Dengue fever a clear and present danger

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.