Rising dengue cases in Punjab had set alarm bells with the state health authorities. The total number of cases in Punjab has crossed 16 thousand and so far there are 61 suspected deaths from dengue and 21 have happened in the past 4 days according to Punjab government’s records.
Here are the possible reasons for a dengue outbreak in Punjab amid a pandemic and how patients can keep the disease away.
When do cases of dengue fever usually spike
Every year sees an upsurge of dengue cases between July and November. The pea comes in monsoon with accumulated freshwater making favorable conditions for mosquitoes to breed and it is not uniformly distributed throughout the year. Female Aedes mosquito plays host to the dengue virus. Aedes can fly up to a limited distance of 400 meters, is a daytime feeder, and can’t breed once the temperature falls below 16 degrees.
Tests that detect dengue
Dengue is determined through the Elisa test. In this kind, IgM and IgG antibodies and NS1 antigen test is conducted using ELISA kit. If IgM and IgG antibodies are detected in the initial blood sample within 3 to 7 days of fever it means the person got the dengue virus in recent weeks.
Another rapid detection test NS1 confirms dengue within a day of fever before ELISA test. The detection of the virus occurs even before antibodies occur. The Punjab government has capped the cost of the tests at Rs 600 in private hospitals, while t is free in government health facilities. Limited kits at government hospitals and overcrowding are forcing people to get tested at private clinics.
Common symptoms of dengue fever
A sudden rise in temperature lasting two to seven days is the first symptom of dengue. The fever is associated with fatigue, headache, flushing, weakness, myalgia, retro-orbital pain, itching, rash, and weakness.
When a dengue patient needs platelet transfusion
According to Dr. Vittul Gupta, chairman of the Malwa branch of Physicians Association blood transfusion is advised once the platelet count goes below 10,000 and shows active bleeding or hemorrhage. Most dengue cases, though are manageable and the risk of complications is less than 1 percent.
Platelet count, however, is not a reliable parameter to predict bleeding. Sometimes platelet infusion did not better condition of children with severe thrombocytopenia. In a recent randomized controlled trial with thrombocytopenia or dengue infection suffering from severe or persistent mild bleeding, supportive care was more effective than prophylactic platelet transfusion.
Symptoms that indicate the patient is deteriorating or improving
Deteriorating: Severe bleeding manifestations, fluid accumulation in serosal cavities with respiratory distress, shocked delayed capillary refill, severe organ involvement are some of the signs that the patients’ health is deteriorating.
Moreover, myocardial dysfunction, liver failure, impaired consciousness, AST or ALT>1000 units of CNS, hepatomegaly are some of the other signs of deteriorating health
Improving: Stable blood pressure, pulse, breathing rate, normal body temperature, return of appetitive, stable hematocrit, no evidence of internal bleeding, good urine output means the patients’ health is improving.
Line of treatment
Mild dengue is treated symptomatically. Dr Gupta says, paracetamol treats body fever and ache. The patients should be encouraged to drink lots of water and Salicylates and other non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided.
Dengue has no specific antiviral therapy. Patients need regular monitoring by primary care physicians along with hematocrit and platelet counts.
Warning signs that a patient needs hospitalisation
Persistent vomiting, fluid accumulation in the pleural cavity, abdominal pain, mucosal bleeding, restlessness, irritability, liver enlargement>2cm, concurrent decrease in platelet count, progressive increase in hematocrit are some of the signs when a patient needs to be admitted to the hospital and managed by a physician and critical care specialists.
Home remedies to help patient
Papaya leaves extract, neem leaves, tulsi leaves, pomegranate juice, coriander leaves, wheatgrass juice, and drinking an adequate amount of fluids is advised at home.
What patients should do and shouldn’t when at-home care
Take paracetamol to keep body temperature below 39 degrees Celsius but not more than four times in 24 hours. Drink fluids as much as possible from water to soup, juice etc along with following a normal diet of home-cooked healthy food.
Aspirin or Brufen should not be used for keeping body temperature in check. Antibiotics and steroids should be avoided. Avoid intravenous therapy unless there is sufficient evidence of internal bleeding. Avoid platelet transfusion there is severe bleeding or reduction in hematocrit.
Why did Punjab see such a major dengue outbreak?
Dengue outbreak has a seasonal pattern with most cases during monsoon and post-monsoon period every year. However, measures to control the breeding of Aedes mosquitoes like Indoor Space Spray and fogging are not carried out in routine, and measures of control in that area are ignored.
Steps taken by Punjab government to control outbreak
Dengue has been capped in private hospitals, test kits have been procured, breeding checkers have been enhanced, informed Dr Gagandeep Singh Grover , nodal officer of vector-borne diseases in Punjab. Moreover, more than 15 lakh houses were visited by the health department for breeding checking. In addition larvicides and insecticides have been procured.