra	8573	54	4936	23	6792	33	7442	41
17	Manipur	0	0	52	0	51	1	187	1
18	Mizoram	19	0	43	0	580	0	107	0
19	Nagaland	0	0	21	1	142	0	357	0
20	Odisha	6433	9	2450	2	8380	11	4155	6
21	Punjab	472	8	14128	18	10439	15	15318	0
22	Rajasthan	1243	7	4043	7	5292	16	8387	16
23	Sikkim	5	0	21	0	82	0	659	0
24	Tamil Nadu	2804	3	4535	12	2531	5	23035	63
25	Tripura	6	0	40	0	102	0	123	0
26	Telangana	704	1	1831	2	4037	4	3061	0
27	Uttar Pradesh	200	0	2892	9	15033	42	3032	28
28	Uttrakhand	106	0	1655	1	2146	4	971	0
29	West Bengal	3934	4	8516	14	22865#	45#	10697*	19*
30	A and N Island	139	0	153	0	92	0	17	0
31	Chandigarh	13	0	966	1	1246	0	1094	0
32	Delhi	995	3	15867	60	4431	10	9232	9
33	D and N Haveli	641	1	1154	0	4161	2	1996	0
34	Daman and Diu	46	0	165	0	89	0	59	0
35	Puduchery	1322	1	771	0	490	2	4746	7
	Total	40571	137	99913	220	129166	245	157220	250

 

 

 

 

 

Dengue:

Dengue fever, also known as breakbone fever, is a mosquito-borne infection that can lead to a severe flu-like illness. The Aedes aegypti mosquito is the main vector that transmits the viruses that cause dengue. The viruses are passed on to humans through the bites of an infective female Aedes mosquito, which mainly acquires the virus while feeding on the blood of an infected person. Dengue is fast emerging pandemic-prone viral disease in many parts of the world. Dengue flourishes in urban poor areas, suburbs and the countryside but also affects more affluent neighbourhoods in tropical and subtropical countries.

 

 

Causes:

There are four dengue viruses (DENV) that cause dengue fever. They are all spread by a species of mosquito known as Aedes aegypti, and more rarely by the Aedes albopictus mosquito.

 

Aedes aegypti originated in Africa, but nowadays it is found in tropical areas around the world, especially in and around areas of human population.

 

HIGH-RISK REGIONS ARE:

Central and South America, The Caribbean, Tropical Asia, including Bangladesh, Indonesia, and parts of China, Northern Australia Unlike malaria, dengue can happen in both urban areas and rural areas, but research published in 2011 suggested that it is more common in rural areas.

 

Signs and symptoms:

Symptoms vary depending on the severity of the disease.

 

Mild dengue fever:

Symptoms can appear up to 7 days after being bitten by the mosquito that carries the virus.

They include:

·        Aching muscles and joints

·        Body rash that can disappear and then reappear

·        High fever

·        Intense headache

·        Pain behind the eyes

·        Vomiting and feeling nauseous

 

Dengue hemorrhagic fever:

A person with Dengue hemorrhagic fever may experience:

·        Bleeding from the mouth, gums, or nose

·        Clammy skin

·        Damage to lymph and blood vessels

·        Internal bleeding, which can lead to black vomit and feces, or stools

·        A lower number of platelets in the blood

·        Sensitive stomach

·        Small blood spots under the skin

·        Weak pulse

 

Dengue shock syndrome:

Apart from symptoms of mild dengue fever, the person may experience:

·        Intense stomach pain

·        Disorientation

·        Sudden hypotension, or a fast drop in blood pressure

·        Heavy bleeding

·        Regular vomiting

·        Blood vessels leaking fluid

Treatment:

Dengue is a virus, so there is no specific treatment or cure. However, intervention can help, depending on how severe the disease is.

For milder forms, treatment includes:

 

Preventing dehydration:

A high fever and vomiting can dehydrate the body. The person should drink clean water, ideally bottled rather than tap water. Rehydration salts can also help replace fluids and minerals.

 

Painkillers, such as Tylenol or paracetamol:

These can help lower fever and ease pain.

 

 

 

Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, are not advised, as they can increase the risk of internal bleeding.

More severe forms of dengue fever may need:

Intravenous (IV) fluid supplementation, or drip, if the person cannot take fluids by mouth

Blood transfusion, for patients with severe dehydration

If you have severe dengue fever, you may need:

·        Supportive care in a hospital

·        Intravenous (IV) fluid and electrolyte replacement

·        Blood pressure monitoring

·        Transfusion to replace blood loss

 

Prevention:

No vaccine can protect against dengue fever. Only avoiding mosquito bites can prevent it.

 

Anyone who lives in or travels to an at-risk area can use a number of ways to avoid being bitten.

 

If you are spending time in a tropical region, use mosquito nets that are treated with insecticide.

 

Clothing:

Reduce the amount of skin exposed by wearing long pants, long-sleeved shirts, and socks, tucking pant legs into shoes or socks, and wearing a hat.

 

Mosquito repellents:

Use a repellent with at least 10 percent concentration of diethyltoluamide (DEET), or a higher concentration for longer lengths of exposure. Avoid using DEET on young children.

