The 4S Strategy: Dengue awareness and prevention

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The 4S Strategy: Dengue awareness and prevention

Sunday, 19 September 2010 00:00 Ma. Rachel Roxas Yapchiongco

In June 2009, Kris Aquinos two sons, Joshua 0 and baby James, were hospitalized because of tweets dengue. Kris suspected that the fountain and tweet bamboo plants in their home were possible breeding grounds of mosquitoes, so she had them removed after that unfortunate experience. The son of my husbands badminton colleague also fell ill due to dengue last year. The grade schooler stayed in the hospital for one week until his blood platelet count became normal. It was also early last year when my cousin was diagnosed with dengue. He was hospitalized for three weeks and had to undergo a blood transfusion. Next to malaria, dengue is a tropical infectious disease that has caused the deaths of many Filipinos. Dengue is a potentially life-threatening disease that Filipinos have no choice but to face with vigilance.

Not just for rainy days Dr. Eric Tayag, head of the DOH National Epidemiology Center, claims that the El Nio phenomenon is a possible factor in the rise of dengue cases in the country. In fact, during the El Nio phenomenon in the country in 1998, dengue cases also rose in number. Another alarming change is the mutation of the dengue-carrying mosquito. As a result, the disease can no longer be confined to a regular predictable pattern. Different symptoms and responses have been observed in dengue-stricken patients, making the disease treacherous. At the beginning of 2010, Health Secretary Esperanza Cabral already asked the public to take necessary precautions to combat the threat of dengue. The DOH is warning the public about the rising number of dengue cases in the country. The number of people afflicted with dengue in the Philippines reached 11,803 in the first quarter of 2010. According to the DOH, this number is actually 61 percent higher compared to 7,335 reported cases during the same period last year. The Department of Healths National Epidemiology Center (DOH-NEC) surveillance updates during the first half of 2009 reported that at least 86 Filipinos died because of dengue. The Department of Health (DOH) marks the month of June as Dengue Awareness Month in the Philippines to build public awareness and encourage practice of preventive measures against this mosquito-borne viral disease.

Symptoms to watch for Dengue is a mosquito-borne infection which leads to a flu-like illness. It is characterized as an acute illness suddenly acquired by an individual that "usually follows a benign course with fever, headache, exhaustion, rashes, and severe muscle pain, frequently accompanied by sore throat, dizziness, loss of appetite, vomiting, and diarrhea." Dengue is transmitted to people through the bite of an Aedes mosquito infected with any one of the four dengue viruses. The virus itself cannot be spread by mere personto-person contact. Tropical and subtropical areas of the world are often affected by dengue, and as many as 100 million people are infected yearly. Dengue symptoms may appear within three to fourteen days after being bitten by an infected Aedes mosquito. Anyone can be affected by dengue - infants, young children, and adults. People with weak immune systems are more susceptible to the virus. It is possible for dengue to strike a person several times. During medical examination, a person with dengue may

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exhibit "low blood pressure, skin rashes, sore throat, rapid pulse, swollen glands, and enlarged liver."

Dengue hemorrhagic fever (DHF) Dengue may cause a potentially lethal complication known as dengue hemorrhagic fever (DHF). Symptoms of DHF include fever, abdominal pain, vomiting, and bleeding. Vital signs of bleeding to look out for are blood spots in the skin, spitting of blood, blood in the stool, gum bleeding, and nose bleeding. Complications of DHF are pneumonia and inflammation of the heart. It was in the 1950s when the DHF was first observed during dengue epidemics in the Philippines and Thailand. As of today, DHF is reported in most Asian countries. It is one of the primary causes of hospitalization and death among children in Asian regions. Dengue cases are increasing in Southeast Asia particularly in Thailand, Vietnam, Singapore, and Malaysia. An estimated 50 million cases of dengue fever with 500,000 cases of DHF requiring hospitalization each year was reported by WHO.

