EPIDEMIOLOGY OF DENGUE FEVER IN RAJASTHAN, INDIA

Dengue fever is one of the most common mosquito-borne viral diseases affecting the population of India. The entire nation has been trying to combat this increasingly spreading disease, affecting humans. Currently, India is facing an outbreak of dengue fever, one which is impacting multiple lives across the nation. Some states, such as Rajasthan, have recorded very high numbers of dengue fever in India. Despite being a dry state – Rajasthan has been an active breeding ground for hundreds of mosquitoes. Today, the state is suffering from hospitals full of patients who need diagnosis, awareness and medication to treat dengue.

In 2018, the state of Rajasthan was among the top 6 states to witness more than 3,000 dengue cases till September and recorded 4 death dues to dengue fever. In 2017, the state had 14 deaths due to the dengue virus; while as of today, the state has recorded more than 12 deaths due to dengue. Further, the number of people diagnosed with dengue in Rajasthan this year so far is at an all-time high of 7,981. The State Health Department found four-lakh breeding mosquito sites between August to November. With such alarming rates of the disease spreading in the state, the Government is under immense pressure to control the outbreak.

Some of the steps taken by the Government of Rajasthan to control the spread of dengue fever are:

  • Setting up control rooms and rapid response teams across the state
  • Free blood tests to control the outbreak
  • Carrying-out of anti-larval activities across the state
  • House-to-house surveys to identify high-risk clusters and infected people
  • Regular fogging
  • Strict directions to doctors and hospitals to not neglect any suspected case of mosquito-borne disease
  • Setting up of different OPDs to provide attentive and ready care
  • Hospitals have been directed to stock up additional medicines and equipment

More so, awareness about the disease, its causes, symptoms, treatment and prevention – must be spread among people in Rajasthan to control the dengue virus outbreak.

Dengue fever is a mosquito-borne viral disease caused by four closely related viruses related, which spread through the Aedes mosquitoes. The fever is spread through the bite of an Aedes mosquito that is carrying the dengue virus. This species of mosquito can breed inside or outside the house in containers holding water and do not have the capacity to fly more than 200 metres away from their place of birth. The Aedes Mosquito is most active during the early hours of the morning and before sunset. Dengue fever is extremely painful, debilitating and often causes high fever, along with headache and extreme muscle or joint pain. 

Causes of Dengue Fever

Dengue is spread via particular species of mosquito known as Aedes that transmits four closely related dengue viruses called as DENV. The Aedes mosquito transfers the virus into a human being by bite, thereafter the chain continues when a normal mosquito bites the dengue infected person, it becomes a carrier of the virus and it spreads further. The Aedes mosquito can breed inside or outside the house in containers that hold water for long, but they do not breed in pools, creeks or other water bodies. 

Symptoms of Dengue Fever

Dengue fever can cause serious health complications and in severe cases can be fatal, if not detected and treated on time. Some common symptoms that can help detect the dengue fever are:

  • Unexplained, sudden high fever
  • Severe headache
  • Nausea
  • Vomiting
  • Rash on the skin
  • Rashes on the eyes
  • Severe weakness
  • Fatigue
  • Acute bone, joint and muscle pain
  • Easy bruising or bleeding
  • Mild bleeding
  • Pain behind the eyes
  • Swollen glands

Sometimes, the symptoms are mild and hence, are considered to be indications of flu, fever or a normal infection. That said, dengue symptoms tend to appear after 4 to 7 days of the bite from the infected mosquito.

Treatment for Dengue Fever

The first step of the treatment would be the detection of dengue virus that is done via blood tests. Once detected, depending on the severity of the case, further course of treatment is suggested. That said, there is no particular medication to treat dengue directly. Mild cases of dengue fever can take pain killers that have acetaminophen or paracetamol components, and strictly avoid any aspirin-containing medicines. In any case, contacting a doctor is must to know the intensity of the infection. Meanwhile, you should take rest and increase intake more fluids. For cases, where symptoms intensify, immediate medical attention is needed.

