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Business News/ Politics / Policy/  The struggle to control the spurt in dengue cases
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The struggle to control the spurt in dengue cases

With Delhi recording 16 deaths due to the dengue, questions are being raised on the changing nature of the disease and the underlying reasons for the increase in the number of cases

People suffering from fever get their blood test for dengue at a fever clinic run by a government hospital in New Delhi. Photo: Manish Swarup/APPremium
People suffering from fever get their blood test for dengue at a fever clinic run by a government hospital in New Delhi. Photo: Manish Swarup/AP

New Delhi: State governments are struggling to manage a spurt in dengue cases in the past month. This year the capital has recorded more than 2,000 cases of dengue, with 16 deaths, against 995 cases and three deaths last year.

Questions are being raised regarding the changing nature of the disease and the underlying reasons for the increase.

The dengue virus has four different strains with varying degree of severity of symptoms. In 2012 and 2013, India saw the worst outbreaks, with more than 50,000 and 75,000 cases, respectively. A worrying aspect is that the disease is spreading to areas where it was not so rampant before.

In a recent paper in Current Science, researchers analysed why dengue is rampant in Tamil Nadu and Puducherry.

“Dengue is a vector borne disease which makes it less of a disease management issue and more about environmental management. Further urbanization throughout the country is bound to increase the incidence of disease and facilitate its increase unless waste management and drain management are undertaken," said P.A. Azeez from the division of environmental impact assessment, Sálim Ali Centre for Ornithology and Natural History, based in Coimbatore.

Azeez added that the surveillance system needs to be strengthened for an effective vector-control programme.

According to a 2014 study published by the Institute of Liver and Biliary Sciences, over the last few decades, India has seen a rapid expansion in the spread of dengue, with an equally rapid change in epidemiology of the disease.

In 1996, the first major DHF (dengue hemorrhagic fever) outbreak was caused by dengue virus serotype 2. And then in 2003, the country faced yet another DHF outbreak caused by dengue virus serotype 3. A sharp increase in the number and frequency of outbreaks followed, and, at present, in most of the states of India, dengue is almost endemic.

“Dengue rises at this time of the year because of the right temperature and this is the time when breeding of mosquitoes is at its peak," said Tarun Sahni, senior consultant, internal medicine, Indraprastha Apollo Hospital, Delhi.

He added that two or three years ago, the virus strain had been particularly virulent, while this year the symptoms haven’t been too severe. “The change in virulence patterns makes it difficult for a vaccine to be developed and also changes the number of deaths," he added.

Dengue, which is spread through Aedes mosquitoes, causes a wide spectrum of illness from mild asymptomatic illness to severe fatal DHF/dengue shock syndrome. “Delhi is hyper-endemic, which implies that all four strains co-circulate, depending on the pool of susceptibility; one or two become dominant every year," said Manish Kakkar, senior public health and infectious diseases expert at the Public Health Foundation of India.

The management of dengue virus infection is essentially supportive and symptomatic, but no specific treatment is available.

There are also no vaccines against the disease despite worldwide efforts to develop one. The closest to approval is French drugmaker Sanofi SA’s experimental dengue vaccine, which showed efficacy for all four variations of the dengue virus and against dengue haemorrhagic fever in its Phase III clinical trials.

“The deaths this year were easily avoidable and the situation is manageable," said Kakkar.

People with dengue symptoms rush to the hospital in panic but all they need is symptomatic treatment at home while the 1% with the deadly strain go unattended, he said. “We need effective risk management and the health system needs to be prepared better and the public more informed," said Kakkar.

PTI contributed to the story.

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Published: 18 Sep 2015, 11:39 PM IST
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