In recent weeks, what is fast looking like an epidemic of dengue fever has been spreading in different parts of India. Delhi is over 600 reported cases, with 16 fatalities; Kerala has over 700 cases; Gujarat, 200; West Bengal, 300. At India’s top hospital, the All India Institute of Medical Sciences (AIIMS), one medical student has died and 20 nurses are infected. In today’s news, it appears that two of the grandsons of Prime Minister Manmohan Singh have also contracted the disease and have been admitted to the hospital.
Dengue fever, you ask?
Here’s the scoop. It’s transmitted by mosquitoes: not the Anopheles, which carries malaria, but the Aedes — especially the Aedes aegypti, which the Centers for Disease Control (CDC) describe as a “domestic, day-biting mosquito that prefers to feed on humans.” There are two strains of dengue. Regular dengue fever (DF) produces fever, headache, back ache, joint pains, nausea, eye pain and rash. Dengue hemorragic fever (DHF) is nastier and potentially deadly:
Dengue hemorrhagic fever is characterized by a fever that lasts from 2 to 7 days, with general signs and symptoms that could occur with many other illnesses (e.g., nausea, vomiting, abdominal pain, and headache). This stage is followed by hemorrhagic manifestations, tendency to bruise easily or other types of skin hemorrhages, bleeding nose or gums, and possibly internal bleeding. The smallest blood vessels (capillaries) become excessively permeable (“leaky”), allowing the fluid component to escape from the blood vessels. This may lead to failure of the circulatory system and shock, followed by death, if circulatory failure is not corrected.
There is no vaccine and no specific medication for dengue. Cases of DHF in particular require rapid hospitalization and fluid replacement therapy for the patient to pull through. This requires, obviously, a medical infrastructure that permits rapid hospitalization, not to mention hygienic hospital conditions, never a given anywhere in the world.
Mosquitoes are the only vector of the disease, meaning that anyone who contracts it in a hospital environment likely did so from mosquitoes hanging out there. The best way to prevent dengue, therefore, is to reduce mosquito breeding opportunities and infestation settings like standing water. In the immediate, the authorities in Delhi (and presumably other places as well) are carrying out a fumigation campagn with pesticides. At the same time, it seems that the country was also insufficiently prepared to deal with a disease that has been endemic for a long time.
The spread of dengue — as well as chikungunya, which has now killed 71 people in Kerala — comes at a time when health experts are revising their longtime opposition to DDT. The WHO has lifted its ban on DDT, and the US government also supports wider use of the once-dreaded chemical. This is controversial, obviously; this article, for example, makes the opposing case.
Dengue has been spreading worldwide as the Aedes mosquito makes itself at home in more and more places. Here is a map that shows the reinfestation of Aedes in the Americas since 1970. As a side note, there is also a hip band out of Los Angeles called Dengue Fever. They play a blend of psychedelic rock and Cambodian pop.
Its the same damn story every year. Wwhy don’t they fog the whole city more regularly. Stagnant water elimination and regular fogging are the only way to fix this problem.
Even the regular DF is NASTY. My dad travelled to India last year and got it…when he got back here, he had to take all the information to the doctor, they had no clue what it could be…
The use of DDT for Indoor Residual Spraying (IRS)(which is what WHO has approved it for) is generally more appropriate for rural areas since:
link (free login required)
These outbreaks seem concentrated in urban areas.
not to mention the fact that while DDT was banned in the 60s/70s, some countries, India included continued using it
thanks mr. mitter for the post :), i know i’ve been biting about it for a few days now..
so.. i’ve had 2 family friends who have traveled to the motherland in the last 2 months.. and one has suffered from dengue and the other from chikungunya..both have arthrlagias still and were sick as dogs… hospitalized in india…and finally had the energy to fly back to be cared for here…
this is going to affect toursim.. the only way of not getting these damn diseases (which have no cure)… is to not get bitten..
yeah..to not get bitten by mosquitos in india? give me a break…
You can see the latest outbreaks of disease worldwide visualised from various sources at HealthMap.
thanks for bringing this to light, Siddartha. Our family lost an infant (my niece) to Dengue Fever;she suffered horribly. They lived in Delhi, and at the time (last year) it wasn’t an epidemic problm, it was a freak illness.
here is a great piece on the mosquito war which was on NPR recently
i live in delhi, dengue is out of hand! and as per usual, it is north/old delhi that is most affected… i live in gk1 and we have regular sprayings through our rwa so we supposedly have not had many cases. but at my work (i work with hiv positive kids) we are on high alert and keeping extra pluggies, nets, and odomos on hand. haven’t had any cases among my co-workers, but a few have had parents go to the hospital, reports say that older people are most vulnerable.
i have to say, tho i love delhi and it has become my second home over the past couple of years (i am prone to calling it dilli, meri jaan) i am really angry as a city resident that things are so out of hand when it comes to government oversight, between the MCD sealing drive that has completely screwed the livelihoods of so many, to the lack of mosquito spraying that leaves us with so many sick and many parts of old delhi at a standstill due to mass illness, plus the fact that south delhi has been out of water for three days counting, my electricity goes off every day for four hours… what is going on, sheila dixit?!?!
(lighter note) of course, the real tragedy is that with everyone down with dengue and chikungunya, i am becoming a hypochondriac and convince myself hourly that i’ve caught it! as we speak, i have this joint pain that won’t go away and i’m rechecking the cdc site… 🙂
oh the pain of dengue…
i got it in 2001 and flew back to the US without knowing what i had. i’ve never ever ever been in so much pain in my life. i walked into University Health Services at Columbia and the doctor [and i have no idea how he knew] hit the nail on the head that i had Dengue.
i wouldn’t wish it on my worst enemy.