Prevention of Dengue Fever

Dengue fever is a result of the bite of the Aedes mosquito; thus, it the best course of preventing dengue is to stop the birth and breeding of Aedes mosquito. The following preventive methods can help stop the breeding of the dengue carriers:

  • Get rid of any containers placed under the air conditioners or coolers
  • Do not store water in containers – inside or outside – and leave them open
  • Maintain distance from anything that has stored clear stagnant water
  • Change the feeding bowls for pets
  • Pour fresh water in flower vases every day
  • Remove any excess water in flower pots or plates
  • Check your water tanks for proper seal
  • Use mosquito repellents and mosquito nets all the time
  • Wear fully covered clothes
  • Use air conditioners to keep mosquitoes away
  • Keep all windows and doors closed
  • Do not apply strong perfumes or soaps, since smell attracts mosquitoes
  • Do not walk outside at dawn or dusk
  • Do not take shelter under the trees at dawn or dusk

There is a dire need to stop the spread of dengue fever in Rajasthan that has been claiming the lives of many people and also impacting the lives and health of others significantly. Regular health check-ups and alertness towards symptoms can really help to combat the problem effectively.

COMMON MOSQUITO-BORNE DISEASES IN RAJASTHAN

Even after being a relatively dry and humid state, Rajasthan has become favourable for mosquito-borne diseases including dengue, chikungunya and malaria. Till date, the state has registered more than 10,000 cases of mosquito-borne diseases and more than 2,000 cases of vector-borne diseases. The state lacks appropriate hygiene levels and has increasingly become a breeding ground for mosquitoes and mosquito-borne diseases. With more than 1,300 cases of dengue and malaria reported in Rajasthan till August 2019 – the state has witnessed an alarming rate of mosquito-borne diseases.

Some of the common mosquito-borne diseases in Rajasthan include:

Chikungunya: Chikungunya is a mosquito-borne, viral disease which is transmitted to humans through the bite of an infected mosquito. The species of mosquitoes that are responsible for spreading the virus are known as Aedes aegypti and Aedes albopictus. These mosquitoes bite an infected person and in turn become the carriers of the chikungunya virus, which is then further spread to every uninfected person who receives the mosquito bite. These mosquitoes generally bite during the day, though are found in well-lit areas even during the night time. The Aedes mosquitoes typically bite outdoor; however, Aedes aegypti can bite indoors too. This disease causes severe joint and muscle pain, fever and severe headache but is usually not fatal except for some rare cases. The symptoms of chikungunya begin to show post three to seven days of the mosquito bite, and except for joint pain, the other symptoms usually fade away within a few days. Chikungunya is generally not contagious, though in rare cases, it can be transmitted via contact with infected blood.

Dengue: Dengue fever is a mosquito-borne viral disease caused by four closely related viruses related, which spread through a particular species of mosquito known as Aedes. The Aedes mosquito transfers the virus into a human being by bite, thereafter the chain continues when a normal mosquito bites the dengue infected person, it becomes a carrier of the virus and it spreads further. The Aedes mosquito can breed inside or outside the house in containers that hold water for long, but they do not breed in pools, creeks or other water bodies. These mosquitoes do not have the capacity to fly more than 200 metres away from their place of birth. The Aedes Mosquito is most active during the early hours of the morning and before sunset. Dengue fever can cause serious health complications and in severe cases can be fatal, if not detected and treated on time. Dengue is extremely painful, debilitating and often causes high fever, along with headache and extreme muscle or joint pain. Sometimes, the symptoms are mild and hence, are considered to be indications of flu, fever or a normal infection. That said, dengue symptoms tend to appear after 4 to 7 days of the bite from the infected mosquito. However, usually a person tends to recover from dengue fever within a week but for cases, where the symptoms intensify – dengue fever can become life-threatening because of several reasons including leakage or damage in blood vessels and dropping of platelets. This stage of dengue fever is also known as dengue shock syndrome, where the patient would need immediate medical help.

