My tryst with Dengue

My tryst with Dengue

The novel Corona Virus continues to hog international headlines and the number of casualties is now inching towards one thousand, even as two Indians, on board the Ship, stranded in Japan, are reported to have shown positive for the virus. In this season of heightened alertness on global public health emergency, which is of international concern, I am reminded of another viral infectious disease, Dengue - a mosquito borne viral infection -, which causes flu-like illness, and occasionally develops into a potentially lethal complication leading to fatal dengue haemorrhagic fever (DHF). I became one of its victims, some time during the year 2018 and here I am sharing my tryst with dengue.

एक मच्छर आदमींको हिजड़ा बाना देता हैं। meaning - One Mosquito can make a masculine man a transgender - (No disrespect to the LGBT community please). With this cinematic dialog, Nana Patekar highlighted the nuisance value of the mosquito - the carrier of dengue virus - which could temporarily incapacitate any sound body and so it did to me confining me to the bed at home and subsequently at the Nanavati Hospital for well over two weeks, with Dengue Fever.

Unfortunately, though not ostensibly fatal, the scare that the Dengue offers is palpable, particularly to the family members of those afflicted with suspected Dengue. The highly publicised death of an affluent veteran Bollywood Director, Mr. Yash Chopra, due to Dengue, gained such ill fame that, I had no way but to yield to the advice of friends and family- particularly my wife- to immediately shift from the family physician that I was consulting to consult doctors at the Nanavati hospital, since my platelet counts were consistently falling. The Nanavati Hospital was already handling a number of dengue cases.  I had no way but to yield to my wife’s dictate and as my fate would have it the Doctor at the Nanavati Hospital saw my reports and after preliminary investigation wasted no time in advising me to be admitted immediately and thus I landed in room 306 of the hospital. By then four of my blood reports were consistently showing fall in platelet counts and the last report revealed platelet count of 50,000. Thus began my tryst with Dengue at the Nanavati Hospital, which incidentally was for the first time ever in that I have ever been admitted to a hospital in my entire lifespan. 

Dr Desai, the physician at the Nanavati Hospital, who attended to me and his  entire team of sisters and support staff at the hospital were overwhelmingly supportive in ensuring that I fight it out and come victorious sooner than later. My days at the hospital were spent with unending stream of messages, well wishes and phone calls that kept coming from friends and relatives. It took six days for me to be discharged from the hospital and another week or so to recover from weakness. Subsequently it was time for me to record my gratitude and appreciation to all my friends and well wishers, who had kept boosting my confidence and kept calling, sending messages and several of them visited me at the hospital. I had then posted a brief note on my experience with dengue and also thanked everyone of them and posted it on Facebook. The current Corona virus saga has tempted me to write about it on my blogpost to highlight the importance of health workers in times of such health calamities and once again pay my reverence to each of them, particularly the nurses. The year 2020, which happens to be the bicentennial birth anniversary of Florence Nightingale, has been designated as the “Year of the Nurse and midwife”, in honor of Florence Nightingale, by the Executive Board, of the World Health Organisation (WHO). This proposal will be presented to Member States of the 72nd World Health Assembly for consideration and endorsement. 

Dengue is a mosquito-borne, viral infection, which causes flu-like illness, and occasionally develops into a potentially lethal complication leading to fatal dengue haemorrhagic fever (DHF). Dengue is commonly referred to as the break-bone fever’ हड्डी थोड बुखार। The global incidence of dengue has grown dramatically in recent decades. The incidence of dengue has increased 30-fold over the last 50 years. It is estimated that close to 100 million infections are known to occur annually in over 100 (only 9 counties in 1955) endemic countries and almost half of the world’s population is known to be at risk with Dengue.

The Dengue virus belongs to the family Flaviviridae, having four serotypes, which are spread by the bite of infected Aedes mosquitoes. It causes a wide spectrum of illness from mild asymptomatic illness to severe fatal dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS). Approximately 2.5 billion people live in dengue-risk regions with about 100 million new cases reported each year worldwide including India which has always been at the receiving end of the dengue virus.

The origin of the word “dengue” - a Spanish word - is believed to have come from the word dinga from the Swahili phrase “Ka-dinga pepo” - meaning “cramp-like seizure” - which describes the disease as being caused by an evil spirit. The first clinically recognized dengue epidemics occurred almost simultaneously in Asia, Africa, and North America in the 1780s. Benjamin Rush is believed to be the first person to have reported the incidence of the clinical case of dengue in the 1780 epidemic in Philadelphia. He coined the term “break bone fever” for the dengue, which has now become quite common a phrase, even in India.

In India, the first epidemic of clinical dengue-like illness was recorded in Madras (now Chennai) in 1780 and the first virologically proved epidemic of dengue fever occurred in Calcutta (Kolkata now)and Eastern Coast of India in 1963-1964.  Subsequently the Dengue spread its tentacles northwards and reached Delhi in 1967 and Kanpur in 1968. Simultaneously it also spread to the southern part of the country and gradually the whole country was involved with wide spread epidemics followed by endemic/hyperendemic prevalence of all the four serotypes of Dengue Virus (DV). The DHF started simmering in various parts of India since 1988. The first major wide spread epidemics of DHF/DSS occurred in India in 1996 involving areas around Delhi and Lucknow and ever since it has spread to most parts of the country.  The epidemiology of dengue virus and its prevalent serotypes has been ever changing.

Dengue disease continued to spread to newer areas, newer populations with increasing magnitude, epidemic after epidemic. Every aspect of dengue viral infection continues to be a challenge; the pathogenesis of severe dengue disease is not known and therefore no vaccine is yet available for protection and the vector control measures are inadequate. Dengue virus was isolated in India in 1944, but the scientific studies addressing various problems of dengue disease have been carried out at limited number of centres. Though clinical studies have reported on dengue disease in India, but these are largely based on diagnosis made by kits of doubtful specificity and sensitivity. A lot more remains to be achieved for creating an impact.

Like in the cases of most epidemics and outbreaks including the current novel Corona Virus outbreak,  enhancing public awareness on most infectious microbial diseases is one of the major challenges for the global health professionals. This global public health problem can be controlled with active participation of the community and with no finger pointing of blame to any one country including China in the current case of nCoV. There is an urgent need to organise health education programmes about infectious diseases and epidemics to increase community knowledge and sensitize the community to participate in integrated vector control programmes. It is time that a whole lot of stakeholders join hands and work as a team to combat this menace before it takes a huge toll on the public health system in India.