Sitting here in chikunguyna country, heading to Denghi tomorrow. Industrial sized Odomos is where it’s at!
Someone told me that part of the problem in Kerala is the dwindling population of frogs, whose habitats have been diminished by polluted waterways and the draining of wetlands for high rise apartments. I wish I had time to look this up right now. Just putting it out there for anyone else who is wondering about non-DDT options…
No report on the poor state of public health in India will be complete without a few words of criticism for the incumbent Minister of Health. His incompetence is matched only by the indulgences showered on him by the senior partner of the UPA. And this person claims to a licensed physician?
That is a cool website.
Mangalam,
Unfortunately, its not as easy as pinning the blame on one person. The entire system is faulty. In Bombay, I worked with the BMC (Bombay Municipal Corp) on a public health policy paper. I studied the structure of the system and found that while there is the “good in theory” model of three levels of care.
Primary: Community Health Centers Secondary: Local Hospitals and Nursing Homes (Maternity, not elderly) Tertiary: Teaching hospitals (KEM etc). (You can visit http://www.karmayog.com/publichealth/publichealthindex.htm to see the reports and various policies). Not trying to plug myself, but my report is there as well, if you want an overview.
The main problems were with the allocation of funds, the tertiary hospitals (mostly located on the south of Mumbai) got the majority of funding and all the good doctors wanted to work there. All the facilities from MRI to outpatient care is available there. Upon visiting and interview folks from KEM, all the young medical students wanted to work there and found it to be prestigous. But their Emergency Depts are overcrowded and people are looking at them as primary care centers, people come from as far as Bihar to go to KEM.
The secondary hospitals are understaffed have few services and are dilapitated. People who go there are usually transferred to the teaching hospitals. The lack of good ambulatory care remains a problem.
The community health centers are run down, have little equipment, and even less committment to the doctors who are supposed to be working there. Folks use them, but mostly for vaccinations or TB medication.
Ok, so the infrastructure is not being properly utilized and there is no referral system. Doctors who teach at the hospitals are allowed to have private practices running simultaneously. Students who were once required to work 2 years in a rural area can now buy their way out of that requirement (someone posted that in the news section some time back). There are a lot more issues but I won’t get into it…not now at least 😉
At least in Mumbai, its not a lack of funds (that city has a lot of money, read: octeroi tax), its lack of priority given to health. With HIV/AIDS rates rising, malaria/dengue, respiratory infections, diabetes and all coming up we truly hope that there will be some initiative by the BMC to give priority to health. All that being said, medical care in India isn’t as frightful as it is percieved at times, they need to put more attention toward infrastructure, working with NGOs, and educating everyone.
And watching the corruption of the gov’t in front of your face was crazy. Although I did meet one really good leader, but like all others, he was going to be transferred in 6 months. Also, there are a lot of control/political issues of declaring epidemics…
Sorry to go on and on, but I thought to share.
Meenakshi,
SO then why is this nutcase wasting his time on trivial issues. Expecting a Health Minister even at the State level to turn things around is futile – the system is simply toooo large and decrepit. But at least one would expect this incompetent to take up the most serious issues. That is something all Ministers have done. This man seems to singularly incapable (I don’t want to lapse into Tamizh and sound boorish) and uninterested in his portfolio. He has already built up a reputation for extravagance, favoritism, nepotism, and corruption; while an unconcerened PM looks on indulgently. It is not very different from the Union Ministry of IT and Communications which is currently being run for the benefit of another powerful political family in Tamizh Naadu. Surprising SM folks won’t criticise the people at the apex rather some cog in the machine.
Unfortunately, the WHO’s recommendation for DDT spraying won’t do much for dengue. As you point out, DF is caused by aegypti, who are active during the day time. Because of the envirionmental consequences of DDT, the WHO recommendation for DDT is to spray tiny amounts on the underside of your hut roof and other dark areas where anopheles like to hide during the daytime. aegypti are pretty active and can’t really be stopped by residual spraying… the only thing that you can do is get rid of standing water, which (as already pointed out) is very difficult to do. if you have larger bodies of fresh water (like rice paddies, etc) you can release specific fish that eat mosquito larvae…. this usually helps alot, but can’t necessarily be done in urban environments where the standing water is stagnant and polluted.
What are you guys cribbing about? That the system in India is not working? Sorry but India has had Dengue outbreaks before and only gotten news now! Malaysia and even ULTRA Clean Singapore has had a far higher amounts of Epidemics. No system can fix this viral disease. Been there ..tried to do that..There are more complications than you guys think. Its not simple (Ask Duane Gubler, Scott Halstead, (pvdi.org) or Others like Eva Harris @ UCBerk or Arvinda D’silva @NC State. ! Dont blame the Indian politicans for stopping the use of DTT .. By the by (West Nile (flaviviridae) is here in the US, Dengue is not far off) So good luck in your travels to Cancun,Gautemala City,Mangua,Brasilia too …Dengue is here to stay. So next time the ABD’s vote .. you may want to ask the NIH to fund some work in that Direction !!!
Hi Siddhartha. Good post. Chikungunia is probably the most common topic of conversation in Nortern Karnataka, where I was in August. I met at least 5 people who had been struck with the disease, including one significantly weakened infant. We are going back with our child in December. There are going to be lots of coils, Good Knight and Odomos going! Still, it is much easier to protect a child (and ourselves) at night than it is during the day, when we may be out and about. BTW, Dengue Fever, the band, has a great sound and a very cool look. I saw them in Toronto last month. I don’t know how far they will get with Khmer lyrics, tho.
Apparently it’s all under control.
chikungunya – sounds like a Mallu child’s name. Like Chikku Kunju
I just found out that one of my previous desi landlords in India has died of this fever and several of my friends have it (they are not Indians).