Dengue fever

A study by Brandeis University, Massachusetts in collaboration with the Indian Council of Medical Research suggests that India has the most number of dengue fever cases in the world. Official figures by the Indian government report that on an average about 20,000 people are hospitalized annually with dengue infections. The Brandeis study suggests that the real number of hospitalizations is closer to six million, and other studies suggest that the actual number of Indians infected annually is probably more than 30 million.

Dengue fever is a disease caused by a family of viruses that are transmitted by Aedes aegypti mosquitoes. They breed in discarded tyres, flower pots, old oil drums, and water storage containers close to human dwellings. Hence, we see a surge of dengue cases during the monsoon season. Dengue is not contagious and does not spread from infected person to others directly.

How does dengue present?
Dengue fever is a flu like illness of sudden onset that starts with simple symptoms such as headache, fever, exhaustion, severe muscle and joint pain and rash.

Is dengue fever a serious infection?
In majority of the children dengue fever behaves like any other viral illness and fever subsides within 3 to 5 days without any treatment or complications.
Complications are usually associated with the more severe forms of dengue fever, dengue hemorrhagic fever and dengue shock syndrome. These include bleeding due to drop in platelets, low blood pressure due to leaking blood vessels, dehydration, liver and neurological damage and even death.

How is dengue fever diagnosed?
Generally, symptoms are suggestive of a diagnosis. Several blood tests are available to confirm the diagnosis of dengue fever.

How should dengue fever be treated?
Dengue fever should be treated like any other viral infection. It does not have specific treatment like malaria and typhoid fever. Children are generally treated symptomatically until fever resolves spontaneously (~5 days). However, care should be taken to avoid medicines like ibuprofen and mefenamic acid as they can increase the chance of bleeding. It is best to treat fever and body pains in these children with paracetamol. In addition to treatment of fever, it is important to maintain hydration levels. Avoid using plain water. It is preferable to use oral rehydration solution (ORS). Avoid food items like beetroot which can mimic blood in stools.

How do I know if the child is developing complications?
Complications tend to occur as soon as the fever stops. Hence, it is usually seen around 4-5th day of illness.
Look for any of the following symptoms:
1. Stomach pain and vomiting
2. Blood in vomitus and stools.
3. Decreased activity
4. Cold limbs
5. Decreased urine frequency

Immediately, consult a general pediatrician as such cases may generally need hospital admission especially if the child’s oral intake is poor.

Is Platelet count very important?
Contrary to the popular public opinion, platelet counts are not important for the child’s treatment. Platelets tend to decrease during infection and increase during recovery. Administering platelets does not hasten recovery. However, the doctor might order platelets transfusion in rare cases when there is visible bleeding.
It is not the drop in platelet count but the drop in blood pressure which can be fatal.
It is more advisable to monitor a marker of leakage called hematocrit rather than platelet count. Furthermore, the low platelet count does not predict if the child is going to be sick. It is best to prevent paranoia around platelet count and running around blood banks to get platelets.

Is there a Dengue vaccine?
No. Research is focused on developing an effective vaccine.

Can Dengue fever be prevented?
The best method of prevention is to avoid mosquito bites and reduce mosquito population. Applying mosquito repellent creams and preventing water logging are very important preventive measures.