Wednesday, January 30, 2008


“Someone about to graduate from his college course collapsed suddenly on the floor and just died. The mother was distraught with extreme pain and sadness.” “There were bleeding in all portals of exit in the 8 year old child's body”. “The family thought it was just one of those common flu…it was too late when the kid was rushed to the emergency”. “The infant succumbed helplessly to death…” “ I thought my child is already okay… I didn’t know he was bleeding internally even after the fever...his platelet has gone too low.” “ Mom, I feel dehydrated and weak with this back pain crippling me.” These were just but some of those I heard every so often the past weeks, either from the relatives’ stories themselves or 2nd hand anecdotal accounts of people close to them, with the last one I heard from my then febrile son. (Photo credits: BBC NEWS UK edition)

I failed terribly in my resolve. I vowed to myself that I will not ever write anything concerning this deadly mosquitoe-borne disease, Dengue. But the nagging feeling won't let up like a broken record playing in my head, disquieting my peace every time I hear horrid stories of children and even adults afflicted with this disease – you should have written something about dengue...let other people know… you should be one with the health professionals actively disseminating information…you should have written something about dengue….

Days passed and the familiar incessant hounding echoes, waging war against my mind and heart. I thought I should do it. Yet still, I am with reservations. Why, you may ask. As aforementioned, the last among the anecdotes above was my own son’s words to me before he was confined to the hospital. I? Moi, a health practitioner by profession, having a son afflicted with” this” dengue? It is with such distaste to my ego and to my recent vivid memory that my son was a victim of this horrible viral disease.

I also wasn’t able to attend our High School batch reunion since I was dead serious with my diligent monitoring of my son’s 2nd night of febrile condition when it was held. And NO, thank God he didn’t succumb to the nasty Dengue. But the thing is, with health in my book and blood (as my mom is an immaculately clean person and has passed on her characteristic insanity of vigorous and obsessive compulsive cleaning to me, lol), my son was still a hapless victim. NO ONE IS IMMUNE!

Luckily, my keen eyes, health background and strong gut prevailed and won over this health battle. Having a health conscious kid is a good thing as well. But, lo and behold, the fight and flight with dengue isn’t a walk in the park as it is filled with some grueling and nerve wracking waiting -and -number's -game days. The cause? The traumatizing routine blood tests that goes on ... and on ... with the much awaited results coming in every 12 panicky hours , heralding either a lower or a better platelet count. Goodness! TRUST ME. Sleeplessness fused with anticipation that goes steeper by the minute can kill.

Globally, there are an estimated 50 to 100 million cases of Dengue Fever (DF) and several hundred thousand cases of dengue hemorrhagic fever (DHF) per year”, according to the Division of Vector-Borne Infectious Diseases , CDC (Centers for Disease Control and Prevention). You can CLICK and view this DENGUE FACT SHEET by the CDC.

The CDC is an agency of the United States based in Georgia whose aim is to provide health information in order to protect the public’s health and safety. It also has affiliations with other CDC’s worldwide that help disseminate health updates, statistics and health decisions.

Dengue is endemic in over a 100 countries, with it’s stronghold on the SE Asia, The Americas and the Western Pacific .There are some fears that it might re surge it’s presence in the US and take a foothold on it one day.

NOTE: It has already reached the Texan border. We may also add that Katrina and Rita paved way for breeding grounds of these nasty critters. Click on THE LOS ANGELES TIMES
to read the full article about this growing fear in the US.

The European countries as well have their own version of CDC , the European Centre For Disease Prevention And Control (ECDC) in Stockholm, Sweden that publishes scientific journals in the form of the Eurosurveillance. This self-governing European scientific journals has a free access online and encourages subscription worldwide for authors and readers alike. It features articles concerning policies and guidelines on the prevention and spread of communicable diseases relevant to the European countries and furnishes reports on them weekly, monthly and quarterly as well. July 2007 - the journal Dengue worldwide: An Overview Of The Current Situation And The Implications For Europe was published. Surely, this is another site that will give a wealth of information within the health spectrum for the laymen and health practitioners alike.

The Philippines, unfortunately, is geographically plagued with mosquitoes. Here is an already pathetic state in terms of tropical and sub-tropical diseases and having a guild of perpetually feasting politicians in this country as the antithesis isn’t a help.

