Dengue fever kills 58 flood victims

PESHAWAR – The July flooding in Pakistan has left behind a trail of disease, including dengue haemorrhagic fever (DHF), which has caused 58 deaths.

Among the dead was an unidentified senior doctor at the Ayub Medical Complex Abbottabad, who contracted the illness while visiting the Shangla District in Khyber Pakhtunkhwa.

The dengue virus flourishes in pools of stagnant water, created by the flood. The Aedes egyptii mosquito, which usually bites during the day, transmits it.

The last DHF epidemic in Pakistan occurred in 1979, according to the World Health Organisation (WHO), killing 78 people and sending another 6,000 to hospitals. It has never disappeared from Pakistan. Karachi alone had 50 deaths in 2006, 22 in 2007, 6 in 2008 and 8 in 2009. Karachi and Khyber Pakhtunkhwa have recorded 43 and 7 DHF deaths, respectively, so far this year.

So many deaths from a single disease have set off alarm bells in the Ministry of Health, which is striving to halt the virus’s transmission.

Dengue's resurgence blamed on flood

Epidemiologists blame flooding as the cause for the disease’s resurgence.

“We should have carried out insecticide, fungicide and germicide spraying soon after the floods receded, but we didn’t, and the situation is now out of control,” said Dr. Jawad Ahmed, an epidemiologist at the Ministry of Health in Islamabad.

Executive district health officers have received orders to makes sure workers apply kerosene to stagnant pools of water in order to kill mosquito larvae, he said.

Of 8,623 suspected patients, 2,098 have been confirmed to have DHF, Professor Dr. Rashid Juma, Director-General Health Pakistan, told Central Asia Online.

“We fear that more people would get infected as the transmission season isn’t over” He said. The disease is endemic in Khyber Pakhtunkhwa and Sindh, two of the four provinces in Pakistan where enhanced measures now exist to prevent its spread, Juma said.

WHO pledges money and advice

Recognising the crisis, the WHO has pledged US $100,000 to establish two isolation units, one each in the Khyber Teaching Hospital Peshawar and Ayub Medical Complex Abbottabad, to serve DHF patients. Both units will be permanent and will help bird flu and swine flu patients too.

Other areas are not free from DHF. The National Institute of Health, Islamabad has confirmed 54 cases in Rawalpindi and 25 in Islamabad. “Two temporary isolation units have been established to cope with the patients,” Juma said.

“We have put in place elaborate measures to avoid spread of the disease to the general population,” he said.

The WHO has issued guidelines to doctors in state-run hospitals to help them identify symptoms.

“After testing positive, the patients are sent to makeshift isolation units in big hospitals where they get medication for a week,” Dr. Saeed Akbar Khan, WHO operations officer, told Central Asia Online.

The disease comes in two forms, Khan said: the benign and self-limiting (classical) dengue fever, and the more dangerous DHF. DHF can be fatal if untreated.

Symptoms include high fever, severe frontal headache, retro-orbital pain, myalgia, arthralgia, nausea and vomiting, and often a rash. In addition, many patients may notice a change in their sense of taste.

The illness is clinically indistinguishable from influenza, measles or rubella. This acute phase lasts up to one week, followed by a one- to two-week recovery characterised by weakness, malaise and anorexia.

Dengue deaths come in different ways

One man resident of Mansehra District, developed symptoms and tested positive for the disease in Peshawar, said Dr. Imtiaz Shah, who works at a Peshawar hospital.

He was sent home with instructions to contact doctors for follow-up care, “But he didn’t and died September 26,” he said. The NIH is testing 20 samples of the man’s relatives, Shah said.

Anwar Rehman of the Shabqadar village in Charsadda was another victim. He died at the district headquarters hospital Charsadda August 25. “His death went unnoticed, but later his blood sample emerged positive,” said Dr. Ahmad Khan at Charsadda hospital.

“We had received the patient with high fever, homeostasis, purpuric rash and in deeply comatose condition,” Ahmad Khan recalled, noting that the patient deteriorated rapidly on the second day. The patient went into shock and died that evening.

The WHO has developed a disease early warning system under which medics maintain patients’ daily charts. Authorities dispatch the charts to provincial health directorates, alerting them of any trends.

“If the situation worsens in any areas, then the health authorities are in better position to concentrate on the measures (needed) to control it,” Saeed Akbar Khan said.