Sri Lanka: 2009 Dengue- 33,081 cases; 334 deaths

[Gert van der Hoek]

Colombo fast becoming a sick city: CMC medical chief

By Yohan Perera

Colombo will soon become a city of the sick if a proper township development plan is not implemented immediately, the Colombo Municipality?s Chief Medical Officer Pradeep Kariyawasam warned yesterday.

Dr. Kariyawasam told a news conference that the increasing number of buildings and the population in the city would result in various health problems among the city dwellers. He explained the increasing number of houses and other buildings built on filled land had prevented the outflow of water from the city. In addition building houses along the marine drive was preventing fresh air reaching the people, Dr. Kariyawasam said.


Coming up with more shocking details he said the sewerage system which was meant for a population of 200,000 was now being used by a staggering 700,000 people in the city causing many problems.

Dr. Kariyawasam said most of the drainage lines in the city were blocked and over flowing. In addition the number of gutters and water collecting places had increased with the growing population, he explained.

Dr. Kariyawasam saw the large number of empty lands in the city as another major problem. He said those empty lands had become ideal breeding grounds for mosquitoes. There are over 1000 such lands in the city, he said.


He pointed out all these conditions in the city would result in epidemics spreading in the city. ?Diseases such as dengue are correlated with township development and when it is not planned properly the city will end up with epidemics,? he added. Commending the CMC he said it had however been able to keep the spread of dengue to a low level although it had increased by 100% in the rest of the country. There was only a 10% increase of dengue in the Colombo city this year, he said.


Referring to the more recent spreading of chikungunya, Dr. Kariyawasam said there had been only 46 cases who sought hospital treatment in the city. It has been found that the dengue mosquito was not the only carrier of chikungunya. Others such as Acdes Egypti, Acades albopictus and Mansonia mosquitoes also carry the disease according to him. He also warned Sri Lanka was running the risk of a bout of yellow fever in the future.


Referring to the precautions that should be taken he said the most essential fact is the cooperation of the public and other organizations including that of the government.

http://www.dailymirror.lk/2006/12/29/front/5.asp

[Gert van der Hoek]

Sri Lanka: Dengue Control Week

April 23 to 28: Dengue Control Week

Nadira Gunatilleke

COLOMBO: The National Dengue control week organised by the Healthcare and Nutrition Ministry in collaboration with the National Dengue Control Unit and Tropical and Environment Diseases and Health Associates under the theme `Dengue is preventable? will be held from April 23 to 28.

The Dengue control week takes place in April and September annually, sources said. The ministry seeks public assistance to control dengue in the country. High risk areas are Colombo, Gampaha, Kalutara, Kandy, Kurunegala, Puttalam, Matara, Ratnapura and Kegalle districts.

About 50 per cent of dengue patients are reported from the Western Province and the main reason for the increase in mosquito breeding in this province is tyres and plastic containers, sources said.

?Dengue is completely preventable. There is no vaccine or specific treatment for dengue. The best solution is controlling mosquitos and reducing mosquito density. So far there is no significant number of dengue patients reported from Sri Lanka but the high risk time period is ahead when the monsoon season begins, they said.

The country sees an outbreak in dengue during June and July and November and December. There are about 140 mosquito varieties in Sri Lanka, the sources said.

Controlling dengue keep homes and home gardens free of tyres, plastic cans, bottles, tins and plants that harbour water inside them. All surfaces of containers, tanks, bird baths etc should be scrubbed and cleaned once a week. Containers should be kept in secure places.

http://www.dailynews.lk/2007/04/20/news31.asp

[Gert van der Hoek]

Re: Dengue in Sri Lanka

Mosquito Breeding Control Act in force from May

Nadira Gunatilleke

COLOMBO: The Healthcare and Nutrition Ministry will take action soon to implement the Mosquito Breeding Control Act strictly from May 1 to control the dengue outbreak.

Raids will be conducted countrywide through Public Health Inspectors and legal action will be taken against persons who violate the Act, Ministry sources said.

The sources said that under the Act a custodian will be appointed to each premises. The Act also allows to take legal action against Pradeshiya Sabhas and Urban Councils which do not clean mosquito breeding sites within their limits.

