The efficiency of the NS1 test as the criterion to confirm dengue in a patient is still being debated upon when the Punjab Health Department in a novel attempt at evading criticism and hiding facts about a probable dengue outbreak in the coming months, have not even provided the district hospitals across Punjab the kits required for conducting the prescribed NS1 test, putting the lives of an entire population at risk, Pakistan Today has learnt.
According to details, Punjab Chief Minister Shahbaz Sharif formed a dengue control group with several eminent professors on board. The board, under the chairmanship of Services Institute of Medical Sciences (SIMS) Principal Professor Faisal Masud was charged with handling the epidemic and to propose recommendations for better management of the disease and its patients. The professors recommended that the NS1 test should be the criterion to confirm the presence of the dengue virus in a patient, instead of the traditionally used Eliza-based IgM and IgG tests. Moreover, the entire district and provincial bureaucracy was motivated to act to cope with the unprecedented dengue epidemic last year.
However, there has been a debate among medical experts about the efficiency of the NS1 test compared with IgM and IgG tests which they maintain are more efficient ways of confirming dengue in a patient.
The World Health Organisation prepared a scientific Working Group Report on Dengue to review the diagnostic tools available. According to the report, the NS1 test can detect the virus only until the fifth day of fever, while after the fifth day; the Immunoglobulin M is the first antibody to appear in the body, whereas IgG is detectable after the eighth day. Medical experts say that most patients visit the hospital after suffering from fever for more than five days and hence the criterion of using the NS1 to confirm dengue in a patient is ‘inadequate’.
However, sources in the health department revealed that the debate about the efficiency of the NS1 test becomes irrelevant because the district health establishments lack the kits required to conduct NS1 tests.
“Even if it is accepted that the NS1 test is the right way of diagnosing dengue in a patient, the hospitals should be provided the kits to conduct these tests, otherwise the doctors are left with no option but to rely on personal opinion,” the source said, adding that the cost of one kit, which is used for around 96 tests is Rs 12,000, while the price varies from brand to brand.
Sources also said last year the dengue epidemic spread throughout the province, with the largest number of cases reported from Lahore, while other districts with a high concentration of dengue patients included Faisalabad, Gujranwala, Pakpattan, Sheikhupura, Okara and Khanewal. This year, so far two cases have been reported from Bahawalpur.
Moreover, the sources revealed that the health department has not purchased the kits for the NS1 tests for district hospitals at all. “It is obvious that when the hospitals do not have the NS1 kits to perform tests, no dengue patients will be reported and the health department will not have to face criticism. But the people will continue to suffer,” they added.
Professor Faisal Masud however maintained that the IgG will remain positive for six months in a patient, so the NS1 test has been prescribed. He further said the IgM and IgG tests are the third and last option. When asked about why the kits have not been provided to hospitals, he said, “I am a scientist and can only give recommendations. It is up to the health department and its secretary to procure the kits and to make them available.”
Health Secretary Captain (r) Arif Nadeem said Eliza kits are available in all the district hospitals, but that he would have to confirm if the NS1 test kits were available or not. He added that dengue can be diagnosed form other symptoms as well and that no dengue cases have been reported yet. In response to a question, he said the Health secretary alone is not responsible for procuring the kits and that the autonomous medical institutions must purchase them too as they were financially strong.
