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LAHORE, Aug 12: The Punjab government has declared ‘compulsory’ the Real Time Polymerase Chain Reaction (PCR) test of every confirmed dengue patient in order to identify serotype of the virus which will help medical experts in providing precise treatment.

The decision has been taken in line with a new protocol issued by the Dengue Expert Advisory Group (DEAG) in its revised guidelines which have been forwarded to health authorities and medical institutions in Punjab for implementation in letter and spirit.

The Prevention and Control Programme of Epidemics in Punjab will ensure PCR investigations, an official familiar to the information told Dawn.

He said the DEAG changed its guidelines when the World Health Organization (WHO) sent an ‘health alert’ shortly after the detection of dengue serotype-1 (Den-1) in the city in the presence of the Den-2 virus and declared it more ‘alarming’ in the beginning of the seasonal epidemic of the disease.

The Centre for Excellence in Molecular Biology (CEMB), Punjab University and the Molecular Biology Department of the Institute of Public Health (IPH) will provide free-of-cost PCR test facility to patients.

The official said that private labs charged between Rs6,000 and Rs8,000 for each test, adding that it was a major initiative in the right direction as such facility was not available in a large scale during the 2011 epidemic.

The Punjab Health Department and the CEMB have contracted an agreement in this regard after the WHO offered its technical support to materialize the scheme.In a related development, the situation has turned more serious when the third serotype of the dengue virus emerges in the provincial capital and medical experts believe that the disease is heading towards a critical phase in the very beginning of the season.

A report issued on Wednesday by the Molecular Biology Department of the IPH revealed that the Den-3 virus was found in the body of 30-year-old Ali Raza.

He was admitted to the Mayo Hospital and was declared confirmed dengue patient following tests of his blood samples.

The detection of three out of four serotypes (Den-1, Den-2, Den-3 and Den-4) has sent a wave of shock among medical and health authorities who are expecting resurgence of the Den-2 which had hit hard in the first worst-ever epidemic in 2011.

With the detection of a new serotype, DEAG members have stressed that healthcare providers need to be more vigilant and should follow a given protocol for patients consulting at the dengue counter in respective hospitals.

The DEAG in its new criteria (a copy is also available with Dawn) has identified and elaborated separately the ‘suspected cases’ and probable cases’ to facilitate medical experts attending patients in their respective institutions.

“Based on DEAG’s criteria, if a patient is declared a suspected case, his CBC (complete blood count) test should be done and results should be made available within one hour,” the group said.

It said if the CBC report showed white blood cells (WBC) count below 3,000 and platelets below 100,000, the patient may be declared ‘probable’ and should be admitted immediately. His status should be updated on the dashboard (online software developed by the Punjab Information Technology Board).The DEAG criteria said the result of confirmatory test of ‘probable cases’ should be made available within 24 hours.

“If the duration of fever is less than five days, the nonstructural protein-1 (NS-1) should be performed on ELISA for confirmation and if the fever is of more than five days duration, then IgM on ELISA may be performed for confirmation”, the DEAG said.

It further declared that the PCR of every confirmed case needed to be done by hospitals and in case of non-availability of the said facility, the serum of the patient along with the laboratory request form duly filled should be sent to the Prevention and Control Programme of Epidemics in Punjab.