Dengue

English: Dengue
Malay: Denggi


What is dengue?
http://www.who.int/features/qa/54/en/

Dengue is a viral disease spread by mosquito bite. The Aedes egyptii mosquito is the carrier of the dengue virus.


1. When does dengue occur?

It can occur anytime. It occurs mainly during the hot and dry season and with occasional rain. Breeding grounds can be outside or inside the house.

Outside the house ...

Watering the plants can help to form puddles on the uneven floor around the flowerpots. If the puddles don't dry up fast, mosquitoes can breed as they just need overnight stagnant water.

Rainwater is trapped in various containers improperly disposed off by unthinking users. Rainwater also collects in unused building materials, paint can lids, disused plastic, leaves that curl and can hold water, slippers, drains, clogged gutters etc.

Inside the house ...

Stagnant water provides a good breeding ground for mosquitoes. It doesn't matter whether the home is in the urban or rural area. Urban homes tend to have more decor and flower vases containing water. Urban homes have a lot of clutter and sunshine hardly hits the interior spaces. The interior spaces are often cold and damp .... a perfect hybernating space for mosquitoes while waiting for water to breed. Thus, it is not surprising that dengue sufferers are often found within urban homes rather than rural homes, which have plenty of sunshine and are often drier internal environment.

Most homes today are equipped with basic appliances - the usual kitchen utensils and bath utilities. These don't need daily attention and are often left as they are till the next spring cleaning activity. Flower vases with water, dishes and bowls left to dry but not properly drained, draining boards that are not frequently drained, stagnant water at the base of refrigerators, water in the containers that hold legs of cupboards, etc are among the many possibilities for dengue development.

Inside the toilet, open water tanks which are untreated with Abate, water in pails which are left overnight or for longer period, dippers half-filled with water, wet toilet slippers, water closets (WC) which are left unused for long periods, toilet floors with stagnant water at the corners and near the drainage holes, empty shampoo bottles left lying around on the toilet floor, dirty diapers left on the toilet floor, empty soap wrappers left on the toilet floor, and various other things found in the toilet, are good breeding grounds for the dengue mosquito.


2. Dengue FAQ
http://www.cdc.gov/dengue/faqfacts/index.html


3. What are the signs and symptoms of dengue?

Weakness that gradually worsens and the infected patient becomes fatigued overnight. The weakness is accompanied by an unusual fever and the entire body becomes painful. There is loss of appetite (LOA), altered taste sensation (food does not taste like food anymore), and weight loss. Sometimes the white of the eye appears red, due to hemorrhage of the capillaries in the eyes.

The patient is usually rushed to the hospital A&E, where dengue is diagnosed and the patient is warded for immediate treatment.

Since the patient is already very weak and cannot get up to go to toilet, a bed-pan is a must. Some patients prefer to wear pampers. A relative or family member may want to accompany the patient since the patient has no energy to do much except sleep and breathe. The patient is moved around in wheelchair.


4. How is dengue monitored?

This is an acute infection. It is short-lived. It peaks between 3-5 days and subsides within 2 weeks.

Platelet count is monitored at the hospital. The platelet count drops very low and can be as low as 20.

Patients are discharged home once the platelet count is sufficiently high. Normal platelet count is more than 300 in adults.


5. What food can the dengue patient eat?

Since the patient has altered taste sensation, he/she has no appetite and will not eat. But the patient must be forced to eat.

Among traditional food that can be fed to help overcome dengue are crab soup and bitter papaya leaf juice.

Crab is ketam nipah - a large crab variety that survives in the freshwater marshes by rivers. They sell these crabs in Sabak, Kelantan @ 3 crabs for RM10. They are cleaned and cooked as soup with added ginger, lemon grass (serai), and salt. Drinking the crab soup is sufficient if the patient cannot eat the crab meat.

The papaya leaf juice is prepared by pounding young papaya shoots and squeezing the juice through a sieve. Only a tablespoon a day is sufficient. It is very bitter. Some people add honey, but it is still bitter and difficult to take.


6. How is the patient monitored after being discharged?

The patient is scheduled for regular visits to the clinic (eg Klinik Staf USM) at weekly intervals, to monitor recovery progress - platelet count (if any) and overall general health.

Patients are still very tired (fatigued) after 2 weeks from the first instance of dengue diagnosis. They must be accompanied by a relative or family member when attending post-dengue clinic.


7. How is the patient's living area cared for?

Dengue is a notifiable disease. Once the health clinic is notified, health officers visit the residential area and look for possible dengue breeding grounds. Fogging notices are posted on gates or postal boxes of each home, usually early in the morning of the day of fogging, at about 9 am. Sometimes the home owners have all gone to work by that time, so they won't know till they get home in the evening.

External fogging kills the mosquitoes and larvae. Fogging is done between 6 pm and 7 pm, a time when the mosquitoes come out to feed.

Internal fogging (inside the homes) is done after external fogging between 6 pm and 7 pm.


8. Is fogging safe?

The home is safe after 30 minutes has passed after fogging. The strong oil odour is still in the house long after this and may last up to 1-2 days. Aerosol marks can be found on glass surfaces, glass windows, TV monitors, laptops etc.


9. Is repeated fogging necessary?

Fogging is repeated every 2-3 days, as long as there are dengue patients identified and warded from a particular residential area.

If 5 patients are identified in a particular residential area (taman perumahan), then it can be expected to have continuous fogging for extended periods.

If there is no dengue patient reported from a particular housing area, it means that the area is dengue-free and no fogging is necessary. This often confuses the residents as when there are plenty of mosquitoes, residents tend to think all mosquitoes are dengue mosquitoes, which is untrue.

The usual mosquitoes that build up among flower pots and in the bushes around and nearby houses are often not dengue mosquitoes, but they are a nuisance. They disrupt the peace and happy living environment and mood. They bite and residents have a hard time getting rid of them.

The usual insect spray seems not to help. Burning treated mosquito coil also seem not to work. So at this present time, there is no cure from the menacing non-dengue mosquitoes.

10. Does fogging disrupt lives?

Yes, because the fogging team starts fogging at 6 pm. Most people work outside the home and only return home by 6 pm. They are often exhausted from their daily 8 am-5 pm weekday work. They just want to eat dinner and rest for the day. Fogging activities tend to disrupt their daily routine.

External fogging by the health authorities, 10 January 2016