‘No need to push the panic button yet’


The dengue epidemic is a wake up call for the country but there is no need to panic yet, said speakers at a seminar on Wednesday.
They also pointed out that many doctors and paramedics in the country are exposed to dengue infection as most of hospitals and laboratories do not follow bio-safety guidelines.
The seminar was organised by the Central Laboratory of the Civil Hospital and the Pakistan Society of Microbiology.
University of Karachi’s Department of Microbiology head Prof Shahana Urooj Kazmi, haematologist from Liaquat National Hospital Dr Mohammad Irfan, entomologist from the University of Karachi Dr Imtiaz Ahmed and Dow University of Health Sciences’ Dr
Farhan Essa gave their presentations on the occasion.
Dr Shahana Urooj Kazmi, who is also the pro-vice chancellor of the University of Karachi, said that more than 100 countries in the world are fighting to eradicate the dengue infection.
“It (dengue infection] has emerged as a global problem that is also surmountable as even a small country like Cuba has almost eradicated dengue,” said the senior researcher.
“Instead of creating panic, all stakeholders [in Pakistan] should contribute to develop an effective strategy to help and manage patients.”
Prof Kazmi recommended setting up of a surveillance and research centre for dengue and other vector-borne disease that should work in coordination with district health units to forewarn the coming epidemics.
“The dengue epidemic is a wake up call for keeping vector-borne diseases in check,” the microbiologist added.
“Controlling vector-borne diseases including dengue fever, Congo fever, malaria and yellow fever requires year-round surveillance and research by a multi-disciplinary team of experts. This team must include doctors, microbiologist, virologists, molecular biologists, entomologists and epidemiologists.”
Prof Kazmi said that the team, with the support of mobile diagnostic labs, can help prepare for disease outbreaks, reduce vector proliferation sites by community participation and disseminate information to control the infection before it assumes epidemic forms.
Dr Irfan Ahmed during his presentation “Management of Dengue: Realities and Myths” said that dengue is preventable and there is no need to panic.
“It [dengue fever] has a mortality rate of only less than 1 percent. As such, there is no cause for panic,” he added.
He proved his point by sharing the current epidemic statistics and said that there were 160 deaths in Lahore against 13,000 reported cases – equivalent to 1.2 percent.
As for Karachi, he said there were six deaths out of 459 confirmed cases reported to different cells in 2011, bringing the percentage to 1.3 percent, compared to 25 deaths against 4,012 cases (0.6 percent) in 2010 in the city.
The haematologist talked about standardised treatment to reduce mortality, psychological trauma, unnecessary transfusions and cost and pressure of admissions in the hospital.
“Seventy percent of patients have simple dengue fever that can be managed at home,” he added.
“Dehydration is the main cause of complications among patients and not necessarily low platelets or signs of circulatory failure. Seventy percent of patients do not even bleed.”
The haematologist said bleeding occurs in 30 percent cases and from 20 to 25 percent of these patients have mild bleeding, three to five percent suffer moderate bleeding while life-threatening bleeding occurs only in less than one percent cases.
“Platelets are given only when signs of bleeding are there, otherwise patients with between 30,000 and 50,000 platelets count with no sign of bleeding do not require platelet transfusion. Fever is there for two to seven days, however, the actual problem starts on seventh, eighth or ninth days.”
Dr Ahmed urged patients and their caretakers to ensure maximum consumption of fluids as juices, ORS and lemonade that could be prepared at home.
The haematologist agreed with other speakers that “molecular tests” are helpful in early diagnosis, however, he pointed out that it is very costly and available only at a few hospitals.
He advised physicians to give reassurance and confidence to the patient and his family and spend some time with them.
The haematologist said in most categorical terms that there was no role of antibiotics while dealing with dengue cases.
Dr Farhan Essa, assistant professor at the DUHS, in his presentation “Laboratory-Based Diagnosis of Dengue” referred to rapid immunochromatographic tests in which results are available within hours.
The pathologist said that the enzyme-linked immunosorbent assay (ELISA) technique is more reliable, however, the tests are run in batches and so the results do get delayed.
He said that attention must be focused on prevention and suggested setting up of a centre for disease control with branches in all major cities.
“The centre is equally relevant for proper control of infectious diseases like swine flu, Congo fever and dengue fever,” he added.
Replying to question raised by a participant of the programme, he said platelets count is not dengue specific and can be low in other conditions also.
Entomologist Dr Imtiaz Ahmed discussed in detail the role of vector Aedes aegypti, its lifecycle and the strategies to control the breeding grounds for mosquitoes causing and transferring infection to healthy individuals.
Later, responding to queries raised during the programme, the speakers said natural disasters like earthquake, floods and devastating rains caused by climatic changes have served as a wake up call for the nation.