Final yr, Tamil Nadu recorded a document excessive in dengue instances, crossing the 20,000 mark for the primary time for the reason that earlier peak in 2017. Whereas the variety of infections has continued to rise steadily this yr, docs and public well being consultants say a greater understanding of the illness, focused surveillance methods, elevated public consciousness and clearly outlined protocols are enhancing early analysis and contributing to decrease morbidity and mortality.
earlier peak
The state had two earlier peaks in 2012 and 2017, with 13,204 instances and 66 deaths, and 23,294 instances and 65 deaths, respectively. Within the following years, each the variety of infections and deaths decreased, however the variety of infections surged once more in 2024. Though the precise variety of infections and deaths this yr couldn’t be confirmed, well being authorities confirmed that round 23,000 to 24,000 individuals have been contaminated with dengue thus far, however the variety of deaths is decrease than final yr.
A. Somasundaram, director of public well being and preventive drugs, stated infectious ailments are usually each seasonal and cyclical. Influenza is seasonal, however some diseases have a cyclical sample. Throughout this five- to seven-year cycle, the illness will increase its capacity to trigger extra extreme infections. If this coincides with a interval when there are giant numbers of vulnerable or weak teams, extra extreme illness may emerge, he stated.
“Public well being techniques are taking precautions. We’re utilizing a triangulation method. We’re specializing in areas with excessive larval index and figuring out locations which might be historically dengue hotspots. We’re additionally conducting mosquito swimming pools, an train by which we accumulate mosquito samples and take a look at them for dengue virus utilizing RT-PCR. This method has helped scale back each the variety of instances and mortality,” he stated.
endemic ailments of india
Dengue fever is endemic in India, the senior physician added. “Within the late Nineties, it was an unique virus. However that’s not the case. Dengue instances enhance when it rains and reduce when it would not. This follows the dynamics of the mosquito circulation. Dengue fever requires fixed checks and balances. “Dengue fever has a singular sample. Dengue outbreaks are inclined to happen as soon as each 5 years, with speedy unfold, typical examples being the 2012-2013 and 2017 outbreaks, when mortality charges have been excessive,” he defined. He added that an outbreak was anticipated in 2021-2022, however it didn’t happen because of the COVID-19 pandemic. “In actual fact, there have been fewer dengue instances throughout that interval,” he says.
Apparently, the Directorate Basic of Public Well being and Preventive Medication performed a dengue serosurvey to find out the rationale for the low prevalence of dengue throughout the pandemic attributable to attainable viral interference. Dengue fever is brought on by 4 serotypes of dengue virus (DENV 1-4). This research was performed mid-pandemic in December 2021 to match antibody ranges (seroprevalence) towards DENV and SARS-CoV-2 and located that the seroprevalence of dengue fever locally was very low at 4.12% for DENV IgM and 6.4% for DENV IgG. Solely 3.76% of the feminine Aedes aegypti pool was DENV optimistic. The report stated that though anti-SARS-CoV-2 IgG antibody ranges remained excessive at 87.3%, the decline within the incidence and/or prevalence of dengue fever throughout the pandemic (2020-2022) could also be because of the attainable viral interference and neutralizing results of SARS-CoV-2 IgG towards DENV.
“Tamil Nadu has a sturdy vector surveillance system put in place by the Directorate of Public Well being and Preventive Medication, beneath which detection of dengue virus in field-caught mosquito pool samples is completed by RT-PCR throughout the state. This surveillance allows early identification of hotspots and applicable public well being measures,” he stated.
what labored
Because the alarm bells ring over dengue fever annually, docs say enhancements in early analysis and immediate referral have resulted in fewer problems and deaths.
Janani Sankar, medical director of Kanchi Kamakoti Little one Belief Hospital in Chennai, stated the hospital has been constantly seeing kids with dengue fever since July, however there have been no admissions to intensive care models, no extreme instances and no deaths. “Early analysis has undoubtedly improved. About 25-30 per cent of the kids didn’t require hospitalization. If the kids lived close by, we defined the warning signs to the mother and father and requested them to report inside 24 hours to examine their very important parameters. In the event that they have been far-off, we didn’t wish to take any dangers and admitted them to the hospital. The youngsters have been discharged inside just a few days,” she stated.