Dengue shock syndrome (DSS) Nearly 30 percent of patients exhibiting DHF may experience dengue shock syndrome (DSS). The patient often feels acute abdominal pain prior to its development. It is possible for the patient to have an apparent recovery from fever and body temperature becomes normal within three to seven days after onset of fever. DHF strikes when the patients condition abruptly deteriorates after short recovery. DSS can be reversed within 24 hours with corrective fluid replacement therapy. But it can lead to death within 12 to 24 hours if treatment is not given immediately or the patient does not respond. It is crucial that medical assistance be given without delay.

Laboratory Diagnosis The diagnosis of dengue fever normally involves testing of the patients blood. Clinical lab findings would include "low levels of white blood cells (leukopenia) and platelets (thrombocytopenia) and, often, an elevated level of the enzyme serum aminotransferase." A normal persons blood platelet count is from 150,000 to 450,000. When a dengue patients blood platelets drop to 80,000 and below, there is potential risk of haemorrhaging. It is important for the patient to be admitted in the hospital for constant blood platelet monitoring.

Test kits for early detection Normal routine tests for dengue viral infection are centered on the detection of specific dengue virus antibodies which are only produced several days after the initial clinical signs appear. That means one should wait for four to six days for a primary infection. However, dengue test kits that detect antigens, instead of antibodies, are now locally available. These test kits have the ability to confirm early infection as early as on the first day of symptoms - by detecting the dengue virus antigen NS1 in the patients blood. According to the test kits manufacturers, results are immediately available in one day. This fast method can possibly prevent epidemics in the country.

Treatment and possible future vaccine As of now, there is no specific medication or vaccine that can treat dengue. Treatment is focused on relieving the patient's dengue symptoms. Paracetamol can be given to bring down the fever. However, aspirin, ibuprofen, and mefenamic acid are discouraged because such medicines can increase the risk of bleeding. Intravenous fluids and electrolytes are administered to the patient to treat dehydration and electrolyte imbalances. Blood transfusion may also be necessary if the patient experiences signs of bleeding. A person diagnosed with dengue needs lots of rest to recover his strength. Some vaccine companies would more or less finish their first clinical trial by 2012, others by 2014, National Center for Disease Prevention and Control (NCDPC) director Dr. Yolanda Oliveros mentioned in 2009. There are medical practitioners who are currently talking of developing vaccines and drugs to help fight dengue. NCDPC is putting together efforts to study the use of some indigenous materials in fighting dengue.

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Prevention and Control The DOH makes use of tri-media (television, radio, newspapers) and the internet to propagate information and advisories on dengue. These dissemination methods help reach more people around the country. Efforts are continuously focused on the 4S strategy against dengue. 1. Search and destroy possible breeding places of dengue-causing mosquitoes like flower pots, vases, discarded plastic bags, bottles, old tires, cans, earthen jars, coconut husks, roof gutters, water drums, and other containers that might hold clean stagnant water. Preventing dengue can be easier achieved by doing your part in keeping the environment clean. Change water in vases frequently. Make sure all water containers are kept covered. 2. Self-protection measures include wearing long sleeves or long pants. It is also best to avoid dark-colored clothes like dark shades of blue and black, as dark clothing has been observed to attract mosquitoes. Apply mosquito repellant on the skin to deter mosquito bites. Mosquito repellant lotions and liquid sprays are available on the market; however, parents are cautioned against using strong repellants on small children because of potentially harsh chemicals. There are organic mosquito repellant alternatives such as all-natural citronella bug spray. You can also use mosquito coils, electric vapour mats and mosquito spray during the daytime. Screens and mosquito nets are also good deterrents against mosquitoes. 3. Seek early consultation because dengue is crucial. See a doctor immediately if you show early signs and symptoms of dengue. 4. Say no to indiscriminate fogging. In the past, fogging was considered as a temporary solution against dengue-carrying mosquitoes. At present, fogging is only advisable and recommended when outbreaks and epidemics are positively determined in a particular area. Fogging can only kill the adult infected mosquito; it cannot get rid of the larvae, locally known as kiti-kiti. Indiscriminate fogging will only drive away other mosquitoes to other places to find new breeding grounds.

