Dengue outbreak affects more than 7000 people in Nepal
BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5496 (Published 04 October 2010) Cite this as: BMJ 2010;341:c5496
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Dear Editors,
Dengue hemorrhagic fever makes a deadly comeback in Greece, 90 years after the last severe epidemic in Athens. [1][2][3][4][5][6]
Greek officials discard laboratory evidence as “antibody cross-reaction”, despite characteristic clinical signs and symptoms.
Perhaps screening for dengue should be applied to every fever in Greece during the summer.
References
[1] http://www.bbc.co.uk/news/world-europe-19481127
[2] http://www.healthmap.org/news/dengue-reemerges-greece-9512
[3] http://www.dailystar.com.lb/News/Health/2012/Sep-04/186676-dengue-fever-...
[4] http://www.nathnac.org/pro/clinical_updates/denguegreece_070912.htm
[5] http://www.examiner.com/article/greece-a-battle-with-mosquito-borne-dise...
Competing interests: No competing interests
The data regarding the morbidities and mortalities may be
misleading,but the emerging trend of dengue in Nepal is inevitably going
to create a major public health chaos in the coming years.
Majority cases of Dengue Fever this year were diagnosed with Primary
Dengue compared to Secondary Dengue which has a more fatal course. With
unconfirmed reports of serotype 1 (DEN1) being the sole cause of outbreak
the last season, questions can be raised against the strategies planned by
the concerned authorities if different serotype such as DEN2,DEN3 or
DEN4 gets introduced and lead to a more fatal Secondary Dengue.
The message has clearly been relayed. The Public health authorities
here in Nepal cannot sigh from the fact that they weren't told about it
much earlier!
Competing interests: No competing interests
Dear Sir,
Our attention was drawn to an article entitled 'Dengue outbreak
affects more than 7000 people in Nepal' published on October 4, 2010 in
your reputed journal (BMJ) in the news section.
Firstly, the information
was completely misleading as the figures regarding morbidity and mortality
in Chitwan was mentioned. To our best knowledge, the data of dengue
outbreak shown is merely based on clinically suspected but unconfirmed
cases. It was evident that concurrent infectious diseases such as
leptospirosis, influenza were also prevalent at the same place. Hence, the
number of deaths (24) due to dengue fever could give ambiguous information
to the local and global community about the real impact of the disease and
may possibly have unpleasant public health implications.
Secondly, a remark made by Mr. Sharma 'a recent entomological survey
prompted by the current outbreak identified its presence in five major
urban areas in Nepalese districts bordering India' was also sheer
deviation from the fact. Indeed, not the current but previous outbreak
prompted the entomological study of Aedes aegypti in 2006 [1].
Ramesh Pun, Microbiologist Nepal Academy of Science and Technology,
Lalitpur, Nepal
Dr. Pramod Khanal, MD Epidemiology and Disease Control Division
(EDCD) Department of Health Services
Dr. Pawan Kumar Hamal, MBBS Medical Officer Sukraraj Tropical and
Infectious Diseases Hospital, Kathmandu, Nepal
Dr. Sher Bahadur Pun, MD, PhD Head of Clinical Research Unit Sukraraj
Tropical and Infectious Diseases Hospital, Kathmandu, Nepal
Reference:
Competing interests: No competing interests
Re: Dengue outbreak affects more than 7000 people in Nepal
Dengue, an acute viral disease transmitted by Aedes mosquitoes, is highly endemic in many tropical and subtropical areas of the world. WHO guidelines define supplementing fluids, blood product in management of Dengue, Dengue hemorrhagic fever and Dengue Shock Syndrome.
Drugs: WHO document suggests antipyretics and oral rehydration salts. In severe cases, additional drugs including vitamin K1, Ca gluconate, NaHCO3, glucose, furosemide, KCl solution, vasopressor, and inotropes (1). However contradictory results are available with such therapies (2). The mechanism behind their failures may be because of not giving due attention to the accompanied low blood pressure due to hyperkalemia, produced due to myofibril and platelet destruction by dengue virus (3). Supplementing fluids, electrolytes and blood product may be causing high level of potassium hence worsening already worsened / high level of potassium in body (4). There is a need to work out strategies in view of high mortality despite the treatment (5).
References:
1. http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf
2. Ngo Thi Nhan, Cao Xuan Thanh Phuong, Rachel Kneen et al. Acute Management of Dengue Shock Syndrome: A Randomized Double-Blind Comparison of 4 Intravenous Fluid Regimens in the First Hour/ Clin Infect Dis. (2001) 32 (2):204-213.
3. Martina BE, Koraka P, Osterhaus AD (October 2009). "Dengue virus pathogenesis: an integrated view". Clin. Microbiol. Rev. 22 (4): 564–81.
4. Robert C. Hartmann, Joseph V. Auditore, and Dudley P. Jackson. Studies on thrombocytosis. i. hyperkalemia due to release of potassium from platelets during coagulation. j clin invest. 1958 may; 37(5): 699–707.
5. John SK, Rangan Y, Block CA, Koff MD. Life-threatening hyperkalemia from nutritional supplements: uncommon or undiagnosed? Am J Emerg Med. 2011 Nov;29(9):1237
Competing interests: No competing interests