The main objective of this is to prevent a possible dengue outbreak that may hit the country parallel to the commencement of the monsoon rain season and the end of school holidays.

All schools will be instructed to clean their buildings and gardens spending half an hour every Friday. All residences private and State institutes have been instructed to clean their buildings and gardens every Sunday.

During a recent press briefing at the Health Education Bureau, Colombo it was revealed that there were 47 deaths caused by dengue in Sri Lanka and 28 deaths in 2005. The number of persons killed by dengue was 87 in 2004 and 32 in 2003.

Last year two per cent of dengue patients suffered from dengue haemorrhage and five per cent of them were serious.

Although there is no specific age group for dengue infection, the most affected age groups were 20 to 24 and two to 29.

Dengue haemorrhage can occur mostly in children of the age group five to nine. The most number of deaths were reported from the age groups of 0 to four and 30 to 34. The Colombo MC and suburbs are the most affected areas.

http://www.dailynews.lk/2007/04/21/news21.asp

[Gert van der Hoek]

Re: Sri Lanka: Dengue

Sustaining dengue and chikungunya prevention programmes in 2007

Role of the citizens, NGO, government and private sectors:

Dr. Pradeep KARIYAWASAM

A MAJOR CHALLENGE: Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF) are acute febrile diseases, found in the tropics, with a geographical spread similar to malaria.

Caused by one of four closely related virus serotypes of the genus Flavivirus, family Flaviviridae, each serotype is sufficiently different that there is no cross-protection and epidemics caused by multiple serotypes (hyperendemicity) can occur.

Dengue is transmitted to humans by the mosquito Aedes aegypti (rarely Aedes albopictus). The term ?dengue? is a Spanish attempt at the Swahili phrase ?ki denga pepo?, meaning ?cramp-like seizure caused by an evil spirit?.

A global pandemic began in Southeast Asia in the 1950s and by 1975 DHF had become a leading cause of death among children in many countries in that region.

Epidemic dengue has become more common since the 1980s - by the late 1990s, dengue was the most important mosquito-borne disease affecting humans after malaria, there being around 40 million cases of dengue fever and several hundred thousand cases of dengue hemorrhagic fever each year.

A clinical dengue fever-like illness has been known to be endemic in Sri Lanka from the beginning of the century, and it was serologically confirmed in 1962.

Following an outbreak of chikungunya in 1965, there was an islandwide epidemic of dengue associated with DEN type 1 and 2, with 51 cases of DHF and 15 deaths, from 1965 to 1968.

Although most of the towns throughout the country were affected during this outbreak, the greatest impact was felt in the western coastal belt. Colombo, the capital, recorded the highest number of cases and the first two cases of DHF was also occurred at this time.

In Colombo, cases of dengue fever have demonstrated a biphasic pattern over the past with two separate peaks, the first occurring around June - August and the second around November - December, following the monsoon rains.

It is clearly evident that Dengue fever is associated with the rainfall and shows an increase following the monsoon rains.

Chikungunya

Chikungunya fever is a viral disease transmitted to humans by the bite of infected mosquitoes, usually Aedes Aegyptii or Aedes Albopictus but many other mosquitoes may be involved with suspected mutation of the virus.

Chikungunya virus (CHIKV) is a member of the genus Alphavirus, in the family Togaviridae.

CHIKV was first isolated from the blood of a febrile patient in Tanzania in 1953, and has since been identified repeatedly in west, central and southern Africa and many areas of Asia, and has been cited as the cause of numerous human epidemics in those areas.

Epidemics of illnesses resembling chikungunya have first been recorded from India as early as 1824. However after isolation of the virus (CHIKV) in 1953 the disease has been reported from a wide geographic region from West Africa to Philippines in Asia.

It has been reported from Sri Lanka in 1969. Most recent outbreaks have been reported from India (Kerala and Tamilnadu) and various Indian Ocean islands including Comoros, Mauritius, Reunion and Seychelles.

The term ?chikungunya? comes from Makonde, the language of the ethnic group Makonde in the South Eastern part of Tanzania and Northern Mozambique. This word refers to the meaning ?that which bends up? with regard to the crippling nature of the illness.