Malaria: Malaria is a life-threatening, mosquito-borne disease which is caused by a parasite transmitted to humans via bites of infected mosquitoes belonging to the Anopheles species. The parasites that are responsible for spreading malaria are from the genus Plasmodium. Upon the bite of the mosquito, the parasites are released into the bloodstream from where they travel to the liver and mature. Post maturity, these parasites enter the blood and start infecting the red blood cells; then within 72 hours, these parasites multiply bursting the infected red blood cells. Simultaneously, these parasites continue to infect the red blood cells causing symptoms for Malaria that occur in cycles for about two to three days at a particular time. Malaria transfers to another person when an uninfected mosquito bites an infected person, and in turn, bites an uninfected person transmitting the parasite. Malaria can be transmitted by blood and hence, an organ transplant, transfusion or use of shared syringes can lead to a person being affected by Malaria. Malaria can also be passed on by the mother to the child upon giving birth. Symptoms of Malaria depend on case-to-case; whereas at a general level, the symptoms start to show within 10 days to 30 days after the infection. However, in some cases, the symptoms might not show for several months because of the parasite lying dormant in the body. Some common symptoms of Malaria include chills, high fever, excessive sweating, intense headache, nausea and vomiting.

That said, with the rise of these common mosquito-borne diseases in Rajasthan, The Government of the State has taken strict steps to control the spread and save more lives. Some of these steps include:

  • Setting up control rooms and rapid response teams across the state
  • Free blood tests to control the outbreak
  • Carrying-out of anti-larval activities across the state
  • House-to-house surveys to identify high-risk clusters and infected people
  • Regular fogging
  • Strict directions to doctors and hospitals to not neglect any suspected case of mosquito-borne disease
  • Setting up of different OPDs to provide attentive and ready care
  • Hospitals have been directed to stock up additional medicines and equipment

In February 2019, Rajasthan reported the highest number of dengue and malaria cases in the whole country. It recorded 555 dengue cases and 782 malaria cases since between January and August. The state has taken some strict measures to stop the widespread outbreak; however, the numbers still continue to rise.

UNDERSTAND DENGUE VIRUS INFECTION OF BLOOD

Dengue is a mosquito-borne viral disease that is transmitted by the bite of a species of mosquito known as the Aedes mosquito. Upon being bitten by the Aedes mosquito, which is the carrier of the dengue virus, the virus circulates in the blood of an infected person for approximately 2-7 days before symptoms tend to show up. Dengue virus is an infection of the blood caused by Aedes mosquitoes that breed inside or outside the house in containers holding water; these mosquitoes do not have a long-life span and cannot fly more than 200 metres away from their place of origin. The mosquitoes are very active during the early morning and evening, though they are likely to bite during any time of the day.

As of today, dengue is a widespread disease with no specific cure but easily treatable symptoms, provided the infection in the blood caused by the dengue virus is diagnosed timely. Though generally not life-threatening, dengue can cause serious complications and even death in rare cases, where the diagnosis and treatment are delayed or the severity of infection in the blood caused by the virus is uncontrollable.

What causes dengue virus infection of blood?

The dengue virus is spread by four closely related viruses known as DENV, spread through a special breed of mosquitoes known as the Aedes mosquito. The virus is transmitted into the human upon the bite of an Aedes mosquito that leaves the virus in the person, thereby infecting the human blood. Thereafter, the cycle continues through normal mosquitoes, which bite an infected human and become the carriers of the dengue virus. 

What are the symptoms of dengue virus infection of blood?

Dengue fever can cause serious health complications and in severe cases can be fatal, if not detected and treated on time. Some common symptoms that can help detect the dengue fever are:

  • Unexplained, sudden high fever
  • Severe headache
  • Nausea
  • Vomiting
  • Rash on the skin
  • Rashes on the eyes
  • Severe weakness
  • Fatigue
  • Acute bone, joint and muscle pain
  • Easy bruising or bleeding
  • Mild bleeding
  • Pain behind the eyes
  • Swollen glands

Often times, the symptoms are mild and hence are considered to be those of normal flu or an infection. However, severe dengue symptoms might tend to appear post 6-7 days of the bite of the infected mosquito. In most cases, recovery from dengue happens within a week but for cases that record severe infection of blood and complications – such as leakage or damage of blood vessels, as well as dropping of platelets below the required count – might undergo some struggle to survive, since a severe infection of blood with dengue virus tends to become life-threatening. These severe cases of dengue virus infection of blood are known as dengue shock syndrome and must be treated immediately to minimize complications and increase chances of survival.

