Dengue treatment should focus on prevention rather than vaccination

Dr. ABM Abdullah, a prominent health expert in the country, currently serves as Emeritus Professor at Bangabandhu Sheikh Mujib Medical University. Recently, he spoke with Views Bangladesh about the rising incidence of dengue in urban areas, the appropriate treatment and management strategies, and the necessary actions the interim government should take to address this issue. The interview was conducted by KM Zahid.

Views Bangladesh: Over the past few months, more than 18,000 dengue patients have been hospitalized, with two-thirds of them coming from outside Dhaka. The death toll has exceeded 100. Why is dengue spreading more in areas outside of Dhaka?

ABM Abdullah: Dengue is not a new disease in our country; we've been combating it since 2000. However, its prevalence has increased in recent years. In 2023, over 300,000 people were infected, resulting in more than 1,700 deaths. This year, infections began rising as early as January. Previously, we believed dengue was a seasonal disease that peaked during the monsoon. That notion is now outdated; we are seeing cases throughout all seasons—winter and summer included. This August and September, however, have witnessed a sharp increase in cases.

Notably, the majority of new hospital admissions are from various district towns and rural areas. Historically, dengue was thought to primarily affect urban populations, but in the last two to three years, we've observed a significant rise in cases in villages as well. This is due in part to stagnant water accumulating in rural areas, which breeds all kinds of mosquitoes, including those that transmit dengue. Moreover, many people in rural areas do not use mosquito nets and lack awareness about dengue, contributing to the rising patient numbers. Another factor is the transport system. Aedes mosquitoes are spreading from urban centers like Dhaka and Chittagong to rural towns and villages via buses, trucks, and other vehicles. This facilitates the transmission of the disease, impacting the general population.

Views Bangladesh: Is there a new variant of dengue this time? Which of the four types of dengue poses the highest risk of death?

ABM Abdullah: The dengue virus is transmitted by the Aedes mosquito. With the increasing impact of climate change, urban areas are becoming more polluted and waterlogged, leading to a rise in the Aedes mosquito population and, consequently, the number of dengue patients. There are four recognized types of dengue virus: Den-1, Den-2, Den-3, and Den-4. While they share similarities, each type has distinct characteristics that affect their severity.

The severity of dengue and the risk of death do not solely depend on the virus type; they are also influenced by how frequently an individual has been infected and the management of their treatment. For example, if someone is infected with Den-1 for the first time, the symptoms may be mild, resembling a common cough or fever. However, if a person has previously been infected with Den-2, Den-3, or Den-4, the severity can significantly increase upon re-infection. This is currently evident, as individuals are quickly progressing to severe stages of the disease. Many may not realize they are experiencing a second or third infection, leading to rapid deterioration and, in some cases, death.

Views Bangladesh: Which age groups are mostly at risk, and who experiences the highest mortality rates?

ABM Abdullah: Dengue can affect people of any age; however, children tend to have a higher incidence rate. This year, we are observing a higher incidence and death rate among males, though the elderly are also affected. Individuals with weakened immune systems and comorbidity, such as those with diabetes, cancer, kidney disease, or heart conditions, face greater risks. Additionally, children and the elderly are particularly vulnerable. Pregnant women are also at increased risk for complications and mortality when infected.

Views Bangladesh: What is the role of awareness and treatment in this situation?

ABM Abdullah: Awareness is crucial. Since dengue is a viral disease, it shares common symptoms with other viral infections, including fever, cough, sore throat, headache, and body aches. The fever can be quite severe, and some patients may also experience vomiting and diarrhea. With the current prevalence of dengue in the country, anyone experiencing fever along with these symptoms should undergo an NS-1 antigen test within three days, as recommended by a doctor.

If the test comes back positive, it’s essential to begin treatment promptly as advised. Dengue can deteriorate rapidly, and if a patient goes into shock, it becomes much more difficult to treat. Timely management is critical to avoid such complications. It’s also vital for the public to know that only paracetamol should be taken for fever; no other medications should be used without a doctor's recommendation. If symptoms persist beyond three days, consult a doctor for further treatment options. Taking inappropriate medications can be counterproductive.

In cases of dengue, if complications arise, there may be limited options even in major hospitals. It’s crucial for patients to stay hydrated, so they should consume plenty of liquids such as water, saline, and rice water. It's important to include a variety of liquids, along with solid foods. Fruits rich in vitamin C, like lemons, oranges, and other citrus fruits, are also beneficial. However, relying solely on green cocoanut water is insufficient, as it doesn’t provide the necessary vitamins, minerals, and nutrients. This can lead to deficiencies and further deterioration of the patient’s condition.