CHIKV infection can cause an acute debilitating illness, most often characterised by fever, severe joint pain and rash.

It is characterised by a rapid transition from a state of good health to the illness. Temperature rises abruptly as high as 40 degree C (typically in children) and is often accompanied with shaking chills.

After a few days fever may subside and rise again resulting in a saddle back fever curve. Arthralgia or joint pain is Polyarticular and symmetrical involving knees, elbows, ankles, and small joint sites of previous injuries. Pain is most intense on waking up in the morning.

Chikungunya patients typically avoid movements as much as possible. Joints may swell without significant fluid accumulation. These symptoms may last from 1 week to several months and are accompanied by myalgia or muscle pain.

Rash characteristically appears on the first day of illness, but onset may be delayed. It usually arises as a flush over the face and neck, which evolves to a maculopapular or macular form with pruritis.

It later spread to the trunk, limbs, palms and soles in that order of frequency. Petechial skin lesions can also be seen.

Other symptoms may include headache, photophobia, fatigue, nausea and vomiting. Hemorrhagic phenomena are relatively uncommon.

The prolonged joint pain associated with CHIKV is not typical of dengue. Co-circulation of dengue fever in many areas may mean that chikungunya fever cases are sometimes clinically misdiagnosed as dengue infections, therefore the incidence of chikungunya fever could be much higher than what has been previously reported.

Sri Lanka experienced an epidemic of Chikungunya in 2006, spreading from Mannar and the Eastern Province to the other parts of the country.

Due to the availability of a non-immune population the disease spread to epidemic proportions in the latter part of 2006 involving even citizens of Colombo.

In all the islands or towns where chikungunya spread between 50 to 80 percent of the local population were affected.

Hence, as the economic centre of the country the magnitude of the problem is critical for the Sri Lankan economy?s survival as Colombo would come to a standstill in case of a large outbreak!

Therefore, for the control and prevention of these two diseases that devastated Colombo in 2006, the Public Health Department of the Colombo Municipal Council has initiated a control programme termed ?No to D and C campaign? which has activities spread throughout the year.

The ?No to D and C campaign? was initiated by the Public Health Department of the Colombo Municipal Council as a joint Public Private partnership towards a better tomorrow. Several leading governmental and non-governmental institutions have teamed up with us in this endeavour.

The strategies undertaken by the Colombo Municipal Council, Public Health Department in controlling and preventing these two diseases are as follows:

* Strengthen the existing surveillance system - We had initiated this surveillance system where our staff visited the hospitals in the Colombo area on a daily basis and collected the information on the reported dengue cases.

* Geographic mapping to identify the high-risk areas - Case information was mapped geographically, including information from past years to identify the potential high-risk areas.

* Rapid vector control (prevention of clustering) - on receiving the case information, a team comprising of a Public Health Inspector, A field Assistant and members of the vector control unit would visit that place and conduct mosquito control activities in an area of 250 metre radius from the housing unit. Rapid action of this nature has prevented clustering of cases during this year to a considerable level when comparing to the previous years.

* Routine integrated vector control programmes

* ?No to D and C campaign? - Special House to House inspection programme - March 31, 2007

* 1,000 volunteers, 12500 houses inspected in high risked areas - Dengue and chikungunya - walk

* 1,000 volunteers and school children

* Around the Municipal Council - School based dengue control programme

* School awareness programme

* Setting up of dengue control teams within the schools

* Buffer zone creation around the schools - 250 metre radius

* Activities for a sustainable behavioral change in the students

* School recycling programme - Government institution based control programme

* Awareness programme

* Shramadana campaigns

* Routine inspections and monitoring

* Prosecutions - Housing scheme based control programme

* Awareness campaign

* Recycling programme

* Shramadana campaigns

* Chemical control

* Prosecutions - Transitional settlement based control programne

* Awareness campaign

* Shramadana campaigns

* Routine inspections

* Empowering the community for mosquito control

* Chemical control

* Mapping of Bare Lands and Construction sites and routine inspection and mosquito control work in and around them

* Strengthen the prosecutions - From May 1, 2007, the charge levied for harbouring and breeding mosquitoes will be Rs. 25,000.

