October 24, 2006	Tuesday	Ramazan 30, 1427

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RAWALPINDI/ISLAMABAD, Oct 23: As the fear of dengue fever outbreak rises in the twin cities, the first death of the mosquito-borne viral disease was reported from a Rawalpindi hospital on Monday sending a wave of alarm among health experts and officials.

With the death of 14-year-old patient, Mehreen, at the Cantonment General Hospital (CGH), the nationwide toll has risen to 26, including 25 in the southern port city of Karachi, the epicentre of the epidemic.

“Mehreen was brought to the CGH from Pindigheb at 10:30am on Monday but she died within half-an-hour”, medical officer Dr Shafiqur Rahman told Dawn.

About 100 dengue fever suspects were brought to the hospital for treatment. But most of them were discharged after short treatment as the hospital lacks proper facilities to handle patients of with serious kind of viral diseases, the medical officer said.

According to the hospital sources, CGH even does not have any facility of laboratory where blood tests of suspected patients could be carried out.

The number of the dengue fever positive cases in different hospital of Rawalpindi and Islamabad surged to 14 on Monday, health ministry officials and hospital sources told Dawn.

Five patients were detected positive in Rawalpindi — two each were received from the RGH and the Railways Hospital and one from the Social Security Hospital.

A spokesman for the health minister said, the ministry had received a total of 77 samples over the last three weeks.

About Karachi, the spokesman said, a total of 1,337 patients with symptoms of dengue fever were brought to different hospitals since October 2. Of them 432 are confirmed cases.

Two major hospitals of the twin cities of Rawalpindi and Islamabad have set up quarantine units to isolate the patients.

Special wards have been established in the Pakistan Institute of Medical Sciences (Pims) where six patients are being treated while 26 have been admitted at the Rawalpindi General Hospital (RGH).

“Seeing the influx of a large number of patients, we have shifted the old isolation ward to a new place, which can accommodate 40 patients at a time,” said Dr Muhammad Mujeeb Khan, Director Accident and Emergency Department, Rawalpindi General Hospital.

On Monday, the National Institute of Health (NIH) received 19 fresh samples of suspected dengue fever cases from different hospitals in Islamabad and Rawalpindi. Of them 13 were from RGH Rawalpindi, one from Poly Clinic, four from the Pims whereas one sample was brought directly by a resident of Islamabad.

The samples are being tested and the report would be available within next 36 hours, the spokesman said.

Meanwhile Dr Abbas Hayat, Head of the Department of Pathology, Rawalpindi Medical College when contacted, said, people should know that there was a difference between the dengue fever and Dengue Haemorrhagic Fever (DHF) known as viral haemorrhagic fever (VHF) that had gripped some parts of Pakistan.

DHF is a cause of death and only people with antibody develop this fatal form of disease which results in haemorrhagic manifestations. Therefore, only individuals who have recovered from dengue fever are susceptible. On a second exposure to the virus, these antibodies facilitate viral entry into the body defence cells known as macrophages where the virus grows rapidly.

Aedes aegypti mosquito, the source of dengue fever, can be recognised by black and white strips, though common mosquitoes may have only slightly different patterns.

In Pakistan the first known case of dengue, Dr Hayat said, was reported in Karachi during June 1994 to September 1995 when 145 patients were affected of which one died. In the same year a large number of cases were also reported in Hub, Balochistan but in 2003, about 1,000 cases were reported of them seven cadets of the Pakistan Military Academy died in Haripur.

The fever also struck Khushab (Nowshera) in the same year when 11 people died out of 2,500 reported cases. He said sporadic cases of viral haemorrhagic fever (VHF) also occurred in late September and early October 2005 in Karachi at about the same time, during which two health care workers died.

Federal health secretary Anwar Mehmood said, guidelines prepared by the NIH have already been issued to all the federal as well as the provincial hospitals to deal with the dengue victims. These guidelines are in conformity with the World Health Organization protocols.

IRIN adds: Health experts say prevention is the best way to check the spread of the disease, as treatment is limited and no vaccine exists. It tends to take hold in poor communities who have limited access to running water and are forced to store water for drinking and cooking.

“The best check to prevent the spread of the epidemic is to provide a regular and uninterrupted supply of water to houses so that people [don’t have to] store water for drinking purposes,” the WHO official said. The warning signals from India and Sindh however do not appear to have been heeded by the government in the Punjab. Sources in the Punjab health department conceded they were taken ‘unaware’ by the first reported cases, and struggled to devise a strategy.