ZOONOSES

A Catastrophic Upheaval: DENGUE 2021

November 15, 2021

526

A Catastrophic Upheaval: DENGUE 2021

Anu Malik 1, Parul Rana2*, Rashika Srivastava3
1 Ph.D. Scholar, Department of Veterinary Microbiology, LUVAS, Hisar, Haryana-125001, India
2 Ph.D. Scholar, Animal Nutrition Division, ICAR-National Dairy Research Institute, Karnal, Haryana-132001, India
3 Ph.D. Scholar, Animal Nutrition Division, ICAR-National Dairy Research Institute, Karnal, Haryana-132001, India
Email: ranaparul.007@gmail.com

Dengue 2021 unravels like a pyrexic plight jolting the roots of the medical fraternity in India amidst the ongoing Covid-19 pandemic. DENGUE is the most frequently occuring mosquito-borne viral disease, predominantly in tropical and subtropical countries like India. It is endemic to the Indian subcontinent, thereby making India the epicentre of dengue fever. The dengue virus is endemic in 128 countries in the current scenario, posing a potential risk of different severity to billions of people annually.

Dengue is mainly an acute, self-limiting, febrile disease caused by a virus of the flavivirus genus from the Flaviviridae family, transmitted by infected Aedes aegypti mosquitoes from patients with the viral infestation or anyone with Covert infection. The disease has an incubation period of about 5-8 days, with its clinical presentation depending on the patient’s age. In infants and young children, it symptomises as an undifferentiated febrile disease condition, with maculopapular rash. In contrast, the illness is a mild febrile syndrome or the classic disease in older children and adults. The strains of this virus are classified into four distinct serotypes: DV-1 to DV-4, based on antigenic characteristics. The epidemiology of dengue is witnessing remarkable changes, with larger and more frequent outbreaks reported from urban and rural areas associated with all four serotypes in India. The disease is clinically classified into mild and self-limiting dengue fever (DF) to severe dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS) which may lead to potentially fatal complexities.
Generally, the monsoon season does come with observation of smattering cases of dengue, but this year the occurrence has risen sharply. The outbreak first emerged at the dusk of the downpour season in the state with highest population in India, Uttar Pradesh. Since then, sporadic increase in cases scattered across different states and union territories of Northern plains, hills and plateau of Northern and Central India including Haryana, New Delhi, Punjab, Haryana, along with escalation in the coasts of Kerala and Tamil Nadu. GlobalData epidemiologists expect the number of diagnosed incident cases of dengue to markedly increase over the next one to two years given the severity of the dengue outbreak further aggravated by the ongoing Covid-19 pandemic. In India, GlobalData epidemiologists have prognosticated that the diagnosed incident cases of dengue are expected to show an increment close to 41,000 cases by the end of this year. The number of incident cases diagnosed to be positive for dengue viral infections is likely to surpass the current reckoned estimate as this ongoing dengue case flare-up is the worst outbreak in many years. A tremendous inadequacy of medical equipment and hospital bed availability due to the Covid-19 pandemic seen in the past year, along with the sudden increase in dengue hospitalisations is likely to create more hurdles for an already strained health system. A total of 15 states and union territories have reported their highest number of dengue cases this year, contributing to about 86% of the country’s total number of dengue infections until October 31. So, keeping this in view, the health ministry has rushed high-level teams to nine states and union territories that are observing an augmentation in dengue cases, in order to help them take immediate public health measures to control the vector-borne disease and manage the situation of this recent outbreak in the country. These high-level teams consisting of experts from the national vector-borne disease control programme, the national centre for disease control, and regional offices have been deployed to Haryana, Kerala, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh, Uttarakhand, New Delhi, and Jammu and Kashmir as per the directions from the union health minister, Dr. Mansukh Mandaviya as of November 1, 2021 during a review meeting on the dengue situation in Delhi. The teams are tasked to support the affected states to initiate an effective public health response to the surging crisis. A report on the status of vector control, the availability and use of insecticides, and the status of anti-larval and anti-adult vector control measures must be prepared. The availability of kits and medicines, detection of dengue cases at the earliest must be ensured.
The main strategy to control the spread of dengue is vector control, which aims at shrinking the size of mosquito populations by using biological means like introduction of mosquitofish in the waterbodies in and around outbreak areas. Each mosquitofish can eat up to 150 larvae in only eight hours, so, around 25,000 mosquitofish have been released into ponds and lakes in Western Uttar Pradesh. This must be supplemented by an augmented environmental management strategy to destroy any potential breeding sites. These may be done by simple approaches for maintaining clean surroundings and hygienic domains by removal of any containers that can collect water. Launching widespread campaigns of insecticide spraying known as ‘fogging’, needs to be adopted in all the affected regions. Close surveillance and monitoring of the situation are critical to mitigate the outbreak and prevent further spread to the neighbouring areas. The government requires an urgent strategic response, especially in the Covid-19 pandemic, to contain the dengue outbreak. There are no specific vaccines or antiviral treatments against dengue fever. So, symptomatic treatment is generally adopted for example usage of paracetamol to bring down the fever. Aspirin and related non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen should be avoided. Recovery from infection by one dengue virus provides lifelong immunity against that particular virus serotype. However, this immunity confers only partial and transient protection against subsequent infection by the other three serotypes of the virus. Evidence points to the fact that sequential infection increases the risk of developing severe dengue. The time interval between infections and the particular viral sequence of infections may also be of importance. The best way to prevent infection is to avoid being bitten by mosquitoes during daytime. Mosquitoes that commonly transmit dengue virus often live in and around the home and in the garden. People should wear clothing that covers the body well (especially legs and feet).Mosquitoes must be kept out of the house by placing insect screens over doors and windows. Application of insect repellents according to the manufacturer’s label instructions, sleeping under a net, even during the day and taking extra precaution to prevent transmission if a family member is infected by avoiding mosquito bites ought to be done individually by public. Mosquitoes are the greatest mass murderers on the planet. Without any effective particular treatment or vaccine against dengue, prevention in this situation is better than cure.