* Supervision, monitoring and evaluations

It is now evident that dengue cannot be controlled without the fullest cooperation of the general public.

In Colombo, we have come to identify that approximately 95 per cent of the cases are within 250 metres from a bare land, 90 per cent of the cases are within 250 metres from a construction site, 85 per cent within 250 metres from a governmental or private institution, 65 per cent within 250 metres from a school and 60 per cent within 250 metres from a garbage collection depot or a disposal site.

These are the approximate findings of the environmental research conducted by the Public Health Department of the Colombo Municipality.

It is also evident that although the people keep their immediate surroundings clean, bare lands, construction sites, governmental and private institutions and schools with all sorts of breeding sites favourable for mosquito breeding are within a distance of 250 metres from their dwellings.

Having a multitude of such high-risk environments, which are known dengue-breeding sites clearly indicate hot spots for outbreaks.

The Public Health Department of the CMC has done well compared to other areas to keep the number of patients to a minimum, even though our staff strength is at an all time low. Just seven years ago Colombo accounted for about 15-30 per cent of the dengue patients found in the country.

Last year our share was less than 7 per cent and although the country had a 110 per cent increase Colombo with its sustained efforts reduced the increase to 9 per cent in the city. This year by mid April the country had 1,574 patients; Colombo District 446, with 74 in the city.

Therefore, it is up to the public of the Colombo city area to help us to sustain these low levels and keep the city of Colombo free of dengue breeding sites by eliminating them.

It is important to remember that dengue mosquito has a maximum flying range of 250 metres (average 50-150 metres), and although you keep your surrounding free of breeding, if your environment is not clean you are at risk of contacting Dengue fever.

Apart from the schools, other governmental institutions, private sector conglomerates should use this strategy to safeguard the health of their workers by sustaining such a programme in the future.

The message from the Public Health Department is to keep your house and garden free of mosquito breeding and keep your surrounding environment, at least around a radius of 250 metres, free of breeding with the help of your neighbours to prevent a dengue epidemic taking place in Colombo this year and in the future.

Remember, breeding dengue mosquitoes is a punishable offence. Don?t practise it and don?t let others practise it. It is your responsibility to safeguard your own and fellow citizens? health.

The writer is the Chief Medical Officer of Health, Colombo.

http://www.dailynews.lk/2007/04/28/fea01.asp

[Gert van der Hoek]

Re: Sri Lanka: Dengue

Sunday, 5 August 2007

Dengue outbreak looms large

By Chanuka Mannapperuma

Health officials have warned of a dengue outbreak this month specially in Colombo following in the incessant rains and poor attention of people towards keeping their environment clean.

"Compared to the corresponding figure last year there was a 75 percent drop in dengue cases. But the situation has now changed.

Forty-six cases were reported in July while from January this year it was 168 cases", said the Colombo Municipal Council Chief Medical Officer Dr. Pradeep Kariyawasam.

Dr. Kariyawasam said, the number of dengue cases has gone up dramatically islandwide and they are conducting health awareness campaigns to educate the public on the importance of keeping their surrounding environment clean.

"But people do not pay much attention," he said.

According to Dr. Kariyawasam, they did not find any chikungunya cases during the past seven months but officials fear that dengue and chikungunya might raise its head again.

He called upon the public to keep their environment clean and also prevent rain water collecting in empty containers which could lead to mosquito breeding.

He said that the public forget the importance of keeping the environment free of mosquito breeding all the time.

"They (the public) concerned about dengue when the epidemic is high and seem to forget it thereafter. People should be alert all the time."

http://www.sundayobserver.lk/2007/08/05/new14.asp

[Gert van der Hoek]

Re: Sri Lanka: Dengue

A mystery fever spreading in Sri Lanka

Thursday, December 25, 2008,

Dec 25, Ratnapura: Creating another health problem in the country, an unidentified mystery fever is spreading throughout the Ratnapura district these days, Sri Lankan health officials said.

According to the Health Director of the Sabaragamuwa Province Dr. Kapila Kannangara most of the patients suffering from this mystery fever have is from the Embilipitiya division, one of a border division in the Ratnapura District.

