PAKISTAN: Dengue fever - more hype than numbers?

Photo: Tahira Sarwar/IRIN

Between October 2006 and January 2008, there were 3,242 laboratory-confirmed cases of dengue (file photo)

KARACHI, 23 September 2009 (IRIN) - Medical experts in Pakistan are divided over the way the media should cover dengue fever. Some say reporting is alarmist and does nothing to help prevent further cases of what is not a particularly fatal illness, whilst others caution against complacency.

“The hype created around dengue by the media is far more troublesome than the actual number of patients we get with this illness,” said Tasneem Ahsan, professor of medicine at Karachi’s Jinnah Post Graduate Medical Centre (JPMC).

“It’s not as fatal as it is made out to be. There is so much fear surrounding this illness that the moment you tell a patient that he may have dengue, it’s like a death sentence,” Ahsan said, blaming the media for creating a “jaw-dropping” reaction from patients.

This “hue and cry”, Ahsan said, would be better directed towards “eliminating the breeding sites” of the aedes aegypti and albopictus mosquito, responsible for the transmission of dengue, as there is no vaccine to fight the illness.

He added that falci parum malaria, the most dangerous form of malaria, was far more prevalent than dengue, but the media was failing to write about it.

It’s not as fatal as it is made out to be. There is so much fear surrounding this illness that the moment you tell a patient that he may have dengue, it’s like a death sentence.

Qutbuddin Kakar of the World Health Organization (WHO) agreed: “While fatalities from cerebral malaria are as high as 20 percent, those from dengue are as low as between 1-3 percent.”

Dengue is a flu-like illness found in sub-tropical areas of the world. Human transmission takes place when the aedes mosquito feeds on an infected person’s blood and bites a healthy person. In the more severe cases, people can die of haemorrhagic fever, a horrific death, doctors say.

“Most cases are of classical dengue and the symptoms and signs are mild,” said Kakar, who has also been providing technical assistance to the vector-borne diseases unit of the Health Ministry for the past seven years. “There is no need for panic, but a need for being informed.”

Only two dengue deaths in 2009

In 2006, Pakistan suffered its worst outbreak of dengue, resulting in 52 deaths. In 2007, 22 people died of the illness and in 2008 just five. Between October 2006 and January 2008, there were 3,242 laboratory-confirmed cases of dengue.

So far in 2009, two people have died of dengue, both in January.

Seemi Jamali, deputy executive director of JPMC, said they had recorded 23 suspected cases of dengue from early August until 17 September.

In Sindh Province since January 2009, there have been 224 suspected cases reported of which 135 were confirmed, said Shakeel Malik, the focal person for dengue in Sindh Health Department. “This data has been collected from 27 hospitals [both public and private], of which 26 are in Karachi.”

Photo: Zofeen Ebrahim/IRIN

Medicated mosquito nets are important in fighting the dengue fever threat

Caution urged

Samreena Hashmi, secretary-general of the Pakistan Medical Association’s Karachi chapter, told IRIN that the media was right to take dengue very seriously. “There is every reason to be concerned as there has been a rise in dengue cases in the last few weeks,” she said.

Hashmi urged the government to increase the number of blood banks. “We need cell separators [machines that collect from a donor either blood plasma only or plasma and platelets] on an emergency basis, and just providing four to Karachi’s burgeoning population of 17 million is not going to be enough… A person suspected of infection needs to get a blood test done every 48 hours to find out the platelet count - because if it drops the person will die,” she said.

With large numbers of people visiting the dengue-endemic, congested cities of Karachi and Lahore for Eid celebrations, experts fear a spike in infections and have urged the government to strengthen its surveillance and begin fumigation campaigns.

“They can spray insecticides and pour kerosene over garbage so that mosquitoes do not breed there,” Hashmi said.

The dengue mosquito is most active in day time so “people cannot be expected to remain inside protective nets,” said WHO’s Kakar.

He said a person bitten with one dengue strain becomes immune to it, but if bitten by another strain, the chances of him contracting a fatal infection increases. “Our concern is life-long protection for which we need to focus on raising awareness among households,” he said, adding that schools, colleges and local authorities should also be targeted by media campaigns.

“It is important to tell people to cover their water containers, storage tanks, flower vases, or cans, bottles and plastic bags dumped outside. Due to recent rains, water may have collected in them, making them perfect breeding sites,” said Kakar.

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