Disease varies in severity
- Incubation period is 2-7 days.
- All haemorrhagic fever syndromes begin with abrupt onset of fever (39.5–41ºC) and myalgia.
- Fever is often biphasic with two peaks.
- Fever is associated with frontal or retro-orbital headache lasting 1–7 days, accompanied by generalised macular, blanching rash.
- Initial rash usually fades after 1–2 days.
- Symptoms regress for a day or two then rash reappears in maculopapular, morbilliform pattern, sparing palms and soles of feet. Fever recurs but not as high. There may be desquamation.
- DF cases experience severe bony and myalgic pain in legs, joints and lower back which may last for weeks (hence breakbone fever).
- Nausea, vomiting, cutaneous hyperaesthesia, taste disturbance and anorexia are common.
- Abdominal pain may occur and if severe suggests DHF pattern.The signs of dengue fever/ Dengue haemorrhagic fever are- High fever, rash, hypotension and narrow pulse pressure, poor capillary refill.
- There may be hepatomegaly and lymphadenopathy.
- A tourniquet placed on an arm may induce petechiae in early DHF cases. DHF sufferers exhibit a bleeding tendency as evidenced by petechiae, purpura, epistaxis, gum bleeding, GI haemorrhage and menorrhagia. There may be pleural effusion, ascites and pericarditis due to plasma leakage.
- Petechiae are best visualised in the axillae.
- Flushing of head and neck.
- Tender muscles on palpation.
- Periorbital oedema and proteinuria may be present.
- Maculopathy and retinal haemorrhages may also occur.
- DSS pattern cases progress through DHF until profound shock due to severe hypotension is present.
- CNS involvement e.g. encephalopathy, coma, convulsions.
Public cooperation vital to combat menace – Dr Palihawadane
By Fathima Razik
The problem of combating the dengue virus needs the cooperation of all concerned, the Director of the Epidemiological Unit of the Ministry of Health, Dr Paba Palihawadane said, and added there is a downward trend at present compared to the month of June when the issue peaked, and compared it to the situation in 2009 when the highest number of cases was reported.
Commenting on obtaining data on the number of cases, Dr Palihawadane said that every base, general, teaching and district hospital provides the number of patients admitted. She said the smaller hospitals refer patients to bigger hospitals where all the facilities to treat such patients are available. “From 300-400 cases per week before, the numbers rose to 1500-2000 per week in June. At present, the numbers have come down to about 1000 cases per week. We see the decline in numbers due to the stringent measures we have taken to step the spread of the virus by educating the general public as well as conducting house to house campaigns to detect possible breeding sites. Our dengue eradicating programmes have been successful,” she said.
Commenting on the issue further, Dr Palihawadane said the Western Province has reported the highest number of cases – as much as 60 percent of the total number of cases, 20421 reported with 452 deaths (both children and adults) as at 14 July.
On being questioned on the use of BTI to combat the aedes mosquito that spreads the disease, which reportedly has not been used while allegations have been levelled that a stock of the chemical that was imported still remains, she said the entire stock of BTI imported had been used at the time while subsequently, it had been patented by the Industrial Technology Institute (ITI) and produced locally in liquid form.
“We have also imported some dunks that are put into stagnant water to destroy the larvae. Our campaign carried out from 20 – 22 June in conjunction with the tri-forces, police, special task force and students following health courses when 105879 houses were visited, had 2760 places with positive breeding sites. In the next campaign from 8 – 10 July, railway yards and platforms were targetted. Both campaigns were successful.
We deployed around 1200 teams comprising three to five persons in each, who from 8.00 am to 4.00 pm went from house to house as well as private factories and institutions to check for possible mosquito breeding sites. Legal action has been initiated against those premises that had such sites. We are also checking on abandoned building sites,” Dr Palihawadane explained.
Speaking of the next stage of the campaign held on July 18, where the focus was on government schools, bus depots and places of religious worship, she said despite the efforts made by the relevant authorities, the general public has to be vigilant in their own homes and places of work. “They should not be complacent and should not neglect to keep their premises free from mosquito breeding sites. Our weather patterns are erratic and with every shower of rain, we need to check our garden and surrounding areas to ensure that no water stagnates. Being constantly vigil in this regard will help towards eradicating the dengue mosquito,” she declared.
Dengue peaks twice a year – CMO
The Chief Medical Officer of Health of the Colombo Municipal Council (CMC), Dr Ruwan Wijayamuni, said that epidemiological data collated from 2009 – 2014 shows two peaks of the outbreak of dengue every year – between June/July and November/December. This year Sri Lanka posted the highest number of cases compared to last year and beginning June, there had been a 55 percent increase of suspected cases of Dengue in Colombo. However, the figure had come down to 40 percent by the latter part of June, he further said.
