‘Dengue-like disease hits Bangalore’, ‘Sting of dengue at a feverish high in Bangalore’, ‘Dengue cases jump 3-fold in State’, are some of the headlines in recent media reports on dengue. However, several doctors in the city feel that there may be a slight misrepresentation in these reports that could unnecessarily result in panic and fear among people.
A doctor with a well-known private hospital in the city, on the condition of anonymity, says a newspaper reporter asked if the dengue prevalence in the city can be referred to as an ‘epidemic’. The doctor says he told the reporter that dengue cases are only rampant but that it is nowhere close to be called an ‘epidemic’.
There have also been several reports referring to a ‘dengue-like’ disease or a type of dengue called dengue shock syndrome that’s doing the rounds. A scientific officer at the Nrupathunga Road-based St Martha’s Hospital says, “It is either dengue or it is not dengue. It cannot be dengue-like”.
Dr H Paramesh, Medical Director of the Ulsoor-based Lakeside Hospital, says that while the media has done a good job in spreading awareness, there are chances that people get scared and keep asking for a dengue blood test even in the case of a regular fever. With the onset of the monsoons, there is automatically a rise in illnesses. These include not only dengue, but also cough, cold, influenza and fevers in general. And not all fevers are dengue. He says that while several infections occur during the rainy season, only some of these happen to be dengue fever.
Weak immune system key to severity
According to the World Health Organisation’s (WHO) Handbook for Clinical Management of Dengue, “A number of infectious and noninfectious diseases mimic dengue and severe dengue…Conditions that present with an influenza-like syndrome, such as influenza itself, measles, chikungunya, infectious mononucleosis and human immunodeficiency virus (HIV) seroconversion illness, may mimic the febrile phase of dengue.”
As for reports on dengue shock syndrome, it’s a severe symptom of dengue and not a type of dengue, the scientific officer at Martha’s says.
He explains that dengue is an illness that has severe and non-severe clinical manifestations. It is transmitted by the bite of the Aedes mosquito and takes about three to 14 days for the symptoms to occur. Symptoms range from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash. Most cases do not even require hospitalisation. Dengue fever does not require any antibiotic intake and doctors generally recommend paracetamol.
This officer says the more severe symptoms of dengue include bleeding and shock. These complications can occur if the patient was diagnosed late, if the patient has an already weak immune system or if the patient has a prior problem like alcoholism or diabetes.
“Persistent vomiting and severe abdominal pain are early indications of plasma leakage and become increasingly worse as the patient progresses to the shock state. The patient becomes increasingly lethargic but usually remains mentally alert. These symptoms may persist into the shock stage”, says the WHO Handbook.
It’s this severe case of dengue that could prove fatal. But Dr Paramesh says that the dengue mortality rate is today about 1 per cent, as opposed to the 5 per cent it was back in 1999.
And unlike many media reports about dengue deaths in Bangalore, the Bruhath Bengaluru Mahanagara Palike (BBMP) records say there hasn’t been a single death in the city so far this year.
No dengue deaths, or no reported cases?
According to the BBMP there have been 439 dengue cases reported in the city this year. Despite media reports about dengue deaths, the BBMP says there have been no mortalities. For example, a recent media report claimed that one person died due to dengue at M S Ramaiah Hospital. BBMP’s Nodal Officer for Mosquito Control, Dr K Sangamithra says that while the news of the death is true, the victim was not from Bangalore and only happened to be admitted in a hospital within BBMP limits. Therefore, she says, the case will pertain to the city/district of origin of the victim.
Dr Sangamithra says the same is true for deaths in other hospitals as well.
For example, Dr S Rajanna, Resident Medical Officer, Bowring Hospital, says the hospital has seen at least three dengue deaths this year.
At St Martha’s Hospital, the Associate Medical Superintendent says there have been three dengue deaths this year that took place in May.
The office of the Medical Superintendent of Victoria Hospital says they have had one dengue death in the first week of July.
Citizen Matters was unable to independently verify whether each of these victims were from outside BBMP limits and if they only happened to be admitted in a city hospital for treatment.
Also, given that many hospitals do not share information on dengue cases with the BBMP, it is likely that even if dengue deaths have occurred, they would have gone unreported.
(as of 15 July)
Disparity in numbers
As far as the number of dengue cases in Bangalore goes, the number 439 which the BBMP records state is likely to be lesser than what it actually could be. This is because not all private hospitals in the city submit a report to the corporation. Dr Sangamithra says several private hospitals including Columbia Asia, Rajarajeshwari Medical College and Hospital, Gayathri Hospital, Chinmaya Mission Hospital, Fortis, and Manipal Hospital send in their reports on dengue cases.
She says all blood samples are to be sent to the sentinel labs located in the city at Public Health Institute, Indira Gandhi Institute for Child Health, National Communicable Disease Centre and National Institute of Virology field station at Victoria Hospital. However, not all hospitals do this, as it is not mandatory.
Dr Sangamithra says that in a meeting last month private referral hospitals were requested to send samples to these labs for testing. She adds that medical officers have been instructed to be in regular contact with private practitioners and nursing homes in their wards to collect information on dengue.
When the BBMP receives reports on dengue cases from various hospitals, details include the name of the patient and area of residence. Dr Sangamithra says that they then direct their teams of health inspectors, link workers, gangmen and nursing students to survey the area. A report should be sent to the BBMP on the same day. If the area is found to be an active breeding ground for the Aedes mosquito, power spraying is carried out. She says spraying is done throughout the year but is intensified during the rainy season.
Since June 1st the BBMP says it has surveyed at least 2,78,288 houses and found that at least 29,894 of them are active breeding spots for the mosquito that causes dengue.
Dr Sangamithra says areas that have been surveyed include peripheral areas like Mahadevapura, Gandhinagar and Malleshwaram. She says surveys are also carried out in apartment complexes, schools and colleges.
The BBMP says that its biggest challenge is source reduction since breeding sites for the Aedes mosquito include water collected in cement tanks, barrels and drums, pots, and tyres. It all boils down to maintaining a clean environment.