History and origin of Dengue is still not very clear. However the word Dengue in Spanish means , fastidious or careful, although how this spanish word got coined is still not known since the origin of the disease ,according to many experts can be traced to Africa. It could also be because of the swahili  phrase 'Ka Dinga Pepo' which meant cramps and seizures caused by evil spirits. The word Dinga in this phrase probably is the origin of the word Dengue. However, the first ever recorded case of this deadly disease can be found in a Chinese medical encyclopedia that was written during the Jinh dynasty dating back to 265-420 AD. The disease was recognised in 1700's when the epidemic occurred in Asia,Africa and the North American continent and after that it gained prominence in medical history.It is all the more surprising that even after all these years a suitable vaccine has not been found for this often fatal disease.

To come back to the present, this contagion is rapidly becoming a major problem in India and in other parts of the world as well, more so in Asian and tropical countries. Apparently, dengue is the most widespread mosquito borne viral disease in the world, infecting over 50 million people each year. Most Dengue outbreaks have occurred in cities where growth has not been accompanied by well managed water supplies and waste management. Experts agree that government agencies alone can never solve the problem unless there is an all round commitment from the NGOs and the citizens of the country.

I was reading about a case that happened recently in Sholapur, situated in the state of  Maharashtra in India – When nine month old Raju came down with a recurring fever, loose motions and a rash all over his body, his parents were first told by a local doctor that their son had Malaria and the doctor put him on an anti malarial treatment. When anti-malarial tablets did not work, Raju was treated for Typhoid. But, even that did not work and  soon the child went into a coma and was rushed to Pune’s KEM hospital’s pediatric intensive care unit where doctors knew exactly what was wrong. Raju was put on a ventilator and given antibiotics and blood transfusions almost immediately. However, his condition did not improve because of the time that had passed and the delay caused by wrong diagnosis made by the family doctor. The baby’s blood pressure dropped and his kidneys stopped working. After spending eight days in the hospital , even as the treatment was in progress Raju died.

Raju was a victim of a virulent form of Dengue fever, a mosquito borne contagion that is becoming a big health problem in India. Like Malaria, it is usually prevalent in tropical regions and in the last two decades, nearly all of India’s states have had outbreaks of dengue fever. The outbreaks of this epidemic is cyclical, and infection rates can accelerate with frightening speed. India is now experiencing an upswing in dengue cases. Till the first week of September this year, more than 11,000 cases and nearly 200 deaths were officially reported. But the true incidence is much higher and the vast majority of cases go undetected and unreported. According to some doctors from the department of Chief Investigation for Dengue at Pune’s KEM Hospital , the actual figures are probably 10 times higher than what is being officially projected since many of them never seek medical help in the first place especially in rural areas where they tend to take country medicine and other such treatments which can put the entire community at the risk of contacting this disease.

There has also been a rapid growth in the occurrence of Dengue Haemorrhagic Fever (DHF) – a potentially deadly form of the infection. Although dengue fever has been in India for a very long time, DHF was first reported in Kolkata in 1963. There have been more than 60 outbreaks since, with the most deadly being in Delhi in 1996 when more than ten thousand people were hospitalised and 430 people died.

What many experts feel is that there should be an awareness program aimed at making everyone aware of the dangers of this disease.We get to see in most major cities pamphlets being distributed and notices are being put up in health centers and government as well as private hospitals to make people aware of the seriousness of this epidemic. But the fact of the matter is that this message reaches only the educated people who are able to read and understand. 

Some relevant facts

According to medical experts, the Dengue virus does not spread directly from person to person. It is transmitted by the female mosquito of the Aedes aegypti or Aedes albopictus varieties. When the mosquito gorges on 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. And at any time during its 65 day life span, the infected mosquito can transmit the virus to humans.

Once the virus enters the human body, it begins to multiply slowly within the blood cells and the symptoms are not immediately apparent. It takes between two to seven days for the virus to incubate. Symptoms vary according to the age and the health condition of the patient. Generally, the sickness starts with a high temperature, agonizing headache, backache, and muscle and joint pain. Nausea, vomiting and loss of appetite are common, also a rash usually appears three or four days after the fever starts. The worst symptoms can last up to ten days, and complete recovery can take a month or even longer.

In the DHF variant, about which I have discussed in earlier, cells release chemicals that trigger leakage of plasma from blood vessels. Massive bleeding from the brain, intestines and other organs results in low blood pressure. And this along with the accumulation of fluids in body cavities can lead to shock. According to Dr N L Karla, a former WHO expert on dengue who has also been a deputy director of the national Malaria Eradication Program – Once a dengue patient is in shock, chances of multi-organ failure and death are very high! This terrifying scenario is characterized by high continuous fever of 104 degree and above, lasting up to seven days that may also be accompanied by loss of appetite, nausea, vomiting, abdominal pain and bleeding from the skin, nose or gums. In some of the worst cases recorded patients’ condition may deteriorate after a few days of fever and they may die within 24 hours. Many people, even doctors, mistake DHF for influenza or some flu like viral diseases or like it happened in Raju’s case , for malaria or typhoid. And , so as a result DHF often goes untreated until symptoms become severe and the patient goes into shock.

What to look for

We have to remember that in Dengue there is often a rash , whereas that never happens with flu or malaria. When you have flu, the fever disappears within five days at the most but in dengue it continues for a week or more.