“We have been concentrating on the areas where there have been high numbers. Of the 47 Municipal wards, 21 are deemed to be high risk areas. Some of them are Mattakuliya, Modera and Mahawatte in Colombo North, Grandpass, Maligawatte, Gintupitiya and Maradana in Colombo Central, Dematagoda and Cinnamon Gardens under Borella, Narahenpita, Thimbirigasyaya, Kirula Ward, Kirulapona and Pamankade in Colombo East and Wellawatte North in Colombo West. Due to the scattered rains we experience, we expect more cases to emerge,” he said.
According to their records, there had been 240 suspected cases from July 1 – 14 while there had been 227 cases reported during the corresponding period last year. Dr Wijayamuni said the CMC is taking rigorous measures to control the spread of the virus by going house to house in high risk areas and fogging within the homes. “This measure is very effective as female mosquitoes that lie in dark areas get killed while it also destroys cockroaches. Paediatricians say dried urine and faeces of cockroaches bring on childhood asthma. In contrast, outdoor fogging has only a repellent effect and mosquitoes can fly away or even develop a resistance to the same,” he said.
Responding to a question on blocked drains, the chief medical officer of health said the engineers of the council have drawn up a plan to clear the drains that are clogged in the next two weeks and added that there are also technical problems to deal with – for example, some of the smaller drains do not flow into the larger drains due to the uneven gradient, and such issues need to be dealt with accordingly. In the same vein, he said action is being taken against owners of premises who have permanent breeding sites such as half built houses and buildings and where there is a slab built over a floor that is open to the sky as water can stagnate after a shower of rain.
Commenting on the issue of the efficacy of BTI, he said the CMC had received 10000 BTI dunks from the Ministry of Health while the council too had bought around 15000 dunks that had been imported into the country from the USA. “These dunks have a shelf life of three years and are very effective when dropped into stagnant water. Each weighs 13 gm and would suffice to destroy larvae in an area of 100 sq ft. They generally last for about one month with a peak performance for two weeks after which the effect tends to reduce. The mosquito larvae feed on the dunks and then die. Thus, these are more effective in terms of cost and application – we need much manpower to spray the BTI but the dunks can be easily dropped into water,” Dr Wijayamuni said.
He also said in response to a query that ideally they would need around 40000 dunks to carry out a wholly comprehensive programme and added the council is working towards obtaining the required quantity.
Decline in number of patients– Director, LRH
As at 16 July, the number of dengue patients admitted to the Lady Ridgeway Hospital (LRH), Colombo was 28 with eight patients being diagnosed as having Dengue Haemorrhagic Fever (DHF), the Director of the hospital, Dr Linton Padmasiri said.
On being questioned on the number of deaths, he said that from January 1 to date, there had been five deaths. He explained that patients who seek treatment are kept in a Fever Observation Room where they are monitored and tests are conducted. Those who live in and around Colombo are sent back home and asked to return on a given date unless their condition needs further investigations – in which case they are admitted to the hospital. From January 1 to date, five patients had died due to Dengue at the LRH – three in January and two other patients in the following months.
“LRH has five paediatric medical wards of which three are dedicated as Dengue High Dependency Units. These units provide special care and treatment for patients diagnosed with DHF,” Dr Padmasiri said. “Fewer patients have sought treatment in the last few days and we attribute the decline in numbers to the campaigns carried out by the Dengue Control Programme in June and subsequently in July. Most of the patients are from Colombo and also from Wattala and Kelaniya,” he said. The change in the weather needs to be noted – the sporadic rains that we experience are periods to watch out for, he cautioned. The Presidential Task Force has advised all institutions, schools and other offices to have their own Dengue Control Committees to monitor and ensure that all breeding sites are destroyed to further enhance the measures taken by the health authorities, Dr Padmasiri added.
*As at 18 July 2014, the number of cases island wide has gone up to 21,988, posting an increase of 1,567 cases compared to the number recorded at July 4, 2014, according to the Epidemiological Unit of the Ministry of Health.
Clean up railway yards – ACREGU urges
Refuting the claim that action is being taken to stem the spread of dengue, the General Secretary of the All Ceylon Railway Engineers General Union (ACREGU), S.T. Vithanage, lamented that the railway yards in Dematagoda, Maligawatte, Maradana and the workshop in Ratmalana have possible dengue mosquito breeding sites which the relevant authorities have failed to check. He urged that steps be taken to clean the yards and the workshop which in his view are probable areas where the mosquitoes are bound to breed.
“The railway authorities should take measures to stem the proliferation of mosquitoes and ensure the safety of the railway workers as well as the general public. Many workers at the Ratmalana workshop were affected by the disease and had sought treatment at the Colombo South Teaching Hospital. Some had to be admitted as well. There is water stagnating in little pools but no one seems to care,” he alleged.