Patients can manage mild cases at home by ensuring adequate hydration and taking paracetamol as directed by a doctor. Most patients will recover within 7 to 10 days. However, if a patient experiences vomiting, diarrhea, or is unable to eat, it is vital to seek hospital care promptly. In such cases, intravenous fluids may be required to stabilize the patient. Children, the elderly, and individuals with underlying conditions such as diabetes, cancer, heart disease, or kidney issues should be admitted to a hospital at the first sign of dengue. Pregnant women should also seek treatment in a hospital to prevent any harm to the unborn child. It’s essential to avoid neglecting symptoms or delaying care, as this can lead to serious complications and even death. Patients exhibiting severe symptoms—such as persistent vomiting, inability to eat, loose motion, decreased pulse, or low blood pressure—must receive immediate medical attention. Procrastination in these cases can be life-threatening.

Views Bangladesh: Is there a vaccine to prevent dengue, and what is the status of vaccine production and application in our country?

ABM Abdullah: Currently, dengue vaccination is being implemented in countries like France and Japan. However, widespread vaccinations that are approved by the World Health Organization (WHO) have not yet occurred, nor have vaccines entered the market for mass distribution. Unlike COVID-19, dengue has not reached a global prevalence that necessitates mass vaccination.

There is a vaccine called Qdenga, but it is not suitable for everyone, as it has age restrictions. Another vaccine, Dengvaxia, also has limitations regarding who can receive it. Furthermore, several vaccines are still in trial phases in countries like the Philippines, Thailand, and India, and they have not yet received WHO approval. Without this approval, these vaccines cannot be administered to the general population. Given the current situation, it is more effective to focus on prevention rather than relying on vaccination. We should prioritize awareness and preventive measures at both individual and community levels.

Views Bangladesh: The mayors of every city corporation in the country have been dismissed, and many city councilors are either in hiding or neglecting their duties. How is this affecting mosquito control efforts? Why is dengue still on the rise?

ABM Abdullah: We are currently facing significant challenges in mosquito control due to a lack of institutional and administrative oversight. With the dismissal of elected mayors and the resignation or absence of councilors, mosquito eradication activities have either halted or are inconsistently implemented. This issue is not confined to Dhaka; similar situations are observed in all city corporations.

As a result, the absence of pesticide workers and fogging operations means that mosquito populations are not being adequately controlled, particularly during this peak dengue season. If this situation continues, we may face even greater challenges with dengue in the coming days. Therefore, it is imperative for the government to address this void urgently, engage the community, and initiate a robust mosquito eradication program. Only through these actions can we hope to reduce both the rate of infection and the number of fatalities.

Views Bangladesh: Every year during the dengue season, there seems to be a syndicate controlling the supply of essential materials, including medications and saline. What actions should be taken?

ABM Abdullah: Doctors are there to provide treatment and patient care, but if a patient's condition worsens day by day, there’s little more they can do. Under the pressure of high volumes of patients, proper medical care can be compromised, leading to a lack of necessary medications and resources like seats. These inefficiencies create barriers to access, which can result in various inconsistencies in care.

What some refer to as a "syndicate" may arise from these inconsistencies and inadequacies in the supply chain of saline and medications. Frequent complaints about these issues are common in a densely populated country like ours, where there are ongoing complaints about medical services and the quality of care provided by doctors. The government must take decisive action to address these problems. It is essential to implement solutions that benefit both the public and patients, ensuring that accountability and responsibility are prioritized within the healthcare system.

Views Bangladesh: The current interim government is prioritizing treatment and raising awareness. However, people from all walks of life continue to complain about medical care. With the government seeking reforms, what type of reforms do you think are necessary in the health sector?

ABM Abdullah: The reality is that our health department has faced ongoing complaints about irregularities and corruption year after year. From procurement processes to administrative roles, there are persistent allegations of malpractice involving doctors. If this government is genuinely committed to reforming the health sector, similar to other sectors, that is certainly welcome.

It’s crucial to acknowledge the multitude of complaints from the public and to engage all stakeholders in reforming practices at the grassroots level. However, the need for reform extends beyond just addressing issues with doctors or medical care; significant changes are also required within the administrative processes of the health sector. A major challenge for this government will be improving access to medical facilities in rural and peripheral areas, which is essential for comprehensive reform.