-dangerous haemorrhagic form seen in some patients
By Iana Seales
Dengue fever cases are up across the country with slight indications that the severe haemorrhagic form has affected a few persons but Chief Medical Officer Dr. Shamdeo Persaud said the numbers are not enough to cause alarm.
Up to last Friday the health sector had recorded 103 cases of dengue- some nine cases more than the corresponding period last year. There was no actual breakdown of the mild and severe forms but according to Persaud hemorrhagic dengue fever is rare in Guyana though he pointed out that this particular form is on the increase in neighbouring Brazil and a few other countries in the region.
On Monday Health Minister, Dr. Leslie Ramsammy had underscored the need for a huge investment in vector control in the country to adequately address such diseases, and he pointed to the importance of mosquito nets. The local bed net programme that was initiated in the hinterland will soon roll into coastal areas. Ramsammy had also noted that Guyana had 400 cases of dengue last year.
Guyana’s border at Lethem is currently under heavy health surveillance and the sector is on high alert. Additionally, airlines have been approached to verify any cases of fever they may encounter by notifying Port Health.
“There was a spike in dengue cases during the first week of February but that aside we have been seeing around seven cases a week but what is important to note is that we have been carrying out more tests”, Persaud said yesterday.
Since the start of the year more testing for dengue fever has increased particularly in the private sector but questions have been raised about the diagnoses being made. Stabroek News spoke with one family that expressed disappointment in the health sector because doctors failed to diagnose a case of dengue fever resulting in near fatal consequences for the young patient.
Tests
The Chief Medical Officer was quick to point out that tests for dengue have increased so far for the year doubling what was carried out around this time last year, adding that there is now a high degree of suspicion among doctors. He said the testing being done here is accurate but in many instances the Caribbean Epidemiology Centre (CAREC) is asked to confirm a particular type of dengue.
DEN-2, the type of dengue that is in Guyana is what most patients are diagnosed with, Persaud said. However there are instances of patients showing up with DEN-3 and DEN-4, which he noted increases the severity of it. Persaud said persons with the severe form of dengue will bleed with the classic symptoms being bleeding through the nose, in the gum, under the skin and vomiting. The mild form of dengue results in fever, nausea, vomiting and aches in the joints.
It is now the practice in the health sector that teams visit the homes of dengue patients and test remaining occupants. Persaud said the local bed net programme will soon reach many homes and persons will be asked to sleep under a net to avoid contracting the disease.
The aedes aegypti, a domestic, day-biting mosquito that prefers to feed on humans and breeds wherever clean water accumulates and around garbage is the dengue host that spreads the disease. Dengue infections produce a spectrum of illnesses ranging from a nonspecific viral syndrome to severe and fatal hemorrhagic disease. Persaud said many local households have to play a greater role in safeguarding their health.
The US Centers for Disease Control (CDC) noted on its website that dengue emerged as a major public health problem due to reasons ranging from global demographic changes, the most important of which have been uncontrolled urbanization and concurrent population growth that resulted in substandard housing and inadequate water, sewer, and waste management systems.
Additionally, the CDC said, increased travel by air provides the ideal mechanism for infected human transport of dengue viruses between population centres of the tropics, resulting in a frequent exchange of dengue viruses and other pathogens and lastly, it noted that effective mosquito control is virtually nonexistent in most dengue-endemic countries.
Stabroek News made a check on dengue with a few hospitals.
The Georgetown Public Hospital reported that there was nothing suggesting an upsurge in dengue fever, adding that the number of cases appeared normal. Two private hospitals said they have seen only a few confirmed cases.
This newspaper also spoke with a family which recounted an experience of dengue that was misdiagnosed by several doctors in the health sector. Dr. Joyce Jonas whose daughter was affected related that the young woman saw a doctor and was diagnosed with a viral infection after showing signs of fever, joint pains and vomiting. She was sent home and told to return in one week if her health did not improve. But though the young woman showed signs of improvement she suffered a relapse and returned with more severe symptoms.
Then she suffered nose bleeds. Dr. Jonas said the bleeding got worse and even then doctors had no idea what was wrong. Tests were carried out for malaria, dengue, typhoid and leptospirosis but they all returned negative. After the doctors were unable to figure out what was wrong the young woman developed rashes on her hands and under her feet and the family concluded it was hemorrhagic dengue after reading up on it.
According to Dr. Jonas the signs were there that the girl was slipping away from her. She said her experience as a trained nurse assisted greatly in the at-home treatment that was administered and now the young woman is on the road to recovery. She said the family has lost faith in the health sector as a result of what happened.
“I do not feel that the medical people are sufficiently alert and it is important that the public is bombarded with information about dengue and other such diseases”, Dr. Jonas added.
Taken from the US CDC website
Q. What are the symptoms of the disease?
A. The principal symptoms of dengue are high fever, severe headache, backache, joint pains, nausea and vomiting, eye pain, and rash. Generally, younger children have a milder illness than older children and adults.
Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms that could occur with many other illnesses (e.g., nausea, vomiting, abdominal pain, and headache). This stage is followed by hemorrhagic manifestations, tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding. The smallest blood vessels (capillaries) become excessively permeable (“leaky”), allowing the fluid component to escape from the blood vessels. This may lead to failure of the circulatory system and shock, followed by death, if circulatory failure is not corrected.
Q. What is the treatment for dengue?
A. There is no specific medication for treatment of a dengue infection. Persons who think they have dengue should use analgesics (pain relievers) with acetaminophen and avoid those containing aspirin. They should also rest, drink plenty of fluids, and consult a physician.
Q. Is there an effective treatment for dengue hemorrhagic fever (DHF)?
A. As with dengue, there is no specific medication for DHF. It can however be effectively treated by fluid replacement therapy if an early clinical diagnosis is made. Hospitalization is frequently required in order to adequately manage DHF. Physicians who suspect that a patient has DHF may want to consult the Dengue Branch at CDC, for more information.
Q. What can be done to reduce the risk of acquiring dengue?
A. There is no vaccine for preventing dengue. The best preventive measure for residents living in areas infested with Aedes aegypti is to eliminate the places where the mosquito lays her eggs, primarily artificial containers that hold water.
Items that collect rainwater or are used to store water (for example, plastic containers, 55-gallon drums, buckets, or used automobile tires) should be covered or properly discarded. Pet and animal watering containers and vases with fresh flowers should be emptied and scoured at least once a week. This will eliminate the mosquito eggs and larvae and reduce the number of mosquitoes present in these areas.
For travelers to areas with dengue, a well as people living in areas with dengue, the risk of being bitten by mosquitoes indoors is reduced by utilization of air conditioning or windows and doors that are screened.
Proper application of mosquito repellents containing 20% to 30% DEET as the active ingredient on exposed skin and clothing decreases the risk of being bitten by mosquitoes. The risk of dengue infection for international travelers appears to be small, unless an epidemic is in progress.
Q. How can we prevent epidemics of dengue hemorrhagic fever (DHF)?
A. The emphasis for dengue prevention is on sustainable, community-based, integrated mosquito control, with limited reliance on insecticides (chemical larvicides and adulticides). Preventing epidemic disease requires a coordinated community effort to increase awareness about dengue/DHF, how to recognize it, and how to control the mosquito that transmits it. Residents are responsible for keeping their yards and patios free of sites where mosquitoes can be produced.
