pop goes the world: deadly dengue is global

POP GOES THE WORLD By Jenny Ortuoste for Manila Standard-Today, 16 September 2010, Thursday

Deadly dengue is global

I asked a colleague at work, lawyer Ian Jacinto, “What’s the current event of national import that’s at the forefront of your mind?”

He answered, “The state of the judiciary. Oh, and the impeachment case of Ombudsman Merceditas Gutierrez.”

“Okay, legal stuff. I should have known. What’s the second most important thing that comes to your mind?”

“Dengue,” he said. “It’s an epidemic now. As a parent, I’m scared for the health of my children.”

And with good cause. The disease is now a global health threat.

Dengue fever, a viral disease borne by the striped aedes aegypti mosquito, affects humans all over the world, especially those living in tropical areas. Transmission may also occur via transfusion of infected blood products.

Dengue’s symptoms include high fever, rashes, headaches, eye pain, muscle and joint pain, severe dizziness, and loss of appetite. It is also called ‘dengue hemorraghic fever’ because in its worst form, it causes bleeding from gums and mucous membrances, vomiting of blood, or bloody diarrhea. It is also called ‘breakbone fever’ because it may be accompanied by extreme pain.

The disease is caused by four closely-related viruses. Recovery from infection by one virus provides lifelong immunity against that type, but only partial or transient protection against the other three.

Information on the World Health Organization website states that dengue was first recognized in the 1950s after outbreaks in the Philippines and Thailand.

The 2010 outbreak table (which may be found on the Internet) updated as of this month reflects a sharp rise in the incidence of cases. The statistics are staggering – and horrifying. In Brazil, 788,809 cases have been reported, with a record 530 deaths, up by 158% from the previous year. Venezuela, 79,335 cases; Philippines, 77,012 cases, 534 deaths, up by 108.8%; Thailand, 63,528 cases, 77 deaths, up 101%; Honduras, 58,587 cases, 67 deaths; Malaysia, 32,688 cases, 103 deaths, up 88%; Sri Lanka, 26,824 cases, 192 deaths; Costa Rica, 21,000 cases; Puerto Rico, 13,106 cases, 20 deaths; and the list goes on.

There is no vaccine for the dengue virus, but there are ongoing vaccine development programs.

The spread of the disease is linked to climate change, said Department of Health entomologist Ursula Segundo last June.  This was echoed by Venezuelan health minister Eugenia Sader. Speaking on their state television network around the same time, she said that the link between climate change and the spike in number of cases was illustrated in their region when the Andean states starting reporting cases for the first time.

A globalpost.com article by Anil Mudra last year on dengue in Argentina is startling. The disease had been eradicated in the country years, ago, but it returned, borne not only by travelers, but by mosquitoes breeding in people’s backyards. In 1997, the first cases were reported after 81 years without dengue. By 2009, dengue cases outnumbered swine flu.

It is no surprise that mosquitoes breed well in warm tropical countries. But when they multiply even in cold climates such as Argentina’s, which used to kill them off, it is all the more obvious that dengue has evolved into an extremely serious health threat.

In Argentine culture, the disease is perceived to strike in poverty-stricken areas with poor sanitation and pools of stagnant water. But it may strike both rich and not. This year in the Philippines, actors Angel Locsin and Enchong Dee, to name a couple, were stricken with the illness. If the rich and famous are not spared, what more the poor?

A 2006 study published in the Dengue Bulletin on cultural conceptions about dengue in Nayarit, Mexico, turned up the interesting fact that there exist “structured cultural domains” with much “descriptive information about the disease coming from direct experience and socialization sources.” This simply means that people’s ideas about dengue came from the individual’s direct experience and the shared experiences of others.

The drawback was that no concepts had arisen regarding prevention and social participation in such measures. Thus, the study recommended that “cultural elements” be considered “when designing and disseminating dengue prevention campaigns” that emphasize “specific preventive measures” fostering the “conscious incorporation of social participation in the dengue prevention culture.”

With dengue endemic in the Philippines, the DOH has done a pretty good job of creating information campaigns that address most, if not all, of the above concerns. The campaigns are rooted in the cultural context and are easy to understand.

The 2009 information campaign used various media channels and the Internet to disseminate advisories and the ‘4-S’ strategy – search and destroy mosquitoes and larva, self-protection measures, seek early consultation, and say ‘no’ to indiscriminate fogging.

The most recent campaign, according to the DOH website, is simple to recall – “D.E.N.G.U.E” – where D is ‘daily monitoring of patients’, E – ‘encourage oral intake of fluids’, N – ‘note any dengue warning signs like bleeding’, G – give paracetamol, not aspirin, U – use mosquito nets, and E – ‘early consultation’.

The risk of contracting the disease is great and should not be disregarded or taken lightly. Philippine culture’s ‘bahala na’ mentality should be set aside at this time. Would you still say “Bahala na” if it is a loved one in the hospital, writhing in fever and pain?

An ounce of prevention trumps a pound of cure. In addition, keep yourself updated on the latest developments, because in health, as in anything, information and communication could spell the difference between life and death.

Now that you’ve been warned, do take precautions. After having done so, we may now return to contemplating no less significant issues such as the judiciary and the proposed impeachment of Ombudsman Gutierrez.  ***

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