Karachi 's health care system is likely to be challenged again this year in handling a possible outbreak of dengue fever. At the peak of the epidemic following the rains in 2006, the city hospitals were full and started refusing patients due to lack of beds. This crisis situation created a panic among citizens and the available health resources were unable to match the influx of patients. At the Continuing Medical Education (CME) s eminar at Aga Khan University Hospital (AKUH), a panel of doctors shared the lessons learnt during the last year's outbreak of dengue and suggested a preparation plan for the imminent outbreak.
Dr Junaid Razzak, Associate Professor and Head, Section of Emergency Medicine, AKUH, stressed on the need for extensive surge capacity. “In addition to the infected patients, there were anxious families, anxious health care providers, and hospitals were full and hesitant to admit new patients. The health system was overwhelmed.” The number of patients received at the Emergency at AKUH had doubled at that time and every five minutes a patient was arriving at the ER.
Explaining the measures taken in 2006 at AKUH to manage the patients and anxious families, Dr Razzak pointed out the misconceptions among the public, “Dengue is quite a benign disease with less than five per cent mortality rate. It is a major misconception among people that any patient infected with dengue is likely to die,” he said. Refuting another misconception, Dr Razzak said, “The cause of death is actually dehydration and not bleeding, as commonly believed. A dengue patient can be treated as an outpatient as well and hospital admission is not required in every case,” he stressed.
A patient infected from Dengue does not need to be isolated or quarantined. The infection does not spread from person to person. “Until the fever subsides, prevent access of mosquitoes to the patient,” advised Dr Afia Zafar, Associate Professor and Head, Section of Microbiology. Through mosquito bites, the infection is disseminated widely by the time the infected patient develops fever and is diagnosed.
Dr Bushra Jamil, Associate Professor and Consultant of Infectious Diseases, traced the history of the epidemic, “In Pakistan, the first confirmed outbreak of DHF was reported in 1994. Since then, the condition was diagnosed sporadically till the year 2006, when Karachi and adjacent areas of the Sindh province witnessed a major outbreak of Dengue fever (DF) and more than 3,500 patients with suspected dengue infection were managed at different hospitals.”
World Health Organization estimates that around 2.5 to 3 billion people are affected from Dengue worldwide. The infection is endemic in 112 countries. In Asia, it has been mapped as moving from east to west as it was reported first in South East Asian countries and later appeared in Thailand , India and then Pakistan . Dr Omrana Pasha, Assistant Professor, Community Health Sciences and Family Medicine, declared it a largely urban phenomenon. Unprecedented growth in urban areas without adequate infrastructure is contributing to the factors responsible for dengue outbreak.
She informed the audience that the Aedes aegypti mosquito bites during the day, lives indoors in domestic settings and breeds in both clean and polluted water. While adult mosquito is destroyed in temperature beyond 38 C, the eggs can withstand desiccation and can hatch next year as well whenever conditions are conducive. She strongly cautioned the public to prevent themselves from mosquito bites by wearing appropriate dresses, using repellents and insecticides and watching against any collection of water even small puddles. “The water collected under air conditioner vents, and even unused WCs in the house can serve as breeding grounds for Aedes aegypti mosquito,” she said.
Dr Anita Zaidi, Associate Professor and specialist Paediatric Infectious Diseases, said that Dengue is recognised as a major health concern and worldwide efforts are underway to find a vaccine. No vaccine is currently available but a breakthrough is expected in the next five years as clinical trials of some vaccines are continuing, she said. Dr Zaidi advised careful monitoring of fluids as overhydration can prove fatal. She said it was unusual for children under three years of age to have clinically obvious symptoms.
The panel concluded that the Dengue infection will continue as an annual threat in Pakistan for many years to come and stressed for public education campaign as well as concerted efforts for the management of the epidemic.
AKU regularly organises CME seminars and workshops for referring physicians. These programmes are design ed to provide a current and practical update on the management of medical problems faced by primary care physicians and specialists.