Malaria fever is different : it is accompanied by chills and the fever is intermittent, often shooting up on alternate days. Moreover, the body ache and headache characteristic of dengue is not seen in Malaria. Up to five percent of DHF cases are fatal, without proper treatment. When the detention treatment gets delayed this percentage can go up to 15 percent.

Most who die are children under the age of 15, but adults too are at a real risk. Talking about one of the cases, a 27 year old woman was brought to Pune’s KEM Hospital suffering from a week of fever and bleeding gums. When tests confirmed that she had DHF, she was administered blood transfusion. Unfortunately, on the third day after the transfusion her condition deteriorated rapidly – her blood pressure plummeted and she went into a coma. She was put on a ventilator, but her condition continued to worsen and she died a couple of days later !

Treatment

Patients who recover from Dengue develop antibodies that provide immunity. But there are four dengue viruses ( DEN-1, DEN-2, DEN-3 and DEN-4), so a person can develop up to four infections in a life time. Often, infection with a subsequent strain results in more serious illness,though experts are unsure why this happens.

Epidemiologists blame the spread of dengue largely on rapid urbanization since most of the cases reported in India, have come from metro cities like Delhi,Calcutta,Chennai,Pune and Mumbai. Residents of mega cities often store water for drinking and washing in open tanks, drums and jars which are kept filled with water are all good mosquito breeding conditions.And the majority of dengue cases occur during and just after the monsoon when the mosquito population is at its highest.

However, no specific treatment will cure dengue.the symptoms are treated with paracetamol and fluids, according to medical experts, Aspirin should not be given to sufferers because the drug can impair blood clotting so paracetamol is a better choice.the patient should be given plenty of water and fruit juices.

Doctors say that anyone who suspects that he or she may be infected with dengue, to visit his or her doctor or go to the nearest hospital immediately so that blood pressure and potentially fatal complications like internal bleeding can be monitored and also blood or plasma can be quickly replaced.

While no dengue vaccine exists today ( hopes are high that it could be available by 2015), scientists around the world are working hard to develop one. So as of now one has to take some measures to keep the epidemic away.

Experts say that those infected should be kept away from mosquitoes so that they don't pass on the virus to others around them. Mosquito nets and even repellents should be used round the clock since one can never be sure.The virus stays in the blood stream of the person infected as long as he or she has the fever.

Pevention is better than cure

This is the best policy to adopt since it may be too late when the disease gets detected...These simple precautions can protect you against dengue

1. Eliminate the breeding sites

• Keep containers outside the home dry. when not in use keep them upside down. Discard items that collect rain or run-off water from any source, especially old tyres and coconut shells.
• Change the water in outdoor birdbaths and pet and animal water containers regularly, if possible on a daily basis without fail.
• Avoid hanging clothes either for drying or even otherwise in dark corners as these serve as hiding places for mosquitoes.
• Control mosquito larvae in ponds and wells by keeping larvae eating fish like Guppies and gold fish. Besides keeping the water clean they also eat any other infection that can accidentally get into the water.
• Make sure and if possible insisit that public health officials safeguard your community by eliminating stagnant water sites in construction and wastewater treatment areas.

2, Protect yourself frrom Bites

• When you go outdoors, especially to your garden where you can find the mosquitoes hiding in the greenery during day time and come out once the sunlight fades away, make sure that you wear long sleeved dresses and cover your feet, also apply a mosquito repellent on all exposed parts like the forehead,face,ears and hand and fingers.
• When indoors make sure that curtains are drawn during the evening hours and at night . Cleaning the floor and the surfaces daily with water mixed with any housecleaning liquid or phenoyl helps in keeping both mosquitoes and flies awayy to a large extent.
• Attach screens and curtains to all windows and doors which are open to the outside.
• Teach children the basics of hygeine and advise them not to play in water or even near still water ponds or in low areas where rain water tends to collect.
• Use mosquito repellent creams or use mosquito coils or electric vapor mats even during day time if possible.Incidentally, if you have the convenience you can use camphor fumes or dhoop in the evenings which is also helpful in driving out mosquitoes.
• While travelling, you can reduce the risk of getting dengue fever by taking care and protecting yourself with suitable clothes that cover your entire body and also making sure that you carry mosquito repellent creams with you all the time.

3, Seek Treatment

• See a doctor immediately if you have any of the flu like symptoms that I have mentioned especially when it is accompanied by fever,joint pain and rash.The earlier you do this the greater are the chances of survival.
• When you hear people coming down with any of these symptoms , among your own family circle,friends or even within your community and neighborhood, encourage them to seek medical help immediately . 

Finally,  to conclude Dengue, unlike Malaria, so far does not have an organized national level program devoted to combating it. The job has been left largely to the state governments, most of whom are ill equipped and too cash strapped to tackle the disease with any vigor. It is also a fact that government agencies alone cannot solve this problem. Until a vaccine is found we need to be careful and take all the precautions that have been advised by the medical experts. The best precaution to take would be to seek the help of a doctor when ever you get any dengue like symptoms insteadof going in for self medication, so that you dont waste precious time.

Most doctors feel that ultimately, keeping dengue at bay is the responsibility of the concerned families and communities. if everyone works together, there is a good chance that dengue can be controlled. Each one of us must do our bit to ensure that all water tanks and other containers are covered so that mosquitoes cannot breed in them. If just this is done, we will definitely win the war against dengue!