Health officials said the patients experience high fever with the symptoms of both Chikungunya and dengue, but the illness is not clearly identified yet.

Officials asked the people with high fever in Ratnapura District to report to the nearest government hospital in the area.

http://www.colombopage.com/archive_08/December25162830RA.html

[Shiloh]

Re: Sri Lanka: Dengue

Source: http://www.colombopage.com/archive_0...2773800RA.html

Mystery fever cases rising in Sri Lanka
Saturday, December 27, 2008, 7:38 GMT, ColomboPage News Desk, Sri Lanka.

Dec 27, Ratnapura: The number of patients suffering from an unidentified fever in Embilipitiya in Ratnapura District has now risen to 700.

Director of the Sabaragamuwa Health Services, Dr. Kapila Kannangara said the patients? blood samples had already been sent to the Medical Research Institute in Colombo as the health officials in Ratnapura district are unable to verify the exact cause of this mystery fever.

The disease is associated with high fever and shows symptoms similar to both Chikungunya and dengue.

[Shiloh]

Re: Sri Lanka: Dengue

Source: http://www.sundaytimes.lk/090125/New...esnews_08.html

Kandy student dies of dengue fever: district on alert
By Shane Seneviratne

One death from dengue and more than 70 cases of dengue fever have been reported from the Kandy district. The victim is a student of Hillwood College, a girls? school in Kandy. Dengue is reported to be raging in Watapuluwa, Mawilmada and Katugastota, areas close to the Mahaweli River. Dr. G. M. Gajanayake of the Kandy General Hospital?s community health unit said the authorities were taking action to check the spread of dengue and advising residents on precautionary steps to take.

Dr. Asoka Senerath of the Kandy Municipal Council health unit told The Sunday Times that 34 dengue cases were reported from municipal council zone itself, and that patients were coming from Galagedara, Wattegama and Werellagama.

Dr. Senerath said the Mahaweli authorities and schools in Kandy have been instructed to be extra vigilant in ensuring the environment is kept clean and not conducive to the breeding of mosquitoes. He said legal action would be taken against those who failed to do so.

Letters about the spread of dengue have been sent out to schools, organisations and residents. A programme is being drawn up to clean Kandy district?s main water sources, especially the Meda Ela and Hali Ela areas.

[Shiloh]

Re: Sri Lanka: Dengue

Source: http://www.dailynews.lk/2009/01/26/news35.asp

Dengue on the rise

SHIRLEY WIJESINGHE

There has been a sharp increase in the reported number of dengue cases in Colombo City during the month of January, Dr. Pradeep Kariyawasam Chief Medical Officer of the Public Health Department, Colombo Municipality told Daily News yesterday.

The total number of dengue victims reported from the CMC area is 79. The cases recorded from Modera alone is 30.

"This situation is serious in comparison to last year," Dr. Kariyawasam cited.

The measures applied to control of mosquitoes such as spraying chemicals, fumigating the locations where mosquitoes breed alone are not sufficient to control dengue on a permanent basis.

[Gert van der Hoek]

Re: Sri Lanka: Dengue

Dengue fever spreading in Sri Lanka once again

Monday, January 26, 2009,

Jan 26, Colombo: Dengue fever is spreading throughout Sri Lanka once again giving rise to another health crisis, health officials warned.

Dr. Prabha Palihawardena, the Director of the Epidemic Disease Unit of the Health Ministry said nearly 600 cases of dengue cases including 5 deaths have been reported during the last three weeks.

Most dengue cases had been reported from Colombo, Gampaha, Kandy, Matale, Ratnapura and Embilipitiya areas.

The Epidemic Disease Unit urges the people in those areas to get treatments from government hospitals if they are suffering from fever for few days.

http://www.colombopage.com/archive_09/January2641635RA.html

[Shiloh]

Re: Sri Lanka: Dengue

Source: http://www.dailymirror.lk/DM_BLOG/Se...px?ARTID=39701

Dengue epidemic: CMC warns households (in Colombo City)

By Yohan Perera

Amidst warning of a dengue epidemic in the Colombo City, the Colombo Municipal Council had warned of legal action against over 100 households and other establishments with polluted gardens.

