Tuesday, 3 August, 2021

Let’s learn from dengue, control infected mosquitoes


Dengue fear has gripped the nation. Dengue caused by the biting of female mosquitos (Aedes aegypti), is slowly taking a form of epidemic, and the public seems to be greatly panicked. The disease has not spared even the Kathmandu Valley whereas most of the Terai districts and few hilly districts have witnessed growing cases of dengue.

In this context, three public health experts talked about a range of issues regarding dengue during the weekly Gorkhapatra Sambad on Sunday. Senior public health expert Prof. Dr. Sharad Onta and Chief Consultant and Spokesperson of Sukraraj Tropical Hospital Teku, Dr. Anup Bastola, and Director of Epidemiology and Disease Control Division (EDCD) and Dr. Bibek Kumar Lal highlighted the efforts put in by the government for its control, precautionary measures to be taken to remain safe from dengue, existing treatment methods and other issues. Excerpts: 

Dengue has now caused a panic among the people. What actually is dengue? What is the current situation like?

Dr. Bastola: Dengue disease was noticed in Nepal in 2004 and it was proved to have infected Nepalis also in 2006. The people in Kathmandu, Pokhara and hilly districts knew it as the disease of the Terai. Last year, dengue entered Kathmandu. This year, it has turned out to be an epidemic and has been found in Kathmandu, Pokhara and Dharan. Since it was found in the capital Kathmandu itself, it has fueled a debate and raised people’s interest. The number of dengue patients has increased in Kathmandu now. Previously, we had mosquitos which were not infected. But now they are infected.

During Dashain last year the people from various dengue-affected districts travelled to Kathmandu, and the mosquitos here bit them and got infected. With the rainy season and potholes, the mosquitos grew wherever there was stale water. There are four types/species of mosquitos: DEN 1; DEN 2 ; DEN 3; and DEN 4. The bite by special species of mosquito (Aedes, aedes albopictus, Culex and Anofilix) causes dengue. Aedes transfers four main diseases: including dengue, elephantitis, chicken guinea and zika.

The mosquito’s activity is high in the morning and evening before dusk. But mosquitos are also active throughout the evening, morning and night. People have a misunderstanding that if a mosquito bites in the afternoon, one will transmit dengue. But that’s not true.

The symptoms of dengue will appear between 4 to 12 days after an infected mosquito bites you.

If a mosquito bites 10,000 people, the symptoms will appear only in 100 persons. It will not be seen in everyone. Symptoms will include pain in the hands and feet, joints pain, fever, back ache, eyeball pain, nausea, loss of appetite. If vomiting worsens with blood in it and severe stomach ache, this can be considered serious dengue. There could also be intestinal bleeding. The virus will inflict the blood stream. This will create a problem and even lead to death if timely treatment is not sought. Our bodies generate energy and if that energy is more and stronger than the virus, it will not allow to be infected.
However, dengue does not have a vaccine yet. This disease has spread globally. The way to stay away from dengue is controlling of infected mosquitos. It is important to generate awareness among the people. We need to pay attention to stop the spread of infected mosquitos.

There is a recovery phase of five to seven days. Paracetamol and fluid intake will help a lot. The bone marrow will stop functioning if one gets infected with dengue. But we should never intake painkiller. The use of painkiller leads to other complications.

People are unnecessarily panicked. More people are found due to the social media. The situation is not as critical as the messages spread in the social sites.
There is dengue in Philippines for 50 years. In Bhutan, Singapore, America, India and China there is dengue everywhere. But we are more panicked.

The situation is not that critical. People are panicked as they fear seasonal viral fever and cold as dengue.

Dr. Lal: The infected mosquito was not born in Nepal recently. But it is true that there is no any effective vaccine against the dengue. Different vaccines are under the stages of experiments. The World Health Organisation has also not pre-qualified the vaccine yet. We are at the front row in terms of the public health in South East Asia. Japanese encephalitis was the big issue before dengue. But Japanese encephalitis was controlled after China invented the vaccine. Nepal is also at risk of elephantiasis.

Before this, around 20 million people of 63 districts were infected by the elephantiasis. After the invention of vaccine against it, the disease was brought under control. Now only 13 districts are affected by it and it is taken as a simple problem.

Everybody was familiar with malaria. Hundreds of people died of it. Now only 400 -500 people are affected. The invention of vaccine helped control this disease too.
As the vaccine for dengue has not been invented, the control of mosquito is only a preventive method.

Mosquito which is now found globally has become a culprit for transmitting many diseases. There are more than 400 dengue infected people in America, 1,400,000 in Brazil, 10,000 in Singapore, 55,000 in Thailand, 150,000 in the Philippines and 35,000 in Sri Lanka.

The government has not compromised on the resources, nor on the will power. So, public should become aware themselves rather than blaming the government.

They should control the mosquitoes.
This is the fact that government cannot clean the homes of the public. Due to the unmanaged urbanisation the environment is favourable for the mosquito breeding.

The mosquitoes can lay eggs even in the clean water. Whether it is a flowerpot or clean water reserved in water containers, it lays eggs and develops the larvae. We do not have any option except for destroying them. The way the mosquito is seen this year shows that it may develop as an epidemic the next year. Thus, we need to work for earlier preparedness. In the past, we had central management. Every work used to be done with the directives from the government.

But now we have three tiers of governments and we are unclear as to who will direct or who will work.

As health is a critical issue, the structure should be made from the federal government and take steps for controlling dengue. If everyone tries to be boss and who will work for the cause? So, directive authority is also needed.

Dr. Onta: The ministry of health is only the part of government. Whether it be a dengue or other diseases, from the eyes of public health there is only one way for its management. During the period of 80s and 90s, HIV was also the matter of panic.

