Information service of the Pontifical Mission Societies since 1927
New York (Fides Service) – Missionaries living and working in various parts of the world often have to face situations of health emergency without even a minimum of preparation. To meet requests for information coming from many sides and assure these courageous Gospel workers of our solidarity we continue to supply reports on health problems, with the assistance of experts in the field of medical care and research. In the article given below, Professor Kevin Cahill, a major American expert in tropical medicine, Director of the Tropical Disease Centre at Lenox Hill Hospital, New York, turns our attention to Dengue also referred to as “break bone” fever, a disease which is widespread in tropical and semi-tropical zones which affects some 25 million people every year.
“This article is one of a series that will appear in Fides as an educational effort to focus on the health problems, particularly of the poor, and to know how widespread, are epidemic diseases that cause so much suffering and death and yet receive so little attention. In recent months Severe Acute Respiratory Syndrome (SARS) has attracted world-wide media coverage. To date there have been fewer than ten thousand cases and fewer than one thousand deaths. Global quarantine measures have been rapidly put in place to contain the spread of SARS and, in addition to the clinical effect on individual patients and the impact on hospitals and health services, the entire economies of Southeast Asia and parts of Canada and the airline industry are threatened.
Media interest was justifiably focused on the emergence of a disease for which there is no preventive vaccine and only supportive therapy. But there are other, almost forgotten, epidemics and we shall focus in this article on an illness that is widespread throughout tropical and semi-tropical lands. Dengue is endemic throughout South East Asia and is emerging as a major health problem in Central and South America as well as throughout the Caribbean. Dengue is an arthropod (insect) borne infection similar in its lifecycle to yellow fever. It is a viral ailment transmitted by Aedes mosquitoes. There are multiple serotypes of dengue and the clinical presentation depends upon the specific viral variant as well as the victim’s previous exposure to dengue infection. Clinical dengue can cause a severe flu-like syndrome and has, appropriately been called “break bone” fever. This common type of dengue is usually a self-limited infection with symptoms lasting from ten to fourteen days. A much more severe form in patients who have had previous infection with dengue can cause rapid death. Dengue Hemorrhagic Fever (DHF) or Dengue Shock Syndrome (DSS) kills adults as well as children and is seen even in infants 3 to 6 months old in whom dengue antibodies had come through the placenta.
There are approximately 25 million cases per year of classical dengue cases and estimates of up to 400,000 cases DHF and DSS. There is virtually no attention to this widespread epidemic, which afflicts primarily poor slum dwelling people who do not have access to mosquito nets and live where sewage and water in the streets offer a perfect setting for explosive mosquito growth.
The cause of this emerging epidemic is not difficult to appreciate; there has been tremendous urbanization throughout the tropics with often no mosquito control programs in the shanty towns and barrios that surround modern cities. There is also an enormous increase in air travel so that patients with infection from as far away as Asia can readily introduce new strains of dengue infection into unprotected Latin American and Caribbean societies.
Clinical management of patients with dengue is purely supportive. There is no specific antidote or drug. There is no preventive vaccine available. For those with the flu-like variety the use of non-aspirin anti-inflammatory agents and fluids can ameliorate the symptoms. In the hemorraghic and shock cases clotting factors, whole blood and intensive supportive care can prevent some deaths.
But the public health story of dengue is, sadly, much like that of malaria around the world. Mosquitoes don’t know where the border of one state is and local eradication schemes are often destroyed by conflict and chaos in a neighbouring state. One of the first victims of conflict is the public health system and critical resources are often redirected from often invisible and un-dramatic preventive medical efforts to bolster immediate military costs. Mosquito control programs need constant application and require a working national infrastructure. It is in the absence of stability that the incidence of dengue is exploding.” (AP) (Fides Service 3/6//2003 EM lines 57 Words: 790)