It’s Showtime! Dengue, Kangaroos And ‘Mee Harak’
By Faraz Shauketaly
Some events, like the birth of the children, will forever be etched in memory, Sigiriya-rock like. The visit of some five persons to my residence in Mount Lavinia claiming to be from the ‘PHI’ will also be forever etched in the part of my memory that records vexatious, unfair, arrogant events in order that I am ‘future-proofed’ or as the older saying goes, ‘once bitten twice shy’. Except I hope that it is not the dengue mossie that has done the biting.
Monday mornings are always frantic. There is something called an Editorial that’s always on and for which one is simply commanded to be on time. The fallout of not attending without valid reason is almost sacrilege. When that Monday is combined with the unauthorized leave of absence on the part of the long-serving but not long-suffering House Management Operative (Housekeeper in years gone by) who has, as usual mistaken four days’ leave for 23 days, chaos usually reigns and pours too on any given Monday.
It is within this ambiance of chaos that the combined barks of Bailey, Max and Panda alerted me to someone other than a visitor from Tangalle, was at the gate. The gate being of the open-it-yourself variety, was duly opened and there appeared to me a group of five persons in my garden. Something was said in ‘squiggle’ (Sinhalese) and then explained simply as “apiPHI’ken – we are from the PHI” – resulted in me launching into an explanation that the House Management Operative was not available, that the junior domestic had gone to the shops and no, the visitor from Tangalle was not party to any event at OBH no matter the circumstances.
In the meantime this group of five – in retrospect possibly an unlawful assembly – proceeded to ‘inspect’ my garden. Bonanza! Was soon found: an upturned bucket that had a few milimetres of water collected around the rim of the upturned bucket. And the plastic sheet that was covering the sand being used by the builders for the new extension, also apparently had enough water to provide a breeding ground for the dreaded mossies. I had only the word of the group of 5 who in my mind qualified to be called a group of ‘unlawful assemblers’.
There was no attempt to at all to show me the offending items. There was no camera to record the evidence, no pots or containers to collect the evidence. Perhaps there were none of these because it is possible that there was no evidence to collect. Who knows? The PHI jobsworth leader claimed to know. And that apparently was that: arbitrary decisions leading me to believe that this was a target-orientated, PR exercise of unusual proportions that seemed to ignore the basics of law.
As they were examining the premises, the rain gods decided to open up and the human in my being, asked this group of unlawful assemblers to come upstairs and sit down whilst I finished preening and printing.
The PHI wanted my ID. I told them that I was not the Chief Occupant and that the person responsible for dealing with these matters was not in. But they insisted: “we want someone’s ID”. Oh Great, here was a Kangaroo court in the making. So I gave them mine and they proffered up a very poorly photocopied single A4-sized piece of paper. It was utterly illegible so I asked the Jobsworth Leader what this was. “A bond” he said, “you must sign a Bond”. OK I thought, lets get them out of the way so I signed. In doing so I noticed a figure of Rs. 25,000. “What’s this 25,000?” I asked. “That’s the fine,” came the response. “You didn’t tell me that,” I retorted. “Well you will need to come to Mount Lavinia Court on Friday.” He repeated this four times. “Where’s my notification or my copy of what you have asked me to sign or any paperwork,” I asked again and again. His response encompassed and captured for me the spirit of impunity that is so very evident in this land: “Even if you ask the Secretary you will not get a copy or any notice. You come to Court or else there will be a warrant and you will face arrest”.
“So you want me to turn up on your say so, you have not identified yourself and so you expect me to turn up and look up, do you?” I reminded him that for any other matter – like a traffic offence, or a request to come to the Police station or attend Court, was always accompanied by some notification. To no avail, he was stuck in his moment of glory. I did what I ought to have done moments earlier: I asked him to get out of my sight if he had finished with his official business, and to close the gate after him.
He left but not before telling me that he ought to have arrested me instead. That’s rich for a motley crew who came in dressed as any civilian would, did not offer any ID, was not in uniform – although he was in uniform in Court on the Friday. Like a cat on a hot tin roof I thought to myself.
There were nine others on the Friday. The fine was shouted at and it was a good thing that I had two friends plus the services of a lawyer. Because, had I been on my own I would have found it difficult to pay the fine as one is not allowed to leave the Court until the fine is paid and the receipt is produced. Provided of course you had the sense to work out that if the bond was Rs 25,000 the fine would be no higher. Then again I don’t know that – because there was no notice given to me. It was a case of ‘in the PHI you Trust’ – rather like the USA where it is ‘In God We Trust’.
The moral: Mosquito lava or not, dengue proved or not, just do what you are told, arm yourself with loads of cash, a friend with nothing else to do that day and turn up. Pay up and shut up. In essence, just be a ‘meeharaka’. That would do nicely, thank you!