Chief Medical Officer Colombo Municipal Council (CMC) Dr. Pradeep Kariyawasam told Daily Mirror yesterday that an epidemic was looming with two deaths during this year both being children.

One has been a boy of seven years and a girl aged 8. Around 113 cases have been reported in the city up to Tuesday since January 1 this year according to him. There has been a threefold increase of cases this year compared to the same period last year.

He explained that more than 95% of the cases are children Dr. Kariyawasam said Mutwal and Mattakkuliya have been worst affected areas.

He warned that the number of cases may increase during the coming months with the rainy season.

Dr. Kariyawasam said ineffective collection of garbage, clogging of drainage lines in the city has been the main cause for the spread of disease. Another cause has been uncollected debris of demolished buildings in the city.

?There are many buildings which are demolished in the city but there seems to be no one to clear the debris, ?the Chief Medical Officer said.

The public inspectors of the CMC have visited the households in the city during the past few weeks and had come around over 100 households and other establishments with polluted gardens. ?We will be compelled to take legal action against them if they fail to clean up their gardens before Friday,? he added.

As a precautionary measure the CMC had a cleaning up campaign last week and more campaigns are being planned during the coming days.

[Shiloh]

Re: Sri Lanka: Dengue

Source: http://www.island.lk/2009/03/26/features2.html

Dengue fever in children

There are reports of a rise in cases of Dengue in Colombo and other parts of the country over the first few months of this year. It is a disease that could affect children as well as adults. Dengue fever is an illness that affects children irrespective of caste, creed, religion or social status. The word Dengue is derived from the word "Ka - Dinga pepo" in the Swahili language. It refers to a sudden cramp like disease caused by an evil spirit. One of the cardinal features of the disease is severe muscle pain and perhaps the word was derived from Swahili to denote this important clinical feature. At other times, the disease has been called "break bone fever" as well, referring to the intense limb pains associated with it.

The virus that causes dengue was isolated in the 1940s and there are four types of the virus that causes disease in humans. Outbreaks of the disease are due to one or more of these four serotypes. The disease is transmitted by one of two species of mosquitoes known as Aedes aegypti and Aedes albopictus. The disease has a very wide range of severity and presentation. In some children it could present as an ordinary flu or viral fever while in others it could be a severe life-threatening illness. It all depends on several factors like the virulence of the infecting virus, immunity of the individual and whether it is the first attack or not. Attack by one type of virus does not confer immunity to any of the other three types. When there are second, third and fourth attacks of dengue in an individual, the rate of incidence of the complications are increased. This is due to the production of a type of antibody by one strain of the virus that enhances the effects caused by another strain. Some of these antibodies are not protective but do augment the complications and deleterious effects of the other strains of the virus.

Dengue fever starts just like any other viral fever. It commences with high swinging fever associated with intense muscle and joint pains. The fever often responds poorly to simple fever-lowering medications like paracetamol. The child may feel ill at the times of fever but in milder cases, especially when it is the first attack, the child may not feel too bad. Anyhow, after a couple of days, the fever appears to get better only to flare up again within a day or so. This is generally known as a saddle-back type of fever. This second phase is the one that is associated with the dreaded complications of the disease.

The dengue virus induces a peculiar increase in permeability to the blood vessels leading to uncontrolled movement of fluid from the blood stream to the surrounding tissues. It is also known as leaking of fluid from the blood stream into the adjacent areas. This leads to a reduction of fluid within the circulating compartment and is associated with a fall in the blood pressure and cardiovascular malfunctioning. The patient remains in a state of collapse or shock. This is known as the "Dengue Shock Syndrome". In addition, the virus causes a certain amount of direct damage to the blood vessels which leads to a bleeding tendency. The disease also causes a fall in the platelets of the blood and this enhances the bleeding as platelets are intimately involved in the clotting processes of normal blood. This problem is known as "Dengue Haemorrhagic Fever". The bleeding manifests as spots on the skin or internal haemorrhage, particularly into the stomach and intestines and this presents as brownish or blackish "coffee grounds" material in the vomitus. In some patients the heart is affected leading to a complication known as myocarditis which leads to heart failure. This particular complication can be very troublesome and needs to be managed very carefully. All these complications are associated with an increased rate of fatalities. However, with competent management, these deaths could be reduced drastically.