 

Mosquito traps and nets:

Nets treated with insecticide are more effective, otherwise the mosquito can bite through the net if the person is standing next to it. The insecticide will kill mosquitoes and other insects, and it will repel insects from entering the room.

 

Door and window screens:

Structural barriers, such as screens or netting, can keep mosquitos out.

Avoid scents:

Heavily scented soaps and perfumes may attract mosquitos.

 

Camping gear:

Treat clothes, shoes, and camping gear with permethrin, or purchase clothes that have been pretreated.

 

Timing:

Try to avoid being outside at dawn, dusk, and early evening.

 

 

Stagnant water:

The Aedes mosquito breeds in clean, stagnant water. Checking for and removing stagnant water can help reduce the risk.

 

To reduce the risk of mosquitoes breeding in stagnant water:

·        Turn buckets and watering cans over and store them under shelter so that water cannot accumulate

·        Remove excess water from plant pot plates

·        Scrub containers to remove mosquito eggs

·        Loosen soil from potted plants, to prevent puddles forming on the surface

·        Make sure scupper drains are not blocked and do not place potted plants and other objects over them

·        Use non-perforated gully traps, install anti-mosquito valves, and cover any traps that are rarely used

·        Do not place receptacles under an air-conditioning unit

·        Change the water in flower vases every second day and scrub and rinse the inside of the vase

·        Prevent leaves from blocking anything that may result in the accumulation of puddles or stagnant water when camping or picnicking, choose an area that is away from still water.

·        Wear clothing/hats that cover the arms, legs and head

·        Wear shoes rather than sandals

·        Apply insect repellent to skin. The most effective repellents are those containing deet (diethyl toluamide) at a concentration of between 30% and 50%

·        Apply permethrin insecticide to clothes

·        Use mosquito nets impregnated with permethrin

·        Use electric insect-repellent devices or mosquito coils

·        When possible, stay in accommodation that has screens on doors and windows or is air-conditioned.

 

REFERENCE:

1.       First Published: Mon, Oct 16 2017. 11 36 PM IST

2.       http://www.livemint.com/Politics/YYIdlEDGJUZT71mI8vk3vK/Kerala-Karnataka-Tamil-Nadu-worst-hit-by-dengue-this-year.html

3.       Kerala, Karnataka, Tamil Nadu worst hit by dengue this year

4.       India has reported a total of 87,018 dengue cases and 151 deaths until 15 October

5.       Last Published: Tue, Oct 17 2017. 04 14 AM IST

6.       https://timesofindia.indiatimes.com/city/bengaluru/bengaluru-reports-37-of-dengue-cases-in-karnataka/articleshow/60139988.cms

7.       Bengaluru reports 37% of dengue cases in Karnataka

8.       Rise in dengue cases in three districts,  Bellary:, September 16, 2014 00:00 IS

9.       http://www.thehindu.com/todays-paper/tp-national/tp-karnataka/rise-in-dengue-cases-in-three-districts/article6414277.ece

10.     Dengue fever, also known as breakbone fever, is a mosquito-borne infection that can lead to a severe flu-like illness. It is caused by four different viruses and spread by Aedesmosquitoes.

11.     Everything you need to know about Dengue fever http://www.thehindu.com/todays-paper/tp-national/tp-karnataka/rise-in-dengue-cases-in-three-districts/article6414277.ece

12.     http://www.who.int/denguecontrol/disease/en/Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL et.al. The global distribution and burden of dengue. Nature. 2013; 496:504–7. doi:10.1038/nature12060.

13.     Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG et al. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis. 2012;6:e1760. doi:10.1371/journal.pntd.0001760.

14.     https://www.mayoclinic.org/diseases-conditions/dengue-fever/diagnosis-treatment/drc-20353084

15.     http://www.who.int/denguecontrol/resources/en/Auckland Regional Public Health Service (2014). Dengue fever fact sheet (PDF). Auckland: Auckland Regional Public Health Service – Auckland District Health Board.

16.     ttp://www.arphs.govt.nz/Portals/0/Health%20Information/Communicable%20Disease/Disease%20Fact%20Sheets/Dengue%20fever/Dengue%20Fact%20Sheet%20Jan2014.pdf

17.     O’Toole, M.T. (Ed.) (2013). Dengue fever. Mosby’s Dictionary of Medicine, Nursing and Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.

18.     O’Toole, M.T. (Ed.) (2013). Dengue hemorrhagic fever shock syndrome. Mosby’s Dictionary of Medicine, Nursing and Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.

19.     DermNet New Zealand (2008). Dengue and dengue haemorrhagic fever (Web Page). Hamilton: DermNet New Zealand Trust. http://www.dermnetnz.org/topics/dengue-and-dengue-haemorrhagic-fever/ [Accessed: 24/03/17]

20.     Health Intelligence Team (2016). Notifiable diseases in New Zealand: Annual Report 2015 (PDF). Porirua: Institute of Environmental Science and Research Ltd. https://surv.esr.cri.nz/PDF_surveillance/AnnualRpt/AnnualSurv/2015/2015AnnualReportFinal.pdf

 

 

 

Received on 20.02.2018                Modified on 18.04.2018

Accepted on 21.05.2018       ©A&V Publications All right reserved