A new buzz for Dengue

The rainy season appears to have arrived early this year and Dr Methipot Chatameteekul, director of the Bangkok Metropolitan Administration’s Communicable Disease Control Division admits to being worried. Rain can increase the risks of an epidemic of the Dengue Haemorrhagic Fever (DHF) virus and even though the public has learnt that a “common” fever can lead to death, as occurred in the case of TV actor Trisdee “Por” Sahawong last year, there is still a need to raise awareness about dengue fever. 
Dr Methipot is also worried that the number of cases will be higher than last year. “The disease goes in a cycle with major outbreaks occurring every two or three years. In 2015, we saw 50 new patients every day in each district. I am concerned that we will see a severe outbreak but hope it won’t be as severe as that of 2015,” he says. 

The most recent report by the Public Health Ministry’s Department of Disease Control reports that as of May 9, 9,717 cases had been registered and 14 individuals had died. 
The latest campaign organised by the BMA last weekend adopted a new approach to awareness raising. Rather than handing out leaflets and conducting a massive fumigation programme, the Administration organised three days of activities at CentralWorld on the theme “Fighting against Dengue”. They included illustrating dengue fever through art, workshops and interactive activities, allowing people to have fun while learning and also listen to celebrities who have experience with the virus. 
“We are still conducting the other campaign but this year we wanted to try a new approach. Talking about disease or infection is often too rooted in scientific knowledge, so integrating art and entertainment should reach a wider public,” Dr Methipot says.
One of the celebrities sharing her experience was Por’s widow, Vanda.
“I was like everyone else when he developed a fever, thinking that it was just a fever and he would recover in days. I was completely wrong. I hope everyone realises just how dangerous this disease is because once it takes hold, it will inevitably affect our lives and our families forever. I don’t want any family to face a tragic loss. If only we learn how deadly the fever can be and learning to protect ourselves, our families will not be at risk. Don’t think ‘it won’t happen to me’; we all face the same risk. You can prevent yourself by cleaning your house, getting rid of still water and avoiding being bitten by mosquitoes,” says Vanda.
Por was infected with dengue virus and in a critical condition for more than two months. The doctors tried to stem the infection by amputating his foot but he finally succumbed to the disease in January last year.
The best prevention is simple: don’t let yourself get bitten by mosquitoes. But that’s not easy in a country where mosquitoes are everywhere. The mosquito lives in urban habitats and breeds mostly in man-made containers filled with still waters. It’s important to empty water from places where mosquitoes breed such as unused utensils, trash cans and flower pots. Other preventive measures include wearing long pants and long-sleeve shirts or using a mosquito repellent containing DEET when visiting places where dengue is endemic. Avoid areas with standing water and stay indoors in the morning until two hours after sunrise and at sunset to further reduce your risk of being bitten.
Dr Methipot notes that in residential areas where trees surround the houses, water is commonly found in flower pot saucers and it is here that mosquitoes love to breed.
The residents usually have maids taking care of the house, many of them migrant workers who have even less knowledge than the house owner.
Dengue fever was first identified in Thailand more than 50 years ago, first in Bangkok before spreading throughout the country. In the last 50 years, dengue has become endemic in 128 countries that are home to some 4 billion people About 75 per cent of the infection occurs in Asia, and most of it in Southeast Asia. According to WHO, more than 740 people around the world are infected by dengue every minute.
Professor Usa Thisyakorn, professor of paediatrics at Chulalongkorn University and the president of the Asian Society for Paediatric Infectious Diseases, says that in the early years, dengue fever mainly affected children. Today it is attacking people of ages.
Dengue virus is transmitted by female mosquitoes mainly of the Aedes aegypti species, better known in Thai as yung laai. They are most active in the daytime.
Dengue is widespread throughout the tropics, with variations in risk influenced by rainfall, temperature and unplanned rapid urbanisation. According to Dr Methipot, the epidemic in Bangkok tends to soar from August to October. The latest severe epidemic was 2015 where Thailand reported 142,925 cases and 104 deaths. 
Symptoms starts with a high fever (about 40 degrees C) that persists for two to seven days and is accompanied by any two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands or rash. There is no specific treatment for dengue fever. Treatment is directed at relieving signs and symptoms.
The dengue fever vaccine was approved by the Thai Food and Drugs Administration late last year and is now available at selected hospitals. However, it is out of reach for many Thais as the cost is more than Bt10,000 for the three injections. Efficacy is around 65.6 per cent and is most viable for those aged nine to 45 years.
Dr Usa says that the age range is based on efficacy studies and that some countries are recommending the vaccine for people up to 65 years.
She cites as an example the tuberculosis vaccine, Bacillus Calmette–Guerin (BCG). It has been used for decades and even though its efficacy is only 50 per cent effective, it’s still worth using. 
The new vaccine is expected to protect against the four dengue strains found in Thailand, but Dr Methipot fears that it will almost inevitably make people careless. 
“There will be people who think that now that there is a dengue fever vaccine, there’s no need to worry and take preventive measures. They don’t even go to get the vaccination so activities to raise awareness are still very much needed,” says Dr Methipot.