Outbreak of Dengue: Need for confronting it sensitively

As outbreak of Dengue has by now assumed the form of a dreaded infection rapidly spreading beyond Dhaka city, hospitals swamped with patients are filled to the brim consequent upon which overstrained doctors, nurses and pathologists are facing a very hard time handling the unprecedented deluge of treatment seekers. Let alone the ordinary people, three medical doctors—Dr. Nigar Nahid Dipu of Dhaka, Dr. Mohammad Shahadat Hossain Hajra of Habiganj and Dr. Tania Sultana of Dhaka Medical College—have died of Dengue on 3 July, 22 July and 26 July respectively. Therefore, naturally a sense of fatality has gripped the mass psyche.
There was empathy and sensitivity in Awami League General Secretary and Road Transport and Bridges Minister Obaidul Quader. He appropriately observed, “People are worried about Dengue. All of us should talk responsibly, and perform our duties properly.”
Given that any virulent disease should be a matter of serious concern for a Health Minister, Health and Family Welfare Minister Zahid Maleque’s statement was improper. He said, “Why such a huge number of dengue patients are there in our country? My simple answer is the spread of mosquitoes, spread of Aedes mosquitoes. These Aedes mosquitoes are healthy and sophisticated. Somehow we could not control the mosquito population. The mosquito population and the Rohingya population are growing at the same pace. The mosquito population is increasing just like the Rohingya population after they came to our country. If the production was less, there would be less Aedes mosquitoes. People would be bitten less by infective mosquitoes and there would be less Dengue.” What is more, the minister’s equating Aedes mosquitoes with the wretched Rohingya people is disparaging to say the least.
The Health Minister further said, “It is the city corporations’ responsibility to kill mosquitoes, not that of the health ministry.” He advised the journalists to be more careful when reporting on dengue, saying, “The journalists must know that every day 15 to 20 people in the country die of road accidents. Ten die of snake bites and hundreds of heart attacks. We don’t keep track of that. But over the past few months, only 8 died of dengue. The situation is now fully under control.” [Vide the Samakal]
Finance Minister A H M Mostafa Kamal stated, “There are a lot of mosquitoes at the ERD office in Agargaon, Dhaka. I have been bitten twice — once affected by Chikungunya and then Dengue. I am not going there anymore out of fear.”
However, Sayeed Khokon, Dhaka South City Corporation Mayor spoke without due consideration of the objective situation. He said, “There are rumours about number of Dengue patients like child kidnapping. The information that three lakh people are suffering from Dengue is completely imaginary and confusing. …Dengue situation is under control in the country. There is no need to panic over the dengue situation. Mosquito insecticides are not ineffective; mosquitoes have become stronger than in the past. That’s why insecticides are now working.”
Writing on Aug 8, 2006 about fatal Dengue hemorrhagic fever in adults during a dengue epidemic in Singapore, researchers Ong A, Sandar M, Chen MI and Sin LY of Tan Tock Seng Hospital, Singapore, observed that adult respiratory distress syndrome, disseminated intravascular coagulopathy, and multi-organ failure were the most common causes of death despite early hospitalization, intravenous fluid, and blood-product support. Of 3186 cases of dengue fever (DF) / hemorrhagic dengue fever (DHF) admitted to their institution, there were 130 cases of DHF and seven dengue-associated deaths (case-fatality rate 5.4%). At least three of the seven fatal cases had serological evidence of primary dengue infection. All dengue-mortality cases had rapidly progressive clinical deterioration at an average of day 4 of fever with intensive care admission occurring on a mean of 5.6 days of fever. [Vide https:/ /www.ncbi. nlm.nih.gov/ pubmed/16899384 ]
Dengue—which occurs in urban and suburban settings with higher transmission rates happening during the rainy season—is a viral infection caused by four types of viruses (DENV-1, DENV-2, DENV-3, DENV-4) belonging to the Flaviviridae family. The viruses are transmitted through the bite of infected Aedes aegypti and Aedes albopictus female mosquitoes that feed both indoors and outdoors during the daytime (from dawn to dusk). These mosquitoes thrive in areas with standing water, including puddles, water tanks, containers and old tyres. Lack of reliable sanitation and regular garbage collection also contribute to the spread of the mosquitoes. As regards the outbreak of Dengue in Bangladesh, the International Association for Medical Assistance to Travellers (IAMAT) states that risk is present throughout the country and year-round with peak transmission during the monsoon season, from June to September. [Vide https:/ /www. iamat.org/ country/bangladesh/ risk/dengue ]
Regarding symptoms, in some cases, Dengue infection is asymptomatic, which means persons do not exhibit symptoms. Those with symptoms get ill between 4 to 7 days after the bite. The infection is characterised by Flu-like symptoms which include a sudden high fever coming in separate waves, pain behind the eyes, muscle, joint, and bone pain, severe headache, and a skin rash with red spots. The illness may progress to Dengue Hemorrhagic Fever (DHF). Symptoms include severe abdominal pain, vomiting, diarrhea, convulsions, bruising, and uncontrolled bleeding. High fever can last from 2 to 7 days. Complications can lead to circulatory system failure and shock, and can be fatal (also known as Dengue Shock Syndrome). The IAMAT’s advice: — “Use a repellent containing 20%-30% DEET or 20% Picaridin on exposed skin. Re-apply according to manufacturer’s directions. If available, pre-soak or spray outer layer clothing and gear with permethrin. Get rid of water containers around dwellings and ensure that door and window screens work properly.”
An influential leader of Congress and member of the then East Bengal legislative assembly, Prabhas Chandra Lahiri in his memoirs wrote, “When Habibullah Bahar sahib was the Health Minister, he completely eradicated all mosquitoes from Dhaka, and then I slept without mosquito nets in Dhaka. That was Bahar.” Poet Jasimuddin wrote, “As health minister, Bahar rid the city of mosquitoes. He would personally go around the slums and supervise this work.” Prof. Abul Fazal echoed similar remarks on Mr. Bahar in one of his memoirs.
Last but not least, it is good to remember: Example is better than precept.

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