Dengue Fever's causative agent is a vector in the form of a female mosquito- more commonly, the female Aedes Aegypti - a low flying, day time biter. DF is prevalent in the tropics of Africa, South America particularly Brazil and Venezuela, the east Mediterranean, South East Asia- particularly Bangladesh, Taiwan, Thailand, Vietnam and sadly, the Philippines,my country and other countries in the Western Pacific. The Dengue virus is transmitted via a mosquitoe's bite to animals and humans alike, and fortunately, not transferable from person to person. Hold on before you do your somersaults though, as the dengue virus easily spreads nowadays with commercialization and global urbanization currently in the upswing. Moreover, with the insurgence of Global Warming, you now have the ideal requisites.

Now how is dengue exactly transmitted by the Aedes Aegypti?

The transmission cycle of the Dengue virus from the Aedes Aegypti mosquito starts with a dengue-infected person (Person 1) who has a circulating virus in his /her blood, a state called as viremia, usually lasting for 5 days. Once an uninfected Aedes Aegypti bites or feeds on the dengue-infected person, it now ingests the virus-contaminated blood from the person. This in turn paves way for the virus to replicate within the mosquito. Consequently, an unwilling human victim (person 2), when bitten by the infected Aedes Aegypti, is transmitted the fatal viral disease. A barrage of symptoms is produced thereafter, appearing in about 4-7 days as the virus replicates itself in the person's blood .

See the diagram below for a more detailed transmission of the disease cycle.

(1)The virus is introduced into humans with the mosquito’s saliva via it’s bite.

(2)The virus stays and spreads in various target organs e.g liver, lymph nodes

(3)The virus, once released from these tissues spreads in the white blood cells and other lymphatic tissues

(4)The virus then releases itself form the tissues and circulates in the blood

(5)A 2nd mosquito ingests the virus in it’s blood

(6)That 2nd mosquito is then inoculated with the virus and therby affecting it’s salivary glands

(7)The virus replicates in the salivary glands and when this mosquito bites on an unwilling victim ,the cycle continues , VICOUS!


CLICK on the maps to get a
closer look where there are
Dengue occurrences and
recent Dengue activity.

Photo credits: Justin Nikolai Rey

The growing number of reported dengue cases as per
the National Center for Disease Prevention and Control is not something to be taken as one of the Philippine’s pride. Now that is blatant admission, I know, but at the same time, something that the Philippine government should address forthright. To mince words would be akin to travel agencies that either fail and disillusion their clients with the usual perks offered just to lure people to book their travel with them, most of which info-unupdated and or worse, just don't give nary a thought in offering health and safety advisories to would-be travelers to our country.

For those of you who frequently travel around the globe, the new CDC Health Information for International Travel 2008, more popularly known as “The Yellow Book “, is now available. I do recommend this as they are informative and updated. CLICK THIS to find out relevant health information of a destination of your choice.

I was able to read a past issue of this somewhere and I was not disappointed. This health travel book, coming up every 2 years, is brimming with basic guidelines and knowledge for every disease endemic, epidemic and sporadically outbreaking in every part of the world. Among which that frequent globe trotters will definitely find useful are the general recommendations for vaccinations and immuno prophylaxis, seeking health care abroad, a geographic distribution of potential health hazards worldwide, prevention of specific diseases and even non infectious risks during travel such as jet lag, motion sickness, sunburn and the like. There are also chapters describing about specific special needs of each traveler like those who have infants and children and even travel advisories to frequent immigrants returning home to visit friends and relatives.

All these with the latter as one of the most important guidelines, I believe, that the WHO (World Health Organization) must tackle seriously. Oh heck, before anyone of you conjure up thoughts that I get a percentage of the sales, noooo. This is gratis advertisement, hey.=) But how I wish, lol.

I also think that the Philippine government lacks an earnest, cohesive and robust campaign drive to eliminate it, if there is any at all. Oh there I go with my lamentations.