It is important to point out that the child remains conscious and alert right throughout the illness, even when he or she is quite ill with the dreaded complications. It is these complications that cause death in dengue and these are much more commoner during second and subsequent attacks of the disease. The ordinary uncomplicated form starts with high fever, vomiting and the patient generally feeling unwell. The period around the 4th to the 7th day is the crucial one for the development of the complications. However, many affected individuals go through the illness just like any other form of flu and recover without any problems. The more severely affected children however, feel quite ill, especially during the late phase of the disease that comes on after 3 to 4 days.

It is noteworthy that a definitive diagnosis could be quite difficult in the early stages of the disease. Although there are some sophisticated tests that could detect the virus in the first 2 to 3 days of the illness, these are not absolutely fool-proof and are also quite expensive. These tests detect the genetic structure of the virus using a technique known as the Polymerase Chain Reaction or PCR. The standard blood counts show typical features of any viral infection in the first couple of days. Subsequently these counts show evidence of thickening of the blood caused by uncontrolled shifting of fluids out of the blood stream and a fall in the platelet count. The tests to detect antibodies become positive from about the 3rd or 4th day but once again, they are not absolutely fool-proof. Negative antibody tests do not exclude dengue fever. A characteristic feature in the leaking phase is the development of a collection of fluid in the chest around the lung, particularly in the right side. This feature, seen quite well in a chest x-ray, is of significant diagnostic value.

It is crucial that a child with dengue comes under medical supervision as soon as possible. Many of them who do not develop any complications will only need simple measures to control the temperature and would only just need further observation. However, if a complication develops, the recovery is determined by how quickly a medical team intervenes with aggressive active management. Many of them would need intravenous fluids to control the shifting of fluids within the different compartments of the body. A lot has been learned during the last decade in managing these patients and constant vigilance is required practically from hour to hour when there are major complications. A lot can be done in the acute phase especially if and when complications develop. All medical facilities in the government sector are quite well equipped to handle these cases and people in these institutions are the most experienced in dealing with these cases. Although fatalities are highlighted in the media, in experienced hands the mortality rate is quite low and is now under 1 per cent. Unfortunately, up to now, there is no vaccine to prevent dengue and it is most unlikely that one would be discovered in the near future. Thus preventive measures are directed towards controlling the mosquito population.

From time to time, there are reports of a resurgence of Dengue Fever in this country. Some families unfortunately have lost beautiful normal children to the disease. The rains do come from time to time and mosquitoes are everywhere. The usual nonchalance and lack of public consciousness of the people are also there in abundance. This means the three cardinal ingredients for perpetuation of Dengue Fever are in place right round the country. It is a disease that conjures up visions of unsavoury consequences and death in the minds of most people. Sporadic cases are seen regularly in our medical facilities and from time to time increased incidence of epidemic nature occur practically throughout the country. It is not a new disease but it is perhaps quite apparent that it has now come to stay. It is most unlikely that any form of control measures undertaken will ever be able to completely eradicate the disease from this country.

It is absolutely essential that the public in the community cooperate with the authorities in their efforts towards eliminating the breeding places and habitats of the mosquitoes that transmit this disease. This is certainly not an enterprise that could be successfully undertaken by the state alone. Civic consciousness, collaboration and support on the part of the general populace are of paramount importance in any control measures undertaken by the authorities. Most unfortunately and quite sadly, it is almost a national trait on the part of many people to remain apathetic and indifferent in such endeavours as long as the basic problem does not affect them directly. It is of the essence to reiterate that dengue can strike anybody and at any time. A unified and concentrated effort to prevent it is the need of the hour.

The writer would appreciate some feed-back from the readers. Please e-mail him at bjcp@sltnet.lk or write to him at the following address :-

Dr, B.J.C.Perera, Consultant Paediatrician, Asiri Medical Hospital, 181, Kirula Road, Colombo 5.

