BY DATUK DR ZULKLIFI ISMAIL
The female Aedes aegypti mosquito spreads the dengue virus by biting a person already infected with dengue fever. An infected mosquito can continue to transmit the virus for the rest of its life. – AFP
Early assessment and appropriate treatment in dengue fever is critical to prevent serious complications and death.
DENGUE fever has been in the news quite regularly for the past few years. Many people have either been infected (and survived) or know of others who have had the infection.
Dengue is endemic here, and the mosquito that is responsible for transmitting the virus, Aedes aegypti, is living amongst us.
So, how can we prevent ourselves from getting infected?
Recent statistics of dengue cases and fatalities in Malaysia are ringing alarm bells across the country. From Jan 1 to 22, 2014, 6,155 dengue cases were reported, compared to 1,792 cases within the same period in 2013 (an alarming six-fold increase). The number of deaths has doubled from five deaths in 2013 to 10 deaths in 2014, all within the same period.
There is no running away from the problem as dengue cases have increased in 12 states across the country.
Signs and symptoms
Dengue fever is a viral infection. Its carrier – the female Aedes aegypti mosquito – spreads the virus by biting a person already infected with dengue fever. An infected mosquito can continue to transmit the virus for the rest of its life.
One bite is enough to infect a person. The virus usually takes five to eight days to incubate before symptoms begin to appear.
There is no antibiotic, anti-viral medication or vaccine to cure dengue fever. Treatment is mainly to alleviate the symptoms.
The usual symptoms of dengue are sudden and acute onset of high fever (40°C/104°F) for up to a week, followed by any of the following symptoms – chills, severe headache, pain behind the eyes, muscle and joint pain, nausea and vomiting, as well as fatigue.
Rashes may appear a few days later.
These symptoms will last for two to seven days. Most people will recover completely within two weeks, but may continue to feel tired and depressed for a little longer before they feel normal again.
In some people, complications can set in – dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS).
In DHF, the symptoms are high or very high fever, spontaneous bleeding, especially from the gums, bleeding under the skin (petechial spots), bleeding in the gut, and liver damage.
DHF is often fatal if left untreated. Most deaths reported have been in young adults, but children can easily succumb if not properly managed.
The symptoms of DSS include very high fever, severe bleeding, weak pulse, drop in blood pressure, restlessness, and cold clammy skin (with signs of shock). At this stage, fatality rates can be as high as 50%. Two-thirds of all DSS fatalities occur in children.
Dengue fever in children
Children, especially toddlers and infants, are particularly vulnerable to diseases because their immune systems have not yet matured. Parents must take precautions to ensure that the early onset of dengue fever symptoms in young children are monitored carefully and treated properly.
Dengue in infants and toddlers presents symptoms similar to the flu – fever, running nose, cough and mild skin rash. Older children may have high fever, pain behind the eyes and joints, headache and backache.
This may be followed by a reddish skin rash with white patches, loss of appetite, nausea, vomiting, and itchiness on the palms and/or soles of the feet. Your child will feel weak and listless.
If the above symptoms with fever are noted, it is best to see a doctor immediately. A blood test will confirm if your child has been infected with the dengue virus.
If dengue fever is confirmed, your doctor will prescribe medication for the fever and pain (most likely paracetamol), and other supportive medications if needed. Medications containing aspirin must be avoided as they will exacerbate bleeding and cause other problems.
Once diagnosed, blood tests will be done every day to check on platelet and haematocrit levels. Give your child plenty of fluids, at least a litre a day if your child is a year old and below 10 kg.
The prescribed fluid intake for children above 40 kg and adults is two litres a day.
Fluids help to rehydrate the body as the fever increases water loss and poor appetite depletes fluids. Dengue also causes blood vessels to leak and increase water loss from blood circulation. Lack of appetite, vomiting and diarrhoea also exacerbates dehydration.
Therefore, keep your child hydrated with fluids such as water, soups, juices and fruits.
If your child’s condition worsens, i.e. if any of the following symptoms are present – bleeding without injury, drowsiness, difficulty breathing, lethargy, excessive vomiting, poor intake of fluids, abdominal pain and giddiness, then waste no time in getting your child admitted to a hospital.
These are signs that your child may be at risk of DHF or DSS.
At the hospital, your child will be put on an intravenous fluid drip and their vital signs will be monitored.
Blood tests will be done at regular intervals to check on the platelet count and blood concentration.
If there is spontaneous bleeding and the platelet level decreases to below 20,000 and continues dropping, a platelet or blood transfusion will be given.
Your child will only be discharged if the platelet count goes up and shows an upward trend. After discharge, your child will still be weak and tired, and will need to rest well and avoid active play.
A repeat blood test may be done after one to two weeks to confirm that the platelet count has returned to normal.
Precautions for children
In addiction to taking the precautions advised by the Health Ministry in eradicating the breeding grounds of the Aedes mosquito in your homes and surroundings, parents can also reduce the risk of mosquito bites by:
·Installing mosquito screens in windows and doors.
·Applying insect repellent on children when they go out to play.
·Keeping children indoors during the early mornings and late evenings when the Aedes mosquito is most likely to strike.
·Dressing children in long-sleeved tops and long pants when playing outdoors.
·Keeping children away from neighbourhoods where individuals have been infected with dengue fever, as there is a high likelihood that Aedes mosquitoes are still present.
·Taking precautions when holidaying in other dengue fever endemic countries in South-East Asia, Latin America and the Caribbean. Dengue does not only happen in Malaysia!
Though your child will gain immunity to the particular strain of dengue virus that caused the infection, there are three other strains (with a fifth strain, dengue V, recently described in Sarawak) of dengue viruses that can cause re-infection.
Therefore, any person faces the possibility of getting dengue fever four or five times in their lifetime.
With these odds, it is best to take as many precautions as possible from getting bitten by the Aedes mosquito.
Intensive research has been conducted on a vaccine for dengue infection, and it may be available sooner than we think.
References:
1. The Star at http://www.thestar.com.my/News/Nation/2014/01/25/Dengue-cases-skyrocket-Number-of-infected-increases-by-threefold-nationwide/
2. Healthcare Malaysia at http://healthcaremalaysia.com/dengue-fever
3. Expat Malaysia at http://www.expat.com.my/dengue.htm
4. Malaysia Kurnia at http://malaysia.kurnia.com/Lifestyle/Health/17/Default.aspx
5. WebMd at http://www.webmd.com/a-to-z-guides/dengue-fever-reference
6. Kids Health at http://kidshealth.org/parent/infections/bacterial_viral/dengue.html#
7. Mayo Clinic at http://www.mayoclinic.com/health/dengue-fever/DS01028
8. World Health Organization at http://www.who.int/mediacentre/factsheets/fs117/en/
9. KK Women’s and Children’s Hospital at http://www.kkh.com.sg/HealthPedia/Pages/ChildhoodIllnessesDengueFever.aspx
