October 20, 2003	Monday	Sha'aban 23, 1424

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PESHAWAR, Oct 19: The World Health Organization (WHO) has issued guidelines regarding the prevention and management of dengue fever to the NWFP health department after about seven deaths reportedly caused by the disease in Haripur district during the last two weeks.

WHO’s Peshawar-based emergency medical Officer Dr Quaid Saeed said the guidelines aimed at preventing further spread of the fever in the areas where the cases of this fever were reported.

The fever is caused by a virus transmitted to humans by the bite of an infected mosquito.

There are two varieties of the disease: dengue fever, which has a benign and self-limiting course, and dengue haemorrhagic fever, which is a severe form of this disease. It can be fatal if unrecognized and not properly treated.

Symptoms and signs of the fever, according to the guidelines, are acute onset of high fever, severe frontal headache, retro-orbital pain, myalgia, arthralgias, nausea and vomiting, and often a macula-popular rash. In addition, many patients may notice a change in taste sensation.

Symptoms are milder in children than in adults. The illness is clinically indistinguishable from influenza, measles or rubella. This acute phase lasts up to one week followed by 1-2 week period of convalescence characterised by weakness, malaise and anorexia.

The dengue haemorrhagic fever’s symptoms and signs remain similar to classic dengue fever for the initial few days of infection with high fever lasting for two-seven days associated with nausea, vomiting, abdominal pain and headache. When this fever begins to subside, the patient may become restless or lethargic, show signs of circulatory failure and  haemorrhagic manifestations. This condition leads to circulatory failure and shock, which causes death.

There is no specific treatment for dengue infection. This is a self-limiting disease. Patients suffering from the disease need symptomatic and supportive treatment such as acetaminophen for fever, rest and high intake of fluids. In case of dengue haemorrhagic fever, the therapy consists of hospitalisation and fluid replacement therapy. The key to survival is early diagnosis and appropriate treatment.

For laboratory diagnosis, serum specimen should be collected as soon as possible or within five days after the onset of the symptoms. For serological diagnosis, a convalescent phase sample obtained at least six days after the onset of symptoms is required. Acute phase samples for virus diagnosis may be stored un-frozen in a refrigerator at 4 degree Celsius.

The world health agency guidelines also include preventive measures, saying that there is no vaccine for the disease. The best prevention from the disease is to clean the places where the mosquito lays eggs. Other methods are use of screens in houses, bed nets and personal protection.

The doctors community across the province has been asked to contact Dr Quaid Saeed on telephone number 091-9213308 and Dr Mohammad Zaheen, director of the public health department, on telephone number 091-9210187, in case of the dengue spread.