My humble suggestions are the following:

#1 FREE CBC COUNT to febrile and suspiciously dengue harboring individuals/locals of municipalities with known endemic dengue activity.
#2 NO TO FOGGING (a grandstanding political act for those wanting to maintain political seats and seeking positions). NOTE: FOGGING must not be the core of Dengue elimination programs as this is just effective for the large mosquitoes and not the eggs. Also, this in turn makes the mosquitoes
more resistant to known chemicals they were previously exposed to and just transfer places.
#3 INTENSE CONCERTED EFFORTS to eradicate dengue.

For last year, it was a whooping 45,350 dengue cases scattered all over the Philippine islands with 416 total deaths. The DOH (Department Of Health-Philippines) has identified hot spots and these are in Metro Manila, Central Luzon and Central Visayas. Quezon City, Manila and Caloocan are on the rise as per DOH ‘s advisory as well. WHOA! I never thought it IS that big! I was taken aback with the figures knowing and considering that these were just the reported ones. Sweet Jesus! “Is this how plagued we are?”, I asked myself. Last year, even up to December, we have had rain showers that have surely added to the escalating number of cases. Add to it the presence of Global Warming for which I am cocksure sending forth these mean flying creatures away from their natural habitat making them highly urbanized killers as well.

These pesky little vampires will leave you a worry wart, having 2 biting activities in a day. They bite preferably after daybreak and in the afternoon at around 4-6 pm, you probably would have been bitten by these mosquitoes for its dinner before you are even able to take your own! The dusk and dawn female bite queen, Aedes Aegypti, isn’t just a cyclical vicious arthropod but a perennial one too, only growing in numbers when the monsoon hits the calendar. Hence, misunderstood as seasonal. With stagnant water pooling in the street gutters, house roofs, old (and even new) rubber tyres, flower pots,etc -they breed and ergo, proliferate.

Given the right conditions, they will thrive. Aedes Aegypti, our culprit bitewhore knows it’s simple math: WATER (in the form of floods, rains and any stagnation) + TROPICAL LOCATION + HIGH POPULATION = EPIDEMIC. The conditions are just set. What a perfect brew.

Among the overwhelming salvo of signs and symptoms of dengue are a moderate to high fever, severe headache, retro orbital pain (pain behind the eyes), severe muscle aches (myalgia) and break bone pain (arthralgia) , back pain, rashes and a body malaise (body weakness) that leaves you sapped out from your natural verve and deprive you of your appetite. Dehydration is also an effect of the infection. Most of which are disease manifestations that range from that of the common flu, a reason enough for unrecorded cases of dengue and for poor prognosis, and if unattended, will result to hemorrhage and shock. Rashes usually appear on the 3rd day after the person has had fever. These rashes also appear just when fever has subsided or is about to abate. Blood shot eyes may also be noticed.

Moreover, the common maxim “All for one and one for all” doesn’t bear true witness to Dengue infections. Dengue has 4 serotypes or viral strains and getting infected from a particular strain won’t give you cross-immunity to the other 3 left. It should be more like “Once bitten, twice shy” as vaccine development are still underway and hopefully, be available in the next 5- 10 years. Too long a wait, actually.


> At the earliest sign of a high fever that doesn’t abate in 3 days, suspect Dengue when you are unfortunately residing in places with known dengue activity. Always remember that living in a tropical country with a conducive environment and weather that makes you prone to such disease must be your rule of thumb to rule Dengue out as the fever’s cause. Be assertive and have your family member or yourself checked for a CBC (Complete Blood Count). The WBC (White Blood Cell) count is lower than normal, a sign of a viral infection in comparison to a bacterial one with an increased WBC count. Platelet may STILL be normal at this stage since the fever is still present but once the fever subsides, if this is dengue, expect a significant drop as this is the time the virus is already targeting the organs in the body including the largest organ, your liver! Aww.

> When the "suspicious" fever suddenly subsides ,and you are still not aware if Dengue is the case, observe better. Take note that this is not something to be ecstatic about because if dengue is certain, this is just the start of a dengue-infected person’s bleeding precaution phase. Ask for a repeat CBC and check your platelet count AGAIN. ASAP! This is the time when the platelet (coagulating factor in the blood) goes down to a significant level, say from a 218,000 to a low of 165,000 of which the normal range is between 150,000- 350,000 thereby leaving the person prone to bleeding. This is the tricky phase when you would have thought that just because the fever abates you on probably the 3rd to 4th day, you are well on your way to progress. Heed me. If this is Dengue Fever you have, you will just experience some sort of a resting phase from the fever, yet progressing to a more fatal stage - the Dengue Hemorrhagic Fever. Ultimately, in severe blood loss, Dengue Shock Syndrome ensues thereby leading to death. This is how sly Dengue could be in terms of it’s seeming likeness with the influenza or the common flu. Watch out for any signs of bleeding including bruises which may go unnoticed.