The severity of instances has undoubtedly come down, she stated, including: “The elevated degree of consciousness, together with the warning indicators, not solely amongst docs but additionally among the many common public has helped so much. Youngsters are additionally being referred to hospitals earlier. There’s a higher understanding of the illness now.” She added that though the variety of instances often declines by the top of the yr, there are actually sporadic instances all year long, albeit in small numbers, in contrast to earlier than when instances have been often reported from July onwards.
Sowmya Sridharan, infectious illness advisor at Cauvery Hospital in Chennai’s Alwarpet, stated individuals have change into extra conscious of all types of fevers for the reason that coronavirus outbreak. “The problems will not be stunning and the well being system will not be burdened. Because of the state authorities’s proactive measures, the mortality price attributable to dengue fever has decreased,” she identified.
“Administration is best with early detection and shut monitoring. In at-risk sufferers, dengue fever can result in problems. Monitoring may also help detect early indicators of decay and problems. Dehydration throughout the febrile section of dengue fever may cause If fluid administration will not be accomplished correctly, hematocrit ranges can rise, platelet counts can drop, and organ failure can happen, resulting in shock and extreme dengue fever, which might have an effect on organs such because the mind, coronary heart, lungs, and kidneys.
S. Chandrasekhar, professor and head of drugs at Authorities Stanley Medical School Hospital in Chennai, stated sufferers with dengue fever often current with a sudden onset of fever, muscle ache and ache behind the eyes. “Nearly 95% of dengue instances are self-limited. We will assess its severity by sure parameters: a drop in white blood cell rely adopted by a drop in platelet rely and an increase in hematocrit. We have to monitor these three modifications.”
Whereas these signs can change seasonally, Dr. Chandrasekhar stated what he has seen prior to now six months is individuals presenting with shock syndrome, low blood stress, low platelet counts and markers of impaired liver operate. “Sufferers required lengthy hospitalization and intensive care. So, we determined to watch these parameters for all dengue sufferers. All liver parameters together with serum albumin have been checked and if any modifications occurred, remedy was really useful. Change technique: Dengue virus triggers an immune response within the physique that may trigger a cytokine storm, so we begin treating sufferers with a give attention to fluid administration, not simply relieving signs. ”
Extended dengue fever
A authorities physician in Chennai stated that fever with low platelet rely often will increase throughout this era. “The illness might be brought on by quite a few tropical infections and is mostly related to dengue, chikungunya, any viral illness, malaria, leptospirosis and even scrub typhus. Figuring out the underlying illness and beginning remedy early is the cornerstone of remedy,” he stated.
Often, within the case of dengue fever, the fever subsides by the fifth to eighth day, and the interval after the fever subsides is necessary. “We name this the immune section, the place platelet ranges drop and problems start to develop. An uncommon development we have seen over the previous few years is that the fever continues for for much longer than 10 days, and platelets drop on the identical time the fever continues. “We name this long-term dengue fever. It may be very troublesome to make a analysis at this stage. We see various sufferers within the adolescent and youthful age teams who’ve low platelet counts, slightly than older sufferers,” he stated.
In Chennai, he stated migrant staff, together with these engaged on development websites, typically undergo from comorbidities and the illness develops late within the illness, making it troublesome to deal with and get good outcomes. “In comparison with earlier years, the mortality price appears to be low and the incidence of problems can also be low,” the physician added.
“synthetic” illness
Dr Chandrasekhar stated total data about dengue fever has improved in Tamil Nadu and sufferers are being managed as per protocols. “All fever wards have charts and docs are conscious of the protocols. At this level within the yr, mortality charges are low and instances would usually happen till the top of February,” he stated.
Aedes aegypti breeds in contemporary, clear water, so after a wet season, standing water in containers and unused gadgets corresponding to pots, tires, and coconut shells start to change into breeding grounds for mosquitoes. Though dengue is transmitted by mosquitoes, it’s slightly a man-made illness, he stated.
