Dengue

Dengue 1-4 arboviral flavivirus causes a febrile illness, symptoms of which are a headache, eye pain, a rash and aching joints (breakbone fever). Children make up 60 percent of dengue sufferers. The more severe dengue hemorrhagic fever (DHF), associated with secondary infection, can cause hemorrhagic skin rashes, internal hemorrhages, nose bleeding allergy-like dengue shock syndrome (DSS), a fever to 42 C degree, and in 15 percent of all cases... death.

By 1945, the U.S. and the U.K. had successfully eradicated yellow fever and similar diseases from the South Pacific. Indonesia was not so lucky due to its occupation by the Japanese, who did much to advance dengue and other water-associated diseases in all of Southeast Asia. Dengue emerged in Manila about 1950. By 1958, dengue surfaced in Bangkok, reoccurring every five years, causing 10,000 infections and 700 deaths, mostly children. (Indonesia is almost at this record after only several months.)

Later, two million people were infected with dengue in New Delhi. After an intense military cooperation between Vietnam and Cuba in the 1980s, Havana was struck by a six-month epidemic where there were 350,000 cases of dengue. To Cuba's credit, it quickly ended the military cooperation and spent US$103 million to end the epidemic and forestall future potential epidemics. (Ref: Coming Plague, Laurie Garrett; Gudavari, Bombay; and Instituto Mexicano Seguro Social).

The first sign of dengue -- a fever -- is often mistaken for the flu. In clinics, doctors can sometimes confuse the clinical symptoms with Japanese encephalitis or even rubella. Dengue outbreaks occur after the onset of the rainy season, in areas where aegypti and albopictus (tiger mosquito) are found. Aegypti is more cosmopolitan. It thrives and matures in fresh water found in homes, schools and businesses, as well as in open sewers and polluted rivers. Tiger mosquitoes are wild, can also carry yellow fever (50 percent fatal), and feed on anything.

Recently, aegypti and tiger mosquitoes have been found to be resistant to DDT and other chlorinated hydrocarbons used in fumigation.

If dengue is suspected, treatment with fluids and fever reducers should begin immediately. Three test methodologies manufactured in Southeast Asia are available in Indonesia: 1. agglutination -- a simple screening technique; 2. Enzyme assay -- a 90-minute sensitive technique; 3. Blot -- a specific several hour technique.

Presently, although a research vaccine exists, there is no commercial production. Differentiation between primary and secondary infection can be accomplished by knowing that IgM antibodies appear by the fifth day of infection, and that IgG antibodies appear by the 14th day of dengue primary infection and by the second day of dengue secondary infection. All tests can be used to detect and differentiate. This and more technology was freely offered to Indonesia in 1997. Response: "This technology is not needed for Indonesia." (tech ref.: Fort Detrick and CDC,USA).

Related: How will US$35 million be dispersed by the Asian Development Bank for schistomiasis control? How will $375,000 be used to eliminate tuberculosis, measles and malaria as reported by The Jakarta Post and Antara?

R SCHMITT

Jakarta