Since Dengue Fever is viral in nature, only supportive therapy is acquired. Rest and plenty of fluids are the tall orders for a dengue patient’s day. As it is, we are all awaiting for that miraculous manna from science laboratories that can, in the world’s hopes, significantly reduce or better, totally eradicate this dreadful virus in the form of vaccines. Paracetamol for fever (not the aspirins as they predispose you more to bleeding and is responsible for the Reye’s syndrome) are given. IV fluids are of course given to prevent further dehydration and to help wash away the toxins. Of course, you have your bleeding precautionary measures as the doctor orders for PT and PTT , both of which give you an idea how long a person’s blood will coagulate. If longer, then the patient is predisposed more to bleeding. A clean environment free from breeding ground tendencies is surely a big help .

DISCLAIMER : These are all from another health practitioner’s own point of view (that’s moi). Still, it is best to always consult a doctor -- not the hit-and- miss (oh there are several) ones but those who have forecast and have a wider range of experience and not just in it for the money. You get the picture, alright.

Prevention is by and large the heart of elimination. We are mostly aware of the usual preventive practices against Dengue but I hope the readers out there will still find these tips beneficial:

#1 Wear brighter/lighter colors (neon and sunnier colors ) when traveling to places with known dengue activities. Mosquitoes love damp and dark places, including dark clothing. Of course, do not forget to apply lotion (OFF or any brand) with DEET protection. Have observed in several instances outdoors that they stayed away from me and practically FLED from me when I sported a new skin - an OFF-lotioned skin, that is :D

#2 Mosquitoes have a poor eye sight as per my research. They can’t see you until they are at least 30 feet (10meters) away. And even as they do, they have trouble distinguishing you from the rest of the objects they see. However, they can smell you from a good 10 feet (3 meters) away. They do have sensitive thermal receptors at their antenna’s tip used in locating blood near the skin’s surface. This sensitivity is magnified threefold with a higher humidity. You are therefore a prime target as you exude those sweat. Some odorous chemicals as by-products of our sweating are just attractive to mosquitoes, lactic acid is one. Coming home with a sweaty shirt? Immediately change to ward off mosquitoes.

#3 Most mosquitoes stay within a 1 mile radius (1609.34 meters; 5 279.9 feet or 1.609 344 kilometer,take your pick- lol) of their breeding site. Might as well gather and bring some neighbors along to investigate, locate and decimate the breeding site.

My son is used to drinking 3-3.5 L of water per day, have trained him to do so, I also do, as our body needs these fluids to catch up with the sensible (our excretory functions producing our urine, feces and sweat and even the air we expel from respiration constitutes this) and insensible losses (eg. during sickness) it undergoes daily. His diligent and habitual water drinking has surely helped his body hydrated during his confinement. Gosh, he was even drinking at least a gallon (1 gal= 4 liters) a day on his dengue-sick days!

His doctor commended his water obsession, ha-ha, as a major attribute for his speedy recovery. His platelets never went down lower than a 100,000, and although initially, there were periods of a downward trend , it has wonderfully climbed up and settled within normal range during his recovery period. Adequate rest is a must too. No rough play until such time that his liver has shrunk. Remember that the liver is one of the target organs of the Dengue virus. No coloured foods too as this may mask bleeding until the patient has fully recovered. I would recommend to use a soft bristled toothbrush (or cotton) to clean the teeth as they assure you of not hurting a possible bleeding gum (evident during DHF).

A total of 4 non-slumberous days confined in the hospital and a good 2 weeks of convalescence at home was what my son had. In severe cases when Dengue Fever has progressed to DHF, hospital confinement will of course be longer as well as the recovery days.

Dengue is indeed becoming a growing menace worldwide. Nevertheless, DO keep in mind that prognosis is very good with early hospitalization and aggressive treatment.