Dengue fever: Emphasise shared responsibility, Cut sensationalism!

By Dr R Neerunjun Gopee

According to official data, as at 18 February, out of just over 1300 cases of dengue recorded since mid-December 2023, 559 are active cases, and the distribution around the island is: Port Louis (the most affected region) 303 cases, North174, Plaines-Wilhems 48, South 16, West 13 cases, and East 5.110 patients are hospitalized, and 457 are being treated at home as part of the 457 Domiciliary Medical Unit (DMU) scheme.

Based on these figures, the scenario works out at about 20 cases reported per day since onset and less than 15 patients per hospital in a total of 5 Regional Hospitals, and 3 District Hospitals (Long Mountain, Mahebourg, Souillac Hospitals) if they too are admitting dengue cases.

According to WHO, dengue is the most common and important arthropod or insect-borne viral (arboviral) illness in humans. Pic – OnlyMyHealth

For a public health service which handles about 4-5 million outpatients and inpatients per year, by no stretch of the imagination can these dengue figures be considered as indicating a humongous epidemic beyond the capacity of the system to cope. Doctors and other health professionals are quite accustomed to dealing with large numbers of patients on a daily basis, and thus the current dengue situation is for them par for the game. Which doesn’t mean that they are not concerned, in fact for our Public Health Division – one of the very best in the world – this is the kind of situation that they are always well prepared for.

Thus, for the current dengue wave there are, according to health officials, ‘teams operating in different regions and hospitals on the island. Examinations are carried out on infected individuals, either directing them to hospitals or advising them to stay at home for treatment. Visits are organized over periods of two, five, and seven days.’

This is in addition to ‘teams for fumigation and treatment, larviciding, following a well-established protocol. The (infected) person is entitled to ten days off, whether in the public or private sector, to avoid any risk of transmission.’ By the same token, infected individuals are also advised to limit their movements.’

Dengue, the disease

A few simple technical facts about dengue may be of general interest, According to WHO, dengue is the most common and important arthropod or insect-borne viral (arboviral) illness in humans. It is transmitted by mosquitoes of the genus Aedes, which are widely distributed in subtropical and tropical areas of the world. The incidence of dengue has increased dramatically in recent decades, with estimates of 40-50% of the world’s population at risk for the disease in tropical, subtropical, and, most recently, more temperate areas. Probably global warming resulting from climate change may be having an impact.

The disease has a seasonal pattern, with the majority of cases in the Southern hemisphere occurring during the first half of the year (as we are currently witnessing) and the majority of cases in the Northern hemisphere occurring during the second half of the year.

Typically, the most common type of dengue (Type 1) is a self-limited disease with a mortality rate of less than 1% when detected early and with access to proper medical care, which is widely available locally.

It is to be noted that there is no specific antiviral medication for dengue; treatment is therefore to relieve symptoms and is supportive in nature. Bed rest with simple medication given for pain and fever are helpful in relieving lethargy, malaise, and the fever. However, because of the severity of the muscle spasms and joint pain in a number of cases, dengue is also known as breakbone fever.

Type 2 concerns a small percentage of persons who get severe dengue, with bleeding (dengue haemorrhagic fever or dengue shock syndrome) who obviously need more intensive treatment, despite which it has a mortality rate of 2-5%.

Prevention of mosquito bite is the key

As with other similar infectious diseases, the only way to truly prevent the dengue virus acquisition is to avoid being bitten by the vector mosquito.The measures are by now well-known: at individual level, use of mosquito repellant and indoor sprays, wearing protective clothing (e.g. long sleeves),remaining in well-screened or air-conditioned places.

Public Health measures target the larval phase with larvicides and cleaning up larvae habitats. Good sanitation and refuse control will prevent growth of mosquito larvae. As we are in cyclonic season, it is worth remembering that cyclones and other natural disasters increase the habitat for mosquito growth in urban areas by increasing rubble and garbage, which act as water reservoirs.

Importantly, breeding of vector mosquitoes can be reduced by eliminating small accumulations of stagnant water around human habitats. Disposing of old tyres, covering water receptacles such as drums, not leaving used paint pails/ lamoques (tin cans) containing stagnant water about in the yard are simple precautions that all can take.

I am not surprised that Port Louis has the highest number. In fact, during a Public Health awareness/education campaign about twelve years ago when I was part of an MOH team going around in Port Louis, we were appalled to find all the unsanitary conditions favourable to mosquito proliferation mentioned above in many a household yard. Have no lessons been learnt?

Unfortunately, instead of pressing these points upon the public, which emphasise the shared responsibility between the authorities and public in controlling and avoiding bites by mosquitoes, the media has a tendency to harp on numbers without contextualisation, and heap inordinate amounts of abstruse technical data of no practical use to the public at large.

This kind of sensationalism can lead to panic and consequent overcrowding of hospitals, as happened during the AH1N1 epidemic. Worldwide in fact, leading to a comment later that the epidemic was spread as much by panic as by mosquitoes!

Fortunately for the country our Public Health experts have a robust handle on these matters, and have a track record the country can be proud of. Such as the elimination of malaria as far back as the early 1970s, officially recognized by WHO.

So let us cut sensationalism, at least where health matters are concerned, though it is the DNA of the media, according to a former president of the Media Trust. In a televised interview years ago, he declared that without sensationalism newspapers wouldn’t sell.

Let us instead stick to the simple, direct messaging which focus the public’s attention on the low cost but effective Public Health measures that are accessible to them and which they should apply for their own and the population’s safety.

Mauritius Times ePaper Friday 23 February 2024