Dengue Alert

Five-year-old Jomar Barquin developed fever Thursday last week.

At first, his parents decided to treat him at home in barangay Tuyan, Naga City, southern Cebu.

When his fever wouldn’t go down, the boy was rushed last Monday to the Vicente Sotto Memorial Medical Center (VSMMC) in Cebu City where he was diagnosed with dengue fever.

Barquin was one of more than 5,000 persons afflicted with the mosquito-borne disease in Central Visayas during the past three quarters.

This is a 42 percent rise in dengue cases in the region compared to the same period of January to October last year, said the Department of Health (DOH) Regional Epidemiological Surveillance Unit.

The RESU recorded 5,552 dengue patients who were examined or admitted in Central Visayas hospitals in the last 10 months with 73 deaths or case fatality rate of 1.3 percent.

During the same period last year, there were fewer cases at 3,916 but the number of fatalities was higher at 95 with a CFR of 2.4 percent.

Cebu City has the number of cases at 13.6 percent (754 cases) followed by 12.3 percent (685 cases) from Lapu-Lapu City and 7.6 percent (419 cases) from Dumaguete City in Negros Oriental province.

The VSMMC for instance, the Infectious Ward or Ward 10 has a 36-bed capacity but on “peak” dengue months of August and September, they would have 60 to 80 patients at one time.

The profile of dengue patients has changed, according to Dr. Jean Aster Zeta, VSMMC Pediatrics consultant.

Zeta said dengue patients were usually of school age but lately, they had patients who were infants -- 25-days-old to 27-days-old.

But the DOH in Central Visayas continues to implement its search and destroy program to curtail the increase in number of Aedes aegypti or the dengue-carrying mosquito as medical doctors are looking at treating patients infected with the virus on a case to case basis after they noticed that people show various symptoms and response to the vector-borne disease.

“There are patients who have fever on the second day have good vital signs but turn for the worse while some are already critical but they are able to recover,” said Dr. Willy Gunhuran of VSMCC.

“It is a case to case basis,” he added.

Gunhuran cited the case of his patient, Vince Rey Bulfan, 9 from Daanbantayan town in northern Cebu who was confined at the Pediatric Intensive Care Unit, after he was brought to the government-ran hospital more than a week ago with a fever.

He said Bulfan's condition reached critical stage a few days ago wherein he had difficulty breathing and had to be intubated.

But yesterday, Bulfan was already propped up in bed and was being given milk by his grandfather, Gregorio Suñer.

Gunhuran said there was a new theory that the patient's response to dengue infection may be linked to one's genetic make up but this had yet to be tested and studied by scientists.

He, however, stressed that prevention remains the key to stop the proliferation of the disease especially that the virus can spread within the radius of 200 to 300 meters of an infected patients.

“Prevention (of the spread of infection) can be addressed by the community. In the hospital, the early help-seeking attitude of parents is crucial,” he said.

The physicians follow a protocol and that a team is on hand to provide treatment but they reiterate that early detection and prevention are the best means to address the illness.

Dr. Zeta said early detection and early fluid management were the initial treatment for dengue patients.

“The first test is CBC or complete blood count, and we focus on the hematocrit than the platelets,” she said.

The hematocrit test is the measurement of the consistency of the patient's blood.

“It is difficult to explain this to the parents. But the visible signs that the patient's blood is thick in consistency is he or she is sluggish, has difficulty breathing and has edema or hupong,” she said.

Zeta also said the patient would also be feeling cold, have a slow pulse and slow blood circulation.

Zeta said physicians follow a protocol when treating patients in hospitals.

“We have a team. If you have doubts, we should seek the assistance of a specialist. We have the intensivists, who specialize at treating critical patients and are always on call,” she said.

“We also have daily updates for critical patients. So we closely monitor their status,” she added.

DOH-7's communicable disease coordinator Dr. Jocelyn Abellana said there is a 42 percent increase in the number of cases between Jan. 1 to Oct. 24, 2009 compared with the same period last year.

“We are considering conducting a refresher course on fluid management for clinicians who handle dengue cases,” said Abellana.

“It has been observed that the kind of fluid and fast replenishment of fluids and the type of needle used are crucial in treating dengue patients,” she added.

Abellana said that more people are aware of the value of seeking early treatment.

“The vector is always present, we have to focus on the elimination of breeding sites. We still implement the search and destroy strategy,” she added.

‘Safe’ insecticide against mosquitoes

Tthe Department of Health in Central Visayas (DOH-7) is introducing an alternative method to prevent dengue during the rainy season.

Insecticide can be used to treat mosquito nets and curtains with no side effects on humans, said DOH-7's communicable disease coordinator Jocelyn Abellana.

Iconet, which is in powder form, is mixed with water and used to soak mosquito nets and curtains.

It contains, among others, Lambda-cyhalothrin, solvent, dispersing agents, stabilizers, surfactant and acid, biocide.

Lambda-cyhalothrin disrupts the normal function of the mosquito’s nervous system, according to the National Pesticides Telecommunications Network website.

The chemical can paralyze or kill any insect that comes in contact with it.

Abellana said the insecticide has been approved by the World Health Organization and has no known side effects on humans.

Mosquito nets and curtains laced with Iconet can be found in homes in Dauin town, Negros Oriental, where residents observed that mosquitoes were trapped in the net died. These curtains and mosquito nets could last up to 20 washings.

The chemical is only effective against mosquitoes. .

Abellana said they have yet to introduce the method to the City Health Department of Cebu City which has the most number of dengue cases in the region.

She said anyone can bring their mosquito nets and curtains to the City Health Department and learn how to lace it with Iconet.

But the best way to prevent dengue is to eliminate the breeding grounds of mosquitoes by removing stagnant water found in vases, unused tires, and surroundings.

Aedes aegypti is a day-biting mosquito which lays eggs in clear and stagnant water.

Adult mosquitoes rest in dark places.

Symptoms of dengue include high fever that may last 2 to 7 days, joint and muscle pain, skin rashes, nosebleed, abdominal pain and dark colored stools.