When four-year-old Nathan came down with a recurring fever and started complaining of stomach pains last April, his mother Stella thought he was just suffering from wind. Still, she took the boy to the doctor, who said some paracetamol should help ease his symptoms.
However, Nathan’s condition didn’t improve. Finally, when his breathing became rapid and his skin turned cold and clammy, Stella rushed him to a clinic, which immediately sent them to a nearby hospital. Nathan had fluid in his chest and his veins had collapsed.
Doctors, struggling to keep his rocketing blood pressure under control, moved him into intensive care. It was too late: less than two days after being admitted to hospital, Nathan died.
Nathan was a victim of a virulent form of dengue fever, a mosquito-borne contagion that has returned. Already, the Department of Health (DOH) is contemplating declaring a dengue outbreak in the country.
This is due to the fact that the current number of dengue cases throughout the country is already approaching the “outbreak levels,” according to Health Secretary Teodoro Herbosa.
The Davao Region is not exempt. From January 1 to June 22, cases have reached 9,073 – that’s about 26.03% higher than the number recorded in the same period in 2023 with 7,199 cases. Data is sourced from the DOH regional office.
If there were only 38 deaths recorded in 2023 in the same period, the figure went to 54 in 2024. Most of the deaths were from Davao City.
The data listed Davao del Norte as having the most dengue cases with 2,416; Davao City trailed with 2,192 cases. More than 1,000 cases were reported from both Davao del Sur and Davao de Oro. More than 800 cases were from Davao Oriental. Davao Occidental has the least number of cases: 500-plus.
“Dengue is the world’s most important viral disease transmitted by mosquitoes,” said Dr. Duane Gubler, health administrator of the US Centers for Disease Control and Prevention. “The mosquitoes become infected when they feed on someone who has the virus.”
Medical scientists identify four distinct viruses, which are transmitted through the bite of a mosquito. Most people infected with dengue viruses have dengue fever. Patients suddenly develop a high fever. They also may have a headache around their eyes or on their forehead.
A rash, which usually appears 24-48 hours after the fever starts, begins at the trunk and then develops on the arms and legs. Patients experience muscle aches and severe bone pain (this is the reason why it is sometimes called “breakbone fever”). Two-to-six days later, nausea and vomiting may take place.
The fever usually lasts three to nine days and then goes away. One to two days after the fever goes away a second rash appears. This rash disappears in one to five days and is accompanied by a slight fever (also known as “saddleback fever”).
A more lethal complication, called dengue hemorrhagic fever (DHF), was first recognized during the 1950s and is today a leading cause of childhood deaths in many countries, including the Philippines.
The World Health Organization (WHO) says DHF patients will experience the following: high fever (40 to 41 degrees Centigrade), headache, loss of appetite, vomiting, cough, and feeling very tired. This lasts two to five days. Then they feel cold and have clammy hands and feet. They also have a flushed face. In most instances, they sweat a lot, are very restless, and irritable. Oftentimes they have little red spots on the forehead, arms, and legs.
Usually, patients get better in two to three 3 days. Sometimes, they do not and their blood pressure goes down and they develop shock (shock syndrome). Medical experts say deaths occur in 5%-40% of children that develop shock. DHF may be fatal in 40%-50% of untreated patients; however, with appropriate treatment the mortality can be brought down to 1%-5%.
As stated earlier, there are four strains of dengue viruses – all of which can cause dengue fever. However, if there is infection with a second strain in a patient who has had dengue fever caused by another strain previously, this person is likely to develop DHF. The exact reason for this is not clear, but medical science believes that antibodies produced after the first infection enhances the subsequent infection related complement activation.
On the other hand, if more than one strain causes the disease, DHF will occur too. Not all people who develop sequential infections get DHF. Again, the reason is not clear.
Dr. Scott Halstead, of the Health Sciences Division of New York-based Rockefeller Foundation suggests that if antibodies are of “neutralizing type,” they do not enhance the growth of subsequent dengue viral infection. However, if there are no neutralizing antibodies, the other antibodies enhance the viral replication.
Until now, there has been no specific treatment for dengue infection. However, early detection and access to appropriate healthcare for case management can reduce mortality, as can rapid detection of severe dengue cases and timely referrals to tertiary healthcare facilities.
“People with these severe symptoms, admission is necessary,” said Dr. Lulu C. Bravo, a professor of infectious and tropical diseases. “The patient is subjected to regular blood test monitoring until stable. Fluids are carefully computed and monitored plus as soon as needed, blood or blood components are transfused.”
The best way to beat dengue fever is not to be bitten by dengue-carrying mosquitoes. When going out, people are advised to wear long-sleeved shirts and long pants. When indoors, it is advisable to stay in air-conditioned or screened areas. All windows and doors must have screens to avoid mosquitoes from getting in. Children must not play near still water