Photos: Sucking on my hand! (6) by , c/o Flickr. Some Rights Reserved / Aedes mosquitofrom Wikimedia Commons. Public domain. / Old tires by Valerie Everett, c/o Flickr. Some Rights Reserved / It's Like Japanese Mosquito Coil. by Hisakazu Watanabe, c/o Flickr. Some Rights Reserved

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Rachel Yapchiongco, also known as Rach to her friends, is a Psychology and Marketing Management graduate of De La Salle University. She took up several units of MBA at the same university. Rachel is a full-time mom to a charming young boy and married to an entrepreneur with a passion for cooking. She shares parenting experiences and slices of everyday life on her personal blog called Heart of Rachel.

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renin 01 June 10, 01:13 PM

Hi Ms. Rachel! This is very informative. Thanks! Reply

RachelY 01 June 10, 06:24 PM

Thanks Renin for reading this article. Reply

tonette jalandoni tan 20 July 10, 07:18 PM

my daughter tested negative in the dengue rapid test IgG & IgM but tested positive for NS1 antigen qualitative screening. does that mean she is positive for the virus in its very early stage? Reply
RachelY 31 July 10, 10:47 AM

@tonette: Latest dengue test kits are capable of detecting antigen NS1 in the blood, even during its early stage. I hope the test result enabled you to seek immediate medical assistance for your daughter. I hope she's doing fine now. Reply
Shubham 31 July 10, 12:58 AM

Must say this article is very appropriate and contains all the vital information about the topic.....Thank you so much for taking out your precious time and writing such an informative article......cheers!!! Reply
RachelY 31 July 10, 10:48 AM

@Shubham: Thank you for your kind words. I'm glad the article has helped you in some way. Reply
richard 27 August 10, 09:54 PM

1. Search and destroy possible breeding places of dengue-causing mosquitoes like flower pots, vases, discarded plastic bags, bottles, old tires, cans, earthen jars, coconut husks, roof gutters, water drums, and other containers that might hold clean stagnant water. AND the septic tank, air outlet must or should be covered with a piece of used mosquito net to block mosquitoes. to kill them put piece of "calboro" and watch how these mosquitoes rushing out dying. If all houses in our provinces do these, ,just in a day we can eradicate a large percentage of them. Reply
richard 27 August 10, 09:55 PM

1. Search and destroy possible breeding places of dengue-causing mosquitoes like flower pots, vases, discarded plastic bags, bottles, old tires, cans, earthen jars, coconut husks, roof gutters, water drums, and other containers that might hold clean stagnant water. AND the septic tank, air outlet must or should be covered with a piece of used mosquito net to block mosquitoes. to kill them put piece of "calboro" and watch how these mosquitoes rushing out. If all houses in our provinces do these, ,just in a day we can eradicate a large percentage of them. Reply

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The 4S Strategy: Dengue awareness and prevention

http://thepoc.net/thepoc-features/health-and-wellness/health-and-fitnes...

richard 27 August 10, 09:57 PM

1. Search and destroy possible breeding places of dengue-causing mosquitoes like flower pots, vases, discarded plastic bags, bottles, old tires, cans, earthen jars, coconut husks, roof gutters, water drums, and other containers that might hold clean stagnant water. AND the septic tank, air outlet must or should be covered with a piece of used mosquito net to block mosquitoes. to kill them put a piece of "calboro" and watch how these mosquitoes rushing out. If all houses in our provinces do these, ,just in a day we can eradicate a large percentage of them. Reply
kell quenery 12 September 10, 10:31 PM

hoo! thanks for your advice! it can really help me and all the people in the philippines :D Reply
James Rivera 25 August 11, 08:44 AM

Thanks alot these help me with my Assignment about dengue Reply Write comment Name:

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