KARACHI: Strategy for constant check on dengue stressed
KARACHI, Oct 18: Senior health care professionals have recommended formulation of a strong surveillance system with equal focus on disease and vector in order to prevent any major outbreak of dengue fever or its severer variants in the coming years in Karachi.
Prof D.S. Akram, Head of the Civil Hospital’s Paediatric Department, Unit-1, Dr Rafiq Khanani, and Dr Shehla Baqi of the Infectious Diseases Department, told a symposium organised by the Continuing Medical Education Department, Dow University of Health Sciences here on Wednesday, that there was a need for concerted effort towards ensuring protection against the disease at personal, community and institutional levels.
Dr D. S. Akram recalled that an outbreak the Dengue Hemorrhagic Fever had been reported in Karachi in 1994 and again in 2005. Referring to her studies involving children in 1980 and 1994, she said these reflected presence of dengue fever virus for the past two decades.
A surveillance study was said to have been done between July and October last year at the CHK and the Lyari General Hospital during which 350 children suffering from fever for less than seven days had been screened for dengue fever according to the WHO criterion. Four were found dengue-positive and 11 cases were indeterminate.
The researcher clarified that children inflicted with the virus were exposed to primary infections, in two age groups -- infancy and three-five years.
The senior paediatrician said surveillance must not be confined only post-monsoon period. Rather, surveillance programmes with provision for monitoring of the suspected cases, case reporting, epidemiological and entomological investigation, etc. be formulated round the year.
The symposium, attended by a large number of senior medical professionals, teachers and students, also supported recommendations put forward by Prof Sharaf Ali Shah, Director, Infectious Disease Unit, DUHS, which included a foolproof strategy that must equally focus on vector surveillance.
It was recommended that hospitals in both private and public sectors be identified as centres for keeping a track of patients with the ailment.
Prof D. S. Akram also urged all her colleagues to ensure that stagnation of water was not allowed at any of their departments or units or their vicinity to ensure that mosquitoes did not have any opportunity to breed.
Equal attention was stressed on control on environmental degradation and effects of chemicals. Besides, reduction in vector breeding sites, solid waste management, proper water drainage, personal protection and public education through spraying of insecticide with regular monitoring of anti-mosquitoes measures should be ensured.
It was noted that while children with dengue fever report primary infections with symptoms like fever, rashes, abdominal pain, rapid progression to shock and encephalopathy being common presentations, the adults report secondary infections with symptoms like headache, arthralgia myalgia and bleeding being the common presentations.
Cited manifestations must be confirmed through lab tests as otherwise one could be confused with other ailments.
Dr Rafiq Khanani of the Pathology Department, Sindh Medical College, said that it was not only that misdiagnosis of dengue fever and its sub-types had turned to be problematic, but mismanagement and inappropriate treatment modality had also emerged as a challenge in a health condition that was largely self limiting.
Elaborating his stance, he said the Dengue Hemorrhagic Fever induced fatality rate had been registered at eight per cent during the 2005 outbreak as against one per cent across the globe.
These cases must not be treated with antibiotics and anti- malarial drugs, Dr Khanani said, reiterating that aspirin must not be given under any condition to those reporting with hemorrhagic fever.
In his presentation: ‘Dengue Viral Hemorrhagic Fever - A Diagnostic Challenge’, he said tests being generally requested for dengue were IgM and IgG antibody to dengue fever.
The senior pathologists also clarified that 99 per cent of the patients with low platelet level did not require platelet transfusion.
Dr Shehla Baqi, Associate Professor, Infectious Diseases Department, DUHS, in her presentation ‘Viral Hemorrhagic Fever’, said that VHFs represented a group of diverse diseases, almost all of which were arthropod-borne that caused acute fever and myalgia, that involved capillary leak syndrome and multi-system compromise.
The researcher reminded the audience that Dengue Fever was linked to urbanisation, and said that besides the government’s measures to combat the disease, people must protect themselves through personal care.
In this context, she suggested proper clothing to keep all parts of body adequately covered, keeping surroundings clean and dry, using repellents, mosquito nets, etc. as some of the basic measures. As dengue vector breeds in clean water, people must keep their water containers covered.
Dr Kaleem Butt, MS of the Civil Hospital Karachi also spoke. Presentations, followed by an interactive session, concluded with a vote of thanks offered by Dr Saleem Ilyas.—APP