[Shiloh]

Re: Sri Lanka: Dengue

Source: http://www.nation.lk/2009/03/29/news1.htm

Dengue raises its ugly head
By Kushali Atukorale

The threat of dengue is escalating again with 2,700 dengue cases, along with 28 deaths, being reported by the end of March 2009.

The Epidemiology Unit of the Health Ministry expects the number of cases could be risen to 12,000 by the end of the year, if proper actions were not taken.

Epidemiology Unit Consultant Dr. Hasitha Tissera said it is very essential to seek medical assistance, if a person suffers from persistent fever for more than three days.

?This is going to be a massive problem as there were only 25 deaths reported in the year 2008 with the reported cases numbering at 6,628. But, 28 deaths have already been reported along with 2,700 cases in the first three months of this year. This is going to be a huge issue,? he asserted and noted that highly vulnerable areas to the disease are Colombo, Kandy, Gampaha, Matale, Kalutara, Anuradapura, Batticaloa, Tricomalee and Puttalam.

Dr. Tissera said immediate medical assistance is the best prevention, if not the number of cases could be risen up to 12,000, which is similar to the year 2006.

The dengue mosquito bites during the day time, especially in the morning and evening, therefore, people should be more careful during that particular time, he added.

He said dengue fever can be divided into two categories: Dengue Haemorrhagic Fever and Dengue Shock Syndrome. Common symptoms are high fever, headache, muscle and joint pains, nausea, vomiting and pain in the bones.

?The symptoms might drop in three to four days, but it can advance to Dengue Hemorrhagic Fever,? Dr. Tissera warned.
Explaining about Dengue Haemorrhagic Fever, he noted that it is very important to seek medical assistance without any delay. ?Symptoms are, bleeding from the nose and gums, brown or black vomit, continuous stomach pain and enlargement of the liver.?

Another category of dengue fever, which is known as Dengue Shock Syndrome can be identified if a patient still feels ill even after the high temperature reduced.

This can be identified by symptoms such as drop in body temperature, paleness and restlessness.
?More than the medicine, it is rest that is really important when curing dengue, and also, the environment should be kept clean. All unwanted containers in which water can be collected should be destroyed. Dengue victims should consume more fluids, fresh vegetables and fruits to boost their immune system,? he noted.

[Shiloh]

Re: Sri Lanka: Dengue

Source: http://www.dailymirror.lk/DM_BLOG/Se...px?ARTID=44925

Dengue fever on the rise in Batticaloa
By Amadoru Amarajeewa ? Trincomalee
Tuesday, March 31, 2009

Dengue fever is raising its ugly head in the Batticaloa district. Statistically 128 dengue positive cases were reported this year and two of the patients died. Provincial Director of Health Services Dr. M. Devarajan said the most number of patients were reported from the Batticaloa Health Officer?s Division. He said 46 patients were reported from Kalawanchikudi and 11 from Valachchainai. More than 12 patients were reported from other areas. Dr. Devarajan said steps were taken to launch public awareness programmes though the Public Health Inspectors, Divisional Medical Officers of Health and the local authorities. He said blood tests to identify those affected will continue.

[Shiloh]

Re: Sri Lanka: Dengue

Source: http://www.reliefweb.int/rw/rwb.nsf/...N?OpenDocument

Dengue fever spreading once again in Sri Lanka
Source: Government of Sri Lanka
Date: 18 Apr 2009

Mosquito-borne Dengue fever is spreading once again in Sri Lanka with a sharp increase in the number of patients, Sri Lanka health officials said.

The Director of the Epidemic disease Unit of Health ministry said that 2,400 dengue cases have been reported within the last two months, from Colombo, Kandy, Ratnapura, Kalutara and Kegalle districts. This statistics show a sharp rise in dengue cases compared to the last year

Health officials urge the people in these districts to destroy the mosquito breeding-grounds to prevent the spread of the disease.

According to medical officials, there are two peak seasons for the spreading of the epidemic in Sri Lanka each year: one is from October to December; another is from May to July.

Dengue viruses are mosquito-borne viruses that each year infect millions of persons living in tropical and subtropical regions of the world.

All citizens are advised to keep their surroundings clean to prevent dengue.