Kathmandu. Last year, a known youth had come to the hospital for treatment after bleeding from his nose. He had tested positive for dengue. This condition is a sign of severe or complicated dengue. It is also considered as a ‘dengue warning’ sign.
Although dengue did not get much attention in Kathmandu last year, doctors feel that many infected people come with the problem of nose bleeding. But last year, many people were seen continuing their regular routine even when they were infected. This condition was also named as Warning Dengue.
Even when there was warning dengue, most people did not even take healthy counseling. Given that one of the strongest signs of complex dengue is the rapid increase in nasal bleeding, it is easy to predict the strong possibility of complex dengue increasing in the coming days. Therefore, the ‘dengue warning’ sign also needs to be widely publicized.
What are the signs of ‘dengue warning’?
Although dengue has been included in the guidelines about the signs of ‘dengue warning’, there was not much in the knowledge or interest of the general public. Although the signs of ‘dengue warning’ are especially useful for the doctors involved in the treatment, it is easier to assess the potential risk of the patient.
Infected people can also know some signs of ‘dengue warning’ themselves. Symptoms of dengue warning include persistent vomiting, abdominal pain, bleeding (nose, gums, bleeding from a woman’s vagina) and extreme lethargy.
Apart from these, rapid reduction in platelet number/hematization, increase in the size of the liver/ swelling, and water retention in the chest or stomach during X-ray or video X-ray (ultrasound) are additional symptoms of ‘dengue warning’.
If the above-mentioned ‘dengue warning’ signs are seen, then immediately going to the nearest hospital and testing can avoid possible complications. If one member of the family is confirmed to be infected with dengue, then it is not customary to test another member of the family if he has similar symptoms.
In 2022, when there was a major dengue epidemic in Kathmandu, three to five times more infected people did not get blood tests even when they had the symptoms of dengue. There is no definite antiviral drug and the belief that there is only a medicine to reduce suffering, it is also customary not to test.
However, if the blood can be tested according to the doctor’s advice, it will be easier for the doctor to treat the patient on the basis of other signs, including the rapidly decreasing platelet number.
The possibility or risk of developing complex dengue in patients can be greatly reduced. Among the above-mentioned signs, the problem of nose bleeding has increased rapidly in Kathmandu, so in the coming days, there is a need for extensive and intensive publicity of the signs of ‘dengue warning’, not only the symptoms of classical dengue.
Could the next outbreak be more deadly?
It has been 20 years since dengue was confirmed in Nepal. If we look at the statistics of dengue, the virus seems to be becoming more deadly and aggressive in Nepal in a span of two to three years. The dengue outbreak in Kathmandu in 2022 was the most contagious and deadly in Nepal’s history.
There has been no major outbreak since then. Therefore, there is a high possibility that dengue outbreaks may occur at any time to come and it can become more deadly. Last year, among the signs of ‘dengue warning’, there was a sharp increase in cases of nasal bleeding. Similarly, in previous years, many infected women have been suffering from excessive vaginal bleeding.
In 2019, when Kathmandu first faced a major outbreak of dengue, it was observed that most of the infected people had classical dengue symptoms such as headache, eye pain, nausea/vomiting, small red chills in the body, joint or muscle pain and some even diarrhea.
Similarly, people were also seen panicking as soon as they were confirmed infected. But now the attitude towards dengue seems to have changed a lot. Many infected people appear to be in the state of ‘dengue warning’. And many ‘walking dengue’ infected people seem to be unaware of the complex situation.
Therefore, as the signs of ‘dengue warning’ have increased over the years, the likelihood or risk of complex dengue and death seems to be increasing. Various studies have shown that even if a different serotype of the virus re-infects the same person, complex dengue can be seen.
Is it possible not to be infected with dengue?
It is said that avoiding mosquito bites is the only way to avoid dengue infection. But the question arises , ‘Is it possible?’ It seems almost impossible in reality. Therefore, the main goal of the concerned agencies at present seems to be ‘zero dengue mortality’. This is due to the fact that the control of the Aedes mosquito, which causes dengue, is almost impossible.
What seems impossible is due to the indifference seen in the campaign to destroy mosquito larvae and the activity of mosquitoes in the day. For example, if a doctor is examining a patient, there is no immediate need to search for/die for mosquitoes if they are bitten by mosquitoes.
Similarly, there is no possibility of a student being killed even if he is bitten by a mosquito while he is studying in class. Or there is no possibility of anyone being bitten by mosquitoes while busy with their work. Even in these representative examples, it is almost impossible to avoid mosquito bites if mosquitoes spread widely.
It is too late to disseminate the symptoms of ‘dengue warning’ intensively from various media to achieve success in achieving the goal of ‘zero dengue mortality’, as the possibility of complications increases if the symptoms of ‘dengue warning’ appear.
Some ingredients are available in the market to prevent mosquito bites. But if it is not used daily and regularly, then the chances of avoiding mosquito bites seem to be slim.
Finally, as 20 years have passed since dengue was confirmed in Nepal, the virus seems to be presenting itself in a more aggressive and complex form. There was a big difference between the dengue outbreaks in Kathmandu in 2019 and 2022.
That is, although more cases were seen in 2019, it was less in 2022 when compared to the severity or complications. But soon after the covid-19 pandemic ended, the dengue outbreak in 2022 was the most contagious and severe/complex so far.
This also shows that with the new outbreak, the virus becomes more infectious and deadly. If this is the case, then the possibility of dengue becoming more infectious (more infected) and deadly (death rate) cannot be ruled out at any time from 2022 to 2025.
Dr Sher Bahadur Pun is the coordinator of the Clinical Research Unit of Shukraraj Tropical and Infectious Diseases Hospital. )
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