Dengue fever a clear and present danger

The number of fatal cases of dengue fever has increased this year, causing the government to look at new approaches for disease prevention and mosquito control. Correspondent Iman Dwianto Nugroho looks into why there is an increased incidence of the disease in Surabaya city and what the government is doing about it.

Children and young adults have taken up many of the beds in Surabaya's hospitals from January to August. From a severe headache to the sudden onset of fever, the disease has gradually weakened them.

"My nephew is suffering from dengue fever," said Suminah. Her feeling of helplessness is shared by countless others whose loved ones are hospitalized across the city.

Dengue fever is caused by the dengue virus, which is transmitted by the day-biting Aedes aegypti mosquito. Children are particularly vulnerable to the disease.

Surabaya Health Office records show that 1,200 patients were treated for the disease in the city from January to August, including Dr. Soetomo General Hospital and Dr. Soewandhi Hospital, where dengue patients are generally referred to.

"The figure will probably continue to rise," head of the Disease Prevention and Eradication department of the city's health office Dr. Slamet Santoso told The Jakarta Post.

The health office initially estimated the number of dengue fever patients was not that high due to the recurring nature of the disease, usually widespread in March and April.

In 2004, for instance, the number of sufferers in March reached 633 people. However, the number dropped in May to 32 patients. Nine people died of the disease that year.

"The figure in 2005 is way beyond our estimates," said Slamet. The number of people with dengue fever, which first infested Surabaya in 1968, rose significantly over the months. In January, 74 dengue patients were hospitalized. The number had increased by March to 183 patients. In May, the number dropped to 167 cases. But the death toll escalated to more than 100 percent, with 20 fatalities between January and August.

The disease has spread throughout the 31 districts of Surabaya, 22 of which are considered to be the sources of the epidemic.

"The 20 patients who died are from 12 districts," said Slamet. The local health office has classified the outbreak in Surabaya as "extraordinary". It is using fumigation to eradicate the mosquitoes, operating 24-hour posts at six community health centers and monitoring the outbreak with 53 other health centers. Patients have access to free medical treatment.

However, the efforts have not reduced the number of dengue fever cases. An employee at Dr. Muhammad Soewandhie Hospital, Sulastri, said new patients were being admitted to the hospital weekly.

"Another patient died last week," she told the Post.

One theory is that the increased number of dengue cases in Surabaya this year is due to a new strain of the virus.

Test results from the Tropical Disease Center (TDC) of Airlangga University (Unair) in Surabaya show that the dengue virus was found in the eggs of the Aedes aegypti mosquito.

Head of TDC analysis Prof. Dr. Soegeng Soegijanto said that the dengue virus scourge in Surabaya was now considered malevolent.

"This is shown by the number of those who have died from the disease," said Soegeng.

However, the analysis indicating the presence of genetical mutations has not been used to curb the disease, as shown by the government in the emphasis it continues to place on fumigation as a prevention method.

From the sum of Rp 3.8 billion (US$400,000) earmarked to prevent and eradicate diseases in Surabaya, Rp 2.8 billion of it has been allocated for dengue fever prevention. Of that amount, Rp 1.1 billion has been used to buy the Malathion and Abate brand of insecticide.

Fumigation, however, appears to have been a waste of time. "Perhaps, the mosquitoes are already immune to the commonly used Malathion and Abate insecticide," Soegeng said.

An Aedes aegypti mosquito has a life cycle of around 12 days. Upon adulthood, female mosquitoes are able to mature their eggs through the human blood they suck.

They lay their eggs in stationary and clean water. Therefore, the best way to prevent them from breeding is to cover and clean water containers periodically.

Sulastri said that someone with dengue fever would usually experience Dengue Shock Syndrome (DSS) when his or her thrombosis level would drop below 100,000 per cubic millimeter. However, a patient with a thrombosis level of up to 148,000 per cubic millimeter could now suffer from DDS, as seen in patients in Surabaya.

"Due to these reasons, the government has issued a policy requiring hospitals to treat patients if they exhibit the symptoms of the disease and their thrombosis levels are in the 150,000 per cubic millimeter region, complying with World Health Organization (WHO) standards," said Sulastri.

In 1986, WHO published a diagnosis on dengue fever describing an abrupt bout of high fever, which would last from two to seven days without any clear reasons.