Six-year-old Lenny was struck with fever one night after two days of rain. But there was something different; she appeared flushed. She was irritable and had poor appetite although she never complained about food. Sarah, the mother, observed that her daughter’s flushed skin had some white areas but she just ignored it.
Sarah thought the fever was just ordinary so she did not bring her daughter to her doctor and instead gave her paracetamol, which she believed would help subside the fever. The fever vanished one day only to return the following day. On the seventh day of on-and-off fever, Lenny experienced what most doctors called as “shock.”
“Lenny was breathing rapidly,” Sarah recalled. “She was restless and her pulse was beating fast. Her skin was cold and clammy and she felt drowsy all the time. She was vomiting and bloods were oozing from her mouth. Before, she completely lost consciousness.”
Sarah brought her daughter to the nearest hospital, some thirty minutes away from home. One of the doctors tried pull Lenny out of shock by replacing the fluids and blood she lost but it was all in vain. The doctor failed to save her.
Lenny died of what is considered as the most widespread mosquito-viral disease in the world. “After a dengue patient has gone into shock,” the doctor who tried to save Lenny explained, “it is just a matter of time before multi-organ failure occurs and death becomes inevitable.”
Dengue fever has been with the Philippines since the 1950s but until now it has not been able to eradicate the disease.
The dengue virus does not spread directly from person to person, health experts claim. It’s transmitted mostly by the female Aedes mosquito. When it gorges the blood of an infected human, the virus enters the insect’s salivary gland, where it incubates for eight to ten days. After that, the mosquito can pass the virus on to the next person it bites.
Symptoms of dengue vary according to the age and health of the patient. “Dengue should be suspected when a high fever is accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, vomiting, swollen glands or rash,” an information sheet from the World Health Organization (WHO) states.
Generally, symptoms last for 2-7 days, after an incubation period of 4-10 days after the bite from an infected mosquito.
But the deadly form of the infection, called dengue hemorrhagic fever (DHF), is another story. DHF’s deadly complication is due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment.
“Warning signs (of DHF) occur 3-7 days after the first symptoms in conjunction with a decrease in temperature and include: severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness, blood in vomit,” the WHO says. “The next 24-48 hours of the critical state can be lethal: proper medical care is needed to avoid complications and risk of death.”
Dr. Lulu Bravo, a professor at the University of the Philippines College of Medicine, said that in DHF, cells release chemicals that trigger leakage of plasma from blood vessels. “Fluids accumulate in body cavities, causing profound shock. Death often results from bleeding in the brain, intestines or other organs,” she said.
“Maintenance of the patient’s body fluid volume is critical to severe dengue care,” the United Nations health agency said.
Medical science says dengue is caused by four distinct virus serotypes (varieties recognized as distinct by the immune system). “Not all dengue are created equal,” stressed Dr. Richard T. Mata, a pediatrician who is known for his anti-dengue advocacy. “Some have small leaks others have big leaks. That’s why some patients dehydrate faster than the other. When it comes to dengue, you better assume that you have the biggest leak.”
As such, Dr. Mata highly recommends aggressive fluid replacement. “Dextrose plus oral fluids is the key,” he said. “If the patient is already admitted, he needs to continue taking oral fluids like Oresol and water to push him to urinate at one- to 3-hour interval.”
In the Philippines, dengue is a leading cause of childhood hospitalizations. “Approximately 36% of annual dengue infection occur among children aged 1-9 years, and the average age of infection is 12 years,” wrote Dr. Maria Rosario Capeding, of the Research Institute for Tropical Medicine, in Dengue Matters.
Up to 5% of DHF cases are fatal; without proper treatment, the rate rises to 15%.
“Children are much more like to get DHF than adults,” explains Dr. Allan Schapira, who was in-charge on infectious diseases at the WHO regional office in Manila when this author interviewed him. “This is the reason why children are much more at risk of dying. In adults, dengue fever usually does not develop to the severe form, DHF. Besides, in many tropical areas immunity builds up during childhood, so many adults do not get dengue fever, even if they were bitten by an infected mosquito.”
In a study conducted over the decade of 2001-2010, it was found that dengue poses a substantial economic and disease burden in 12 countries in Southeast Asia: Bhutan, Brunei, Cambodia, East Timor, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam.
During those years, an annual average of 2.9 million dengue episodes and 5,906 deaths were recorded. “The annual economic burden was US$950 million or about US$1.65 per capita,” the study said. “The annual number of disability adjusted life years (DALYs) was 214,000, which is equivalent to 732 DALYs per million inhabitants.”
The economic burden of dengue is not limited to medical care only. “About 60% of dengue-related costs are not directly associated with healthcare expenditure,” points out Professor Donald Shepard of the Heller School’s Schneider Institutes for Health Policy.
“Loss in productivity from illness and premature death are a common source of indirect costs,” the American health professor explains. “Output from the industrial and service sectors declines as employees are incapacitated or need to stay at home for care for children or relatives. Fear of contagion, amplified by mass media coverage during epidemics, may keep tourists away and therefore have a greater impact in regions that rely on tourism to drive the local economy.” (To be concluded)