In every disease, their prevention is the first priority. There are some ways to prevent the disease. There was Tuberculosis in Britain before the invention of BCG vaccine. But still it was prevented adopting other preventive measures. There is no vaccine for dengue now. But we still have various options. There are possible ways to control it.

The preventive measures are adopted worldwide in the same way. There is no cent per cent result though we adopt the preventive measures. But it may be epidemic so we need to be aware of it.

We a re in the preparedness state for measles and not for dengue. There is an easy way to transfer the mosquitoes from Thailand, Singapore, China and India now. But we need preparedness. Preparedness is necessary to tackle the problems.

The government is also working with the available resources under its jurisdiction. We have failed in preparing necessary management to control the disease. Every hospital in Kathmandu is full with dengue patients. How many cases are there? What is the report? It is very unclear. The government is not able to monitor them. Some private hospitals have taken dengue as earning means, as a business. Physicians who do not have knowledge about the disease are also found examining patients. The government and public hospitals have specific protocols. But there is no any protocol in the private hospitals.

Dengue has become a business opportunity to the private hospitals. The government officials must be deployed in the private hospital for monitoring. The people are being victimised in the name of controlling the disease.

Renowned doctors and even government minister are suffering from dengue. Dengue drew a lot of attention and made news headlines after it entered Kathmandu, but was not much talked about when its prevalent was limited in districts.

Nepal faces similar problem every year, but why are we and the government failing in its management?

Dr. Onta: A few years ago we had influenza epidemic, we have now forgotten that. Some media term seasonal cold and cough as swine flu. The situation is not as reported in the media. Dengue did not appear in Nepal as an exception, it’s a global problem. We also have problem of measles and elephantiasis.

We do have prevention structure in place, but work is not being done as required. Today we have dengue and after two months another epidemic may appear. We need prior alertness.

I too get anxious at times, when some media share bias and inflammatory news.

Further, nowadays we have social media, where people can simply write as they wish. How do we manage this?

The concerned authorities should think about this. Every person has a duty. We should not expect everything from the government only. Is the government going to clean our backyard? Citizens should be aware and spread awareness.
An epidemic comes under control after a phase. This dengue too will come under control during the winter season. But it does not suit to keep quiet and not control it. Next year, similar problem will arise. We know next year it could be worse than this yaer. So we, the citizens and government, should become more responsible.

Dr. Bastola: We need a clear strategy as to what do we do next year, and in next five years. The government should move forward by developing such a strategy. This disease did not get much publicity while it was confined to outside the valley, but once it entered Kathmandu, it got more attention.

It has got more space in the media. The citizen’s problems suddenly increased so high that it has created a fear as if being beaten by a mosquito is going to cause dengue. There is no reason to be panicked like this. This disease will show symptoms until Kartik (Oct/Nov). Winter cold will kick in around Mangsir (Nov) and the activity of mosquito will decrease and this disease will come under control. But we can’t just keep quiet. We need to focus and take initiatives to prevent it from recurring again. It can be managed in time if we move ahead by developing an appropriate policy for dengue control.


How long does it take for a mosquito egg to grow?

Do only day time bites by mosquito transmit dengue?

Is there any health emergency to be declared? What is your suggestion to the citizens?

Dr. Bastola: Dengue is not transmitted only from daytime bites, but rather it can occur by the bite of anytime, evening, morning, daytime or even night depending on mosquito’s activeness. Therefore, we have difficulty in its treatment. But now we have found out newer facts. Unnecessary treatment rather invites problems to the patients.

If a disease does not get proper treatment, it will have side effects and could even lead to death. This Saturday itself, I examined 400 patients, among which only 200 had dengue. I advised them to take paracetamol and eat more fluids. If they had visited a private hospital, what sort of response would they have got? Doctors should be aware of citizens’ health.

Focus should not be towards profitmaking or earning. Even surgeons are examining dengue now. Some hospitals are making it as a money-minting business. There is an urgency to make people more aware through media.
We even get phone call query whether physical relationship transmits dengue.

We need to share information in schools and colleges on this disease. We need to conduct door-to-door campaign to generate awareness among the people. The society is terrified due to lack of appropriate information about dengue.

Dr. Onta: What messages are we going to relay is the main thing. We need to plan as to whom we are giving the message. All the three levels of government should broadcast messages on this. We need to give a message to empower the public.

Advice alone won’t help. Just keeping the house clean is not enough. Health workers should be very careful and alert in giving right messages. Health professionals should feel their professional obligations. The message should first reach the policymakers. Making only speeches in the parliament will not control it. It has to hold policy-level discussion focusing on solution approaches. It is also not a matter for the opposition party to put blame.

Social media has nonsense posts like ‘the government is scared of one mosquito, how a military which cannot kill even a mosquito can protect its citizen. Such nonsense is making rounds in the social media.

Dr. Lal: A mosquito can bite anytime of the day. But some media are broadcasting fake news as if only the daytime misquote bites will cause dengue, which is not true. A mosquito egg becomes adult in four to twelve days.
Wherever the disease has been controlled, it is due to local activeness. It does not help by only blaming the government. The media should play a positive role in spreading public awareness. If the media spread positive messages, it will help raise citizen’s awareness.

The government is doing its job. But it is not yet enough in advocacy. Dengue was first seen in Sunsari and it came under control with the local initiatives. We need to focus on the systemic structure of control.
Health sector always has challenges. Every New Year may bring newer epidemics.

Structural improvement has to happen at the government level for its control. The federal government has to prepare this. By devising a slogan like “everyone’s support: elimination of dengue’ a campaign should be started. This is not a situation for health emergency declaration; we have several options to control it. If everyone participates, it will be easier to control it.

Public awareness should be brought to practical use. Nobody else is go ing to come to clean our locality. We need to do it ourselves.