Certain symptoms, which when noted, indicate the need for immediate medical help are:

  • Intense abdominal pain
  • Consistent nausea and vomiting
  • Bleeding from gums, nose, or under the skin
  • Blood in urine or vomit
  • Shortness of breath
  • Pacing heartbeats
  • Ice cold skin
  • Unexplained restlessness

Moreover, it is possible that a person who has contacted dengue virus before to be infected with the virus again, since it is a group of four closely related viruses called DENV. Though one virus can only affect a person once in a lifetime, the other viruses can likely infect the blood of a person who has already been infected before with another virus of the family. These cases are called secondary infections and often result in severe complications than primary infections.

What are the treatment options for dengue virus infection of blood?

There is no specific vaccination or particular medicine that can directly cure dengue. However, it aims to control and treat symptoms which ultimately remove the infection from the blood. Also, the treatment of symptoms is also dependent on the severity of the virus infecting the blood. In case the symptoms are mild, pain killers that have acetaminophen or paracetamol components are recommended, and any aspirin-containing medicines are instructed to be avoided. Moreover, rest and increased intake of fluids are recommended to fight the virus temporarily. However, to know the intensity of the symptoms, an assessment for the doctor is necessary.

How can dengue virus infection of blood be prevented?

The dengue virus is spread by the bite of the Aedes mosquito; hence, the best course of preventing the dengue virus infection of blood is to prevent the mosquito bite by taking some steps such as below:

  • Get rid of any containers placed under the air conditioners or coolers
  • Do not store water in containers – inside or outside – and leave them open
  • Maintain distance from anything that has stored clear stagnant water
  • Change the feeding bowls for pets
  • Pour fresh water in flower vases every day
  • Remove any excess water in flower pots or plates
  • Check your water tanks for proper seal
  • Use mosquito repellents and mosquito nets all the time
  • Wear fully covered clothes
  • Use air conditioners to keep mosquitoes away
  • Keep all windows and doors closed
  • Do not apply strong perfumes or soaps, since smell attracts mosquitoes
  • Do not walk outside at dawn or dusk
  • Do not take shelter under the trees at dawn or dusk

Moreover, if anyone known has contacted the virus, it is best to stop the virus from spreading further to other people by restricting any more mosquitoes to bite the already infected person. 

What could be the possible complications from dengue virus infection of blood?

The dengue virus is usually not life-threatening; however, in cases where the infection of the blood is severe, or it is a second-time infection, or even in cases where medical treatment is delayed, dengue virus can cause damage to the heart, lungs and liver. It can lead to the blood pressure dropping too low, causing shock and death in rare cases.

What vaccinations can be taken to prevent dengue virus infection of blood?

Currently, there are no particular vaccinations to prevent the dengue virus from infected the blood of the humans; however, trials are on to find a cure soon.

KNOW THE IMPORTANCE OF REGULAR FULL BODY CHECK-UP

Decades ago, people only used to visit the doctor when they would fall sick or needed surgery. However, today times have drastically changed. In this new, fast-paced life, everyone wants to be on the top of their health. Hence, preventive healthcare has become critically important as people want to minimize their chances of falling sick or needing any form of medical treatment.

Moreover, today with the increasing number of diseases, stress, lifestyle habits, etc. preventive healthcare has become all the more important. People have become more aware and conscious, and want pre-emptive medical advice on how to best stay healthy. One important aspect of preventive healthcare is regular health check-ups. Doctors advise patients to get regular health-checks to stay on top of their health. It is very necessary to know the importance of regular full body check-up to be on the right track of preventive healthcare.

Some of the strong advantages of regular full body check-ups include:

Reduced medical costs: Contrary to popular belief that health check-ups can shoot up your costs and sway your budgets, they instead tend to reduce your potential medical expenditure. Multiple hospitals and diagnostic companies offer deals and packages which provide preventive health check-ups at an overall reduced price as compared to check-ups performed upon need. Moreover, regular screening help to timely detects critical health problems such as cancer, tuberculosis, etc. which can be easily prevented at an early stage. Moreover, timely diagnosis helps reduces the duration of treatment which helps save more money and simultaneously improve chances of survival and full recovery. In many cases, regular health checkups help to avoid surgeries and other serious medical expenditure.

Minimise existing health risks: Even if you tend to take your current health granted, but some health indicators can cause severe problems in the long-run if they are not timely managed today. Problems such as high blood pressure, high cholesterol, diabetes, etc. can be easily managed and controlled with proper and timely medical screenings. Regular health check-ups closely monitor the health statistics and take preventive action, immediately in case of discrepancies. This helps reduce the risk of heart attack, heart problem kidney failure, etc.

Improve overall health: Regular health check-ups function as scheduled report cards that provide detailed insights into the overall condition of the body and it functioning. This helps to stay alert, identify triggers and avoid severe complications. Moreover, reports also help to attain ideal body results provided preventive measures are adopted. These checkups also act as a motivating factor for maintaining a healthy diet, body weight and exercise regime.

Minimise stress issues: Today, stress has become one of the leading contributors to health problems. Even every life stress tends to severely impact our health and can cause a lot of health issues. These can be avoided provided preventive health check-ups are taken which help to keep vitals and necessary health indicators in check. Blood sugar, cholesterol, blood pressure, weight, gastrointestinal problems, etc. need to be consistently checked to avoid any serious complications further.

Reduce chances of falling sick: Regular medical screenings help to minimize one’s chances of falling sick by providing fact checks and also promoting modifications to avoid intensification of the problem. You would be able to before time detect any discrepancies in health indicators and take preventive measures to avoid falling sick. Prevention is always better than cure.

That said, the frequency, type and exhaustiveness of health check-ups can vary from case-to-case. Some of the factors that influence regular screening include:

  • Age
  • Family history
  • Medical history
  • Current health problems
  • Existing health condition
  • Surrounding environment
  • Lifestyle choices (smoking, alcohol, diet, etc.)
  • Physical activity

Common health check-ups for adults

Some of the common health check-ups which can be very beneficial include:

Annual check-ups

  • Blood pressure
  • Body Mass Index (BMI)
  • Full-body exam (nose, skin, heart, body, neural)
  • Preventive assessment
  • Bone strength
  • Respiratory
  • Dental
  • Vitamins

Cancer check-ups (as suggested by the doctor)

  • Colorectal
  • Skin
  • Blood
  • Breast (women)
  • Cervical (women)
  • Prostate (men)

Sensory check-ups

  • Eyes
  • Dental
  • Ear (in case of any problematic symptoms)

Also, as a part of the regular health check-ups, one must also get necessary immunisations, such as below:

  • Tetanus
  • Diptheria
  • Influenza
  • Pneumonia
  • Hepatitis A, B and C
  • Chicken Pox
  • Small Pox
  • Meningococcal
  • Shingles
  • Haemophilus Influenza Type B
  • Measles, mumps and rubella (MMR)

It is very important to take charge of your health and invest in your overall wellbeing. Prevention is always better than cure and regular screenings are the most effective preventive healthcare measure. Consult your doctor for the necessary tests based on your age, gender, etc. as soon as possible.

DENGUE FEVER

DENGUE HEMORRHAGIC FEVER – PRIMARY AND SECONDARY INFECTIONS

Dengue fever is a mosquito-borne viral disease caused by four closely related viruses related, which spread through the Aedes mosquitoes. The fever is spread through the bite of an Aedes mosquito that is carrying the dengue virus. This species of mosquito can breed inside or outside the house in containers holding water and do not have the capacity to fly more than 200 metres away from their place of birth. The Aedes Mosquito is most active during the early hours of the morning and before sunset. Dengue fever is extremely painful, debilitating and often causes high fever, along with headache and extreme muscle or joint pain. The fever rarely causes death; however, it can progress into a serious form known as Dengue Hemorrhagic Fever.

Dengue hemorrhagic fever is linked to the secondary dengue infection, which implies that the person is infected with another serotype of dengue virus than before resulting in a more severe form of dengue virus. Essentially, dengue is an arthropod-borne disease which is caused when one of the four serotypes of dengue virus infects the person; infection by one of the dengue viruses’ immunes a person from the serotype for the whole life and this infection is known as primary infection which is not very severe and easily manageable with directed cure. However, if a person, who has had a primary infection before, is later infected by any of the other three serotypes of the dengue virus, a severe complicated version of dengue will emerge known as dengue hemorrhagic fever. Repeated exposure to the dengue virus makes one more prone to developing dengue hemorrhagic fever.

Symptoms of dengue hemorrhagