DENGUE/DHF UPDATE (67): NEPAL, SITUATION UPDATE
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International Society for Infectious Diseases
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Date: Sat 17 Aug 2024 07:24 NPT
Source: The Kathmandu Post [edited]
https://kathmandupost.com/health/2024/08/17/massive-dengue-outbreak-hits-anbukhaireni-in-tanahun
Amid heavy rainfall in many places across the country [Nepal],
Anbukhaireni Rural Municipality of Tanahun district has been hit by a
massive dengue outbreak, with over 900 positive cases in a single ward
within a month. Local health facilities are struggling to cope with
the overwhelming number of seriously ill patients.
“Over 900 people from ward 3 have tested positive for dengue within a
month,” Agam Raj Upadhyaya, health coordinator of the rural
municipality, told the Post over the phone from Anbukhaireni.
“Forty-five patients are currently being treated on just 15 beds at
Anbukhaireni Hospital. The hospital floors and corridors are packed
with infected people.”
Health officials warn that the actual number of dengue cases could be
higher, as people having mild symptoms are not getting tested and are
resting at home. They also informed that around 2 dozen seriously ill
patients have been sent to Chitwan, Pokhara, and Kathmandu for further
treatment.
“What worries us most is that with the spike in positive cases, we are
also seeing an increase in seriously ill patients,” said Upadhyaya.
“These patients need intensive care, which is why we have to refer
them to Chitwan, Kathmandu and Pokhara.”
Dengue is a mosquito-borne viral disease transmitted by female Aedes
aegypti and Aedes albopictus mosquitoes. The same vector also
transmits chikungunya, yellow fever, and Zika, according to the World
Health Organisation.
So far 2 died and 3755 tested positive with the dengue virus that has
spread in 74 districts across the country. Public health experts say
the real number of infections could be several times higher, as the
government’s case reporting system is not very effective, and more
than 80% of the cases are asymptomatic.
Data provided by the Epidemiology and Disease Control Division shows
that only 715 people have tested positive for the virus in Tanahun,
far less than what is reported by the rural municipality. “We don’t
know how they are counting, but we have reported all the confirmed
cases,” said Upadhyaya.
Other health officials also told the Post that health authorities are
misrepresenting the true extent of dengue infection and deaths.
Public health experts warn that dengue cases could escalate in the
coming days as heavy rainfall continues across the country, and
post-monsoon season, which is considered the main dengue season, is
yet to start.
“The coming days will be more challenging for us, as dengue cases
could surge,” said Dr Sher Bahadur Pun, chief of the Clinical Research
Unit at Shukraraj Tropical and Infectious Disease Hospital at Teku in
Kathmandu.
Public health experts criticise the authorities for their narrow focus
on merely counting cases and deaths, which does little to control the
spread of the deadly disease. Experts say the disease will not stop
spreading unless the lessons and experiences gained from previous
outbreaks are implemented.
Meanwhile, the Epidemiology and Disease Control Division on Friday [16
Aug 2024] issued new guidelines to control the spread of the dengue
virus. The guidelines stress the need for searching and destroying
mosquito larvae, but do not recommend insecticide spraying, as past
experience shows that this measure is futile in controlling the
epidemic. Officials say fogging with insecticides is only a symbolic
measure and does not effectively kill larvae, pupae, or eggs,
particularly if done during the day.
Experts say a massive awareness campaign is instrumental in destroying
the breeding ground of the dengue-spreading vector, and the public
must be made aware of the treatment. Many people infected with dengue
show mild symptoms, which do not need any treatment or can be treated
with paracetamol at home.
Dengue-transmitting mosquitoes breed in clean water and bite people in
daylight. Uncovered water tanks and discarded objects such as plastic
cups and bottles could be breeding grounds for dengue-carrying
mosquitoes. According to doctors, mild to high fever, severe muscle
pain, rashes, severe headache and pain in the eyes are some of the
symptoms of dengue. Doctors advise that those with these symptoms
should seek immediate treatment. While there is no specific cure for
the disease, early detection and access to proper medical care can
lower fatalities.
Nepal reported its first dengue case in a foreigner in 2004 in the
Chitwan district. Since then, an increasing number of dengue
infections, including major outbreaks, have been reported from many
districts. At least 20 persons died, and more than 52 000 were
infected by the virus, which had spread to all 77 districts in 2023.
In 2022, a total of 88 people died, and over 54 000 were infected by
the virus across the country. During that period, hospitals in the
Kathmandu Valley were overwhelmed with dengue patients, and pharmacies
ran out of paracetamol, the most widely used medicine to treat fever.
In 2019, the disease killed at least 6 people and more than 16 000
were hospitalised across the country. The virus had spread to 68
districts at the time.
Though the post-monsoon period is considered the dengue epidemic
season, the deadly disease has already become endemic in Nepal, as
outbreaks are reported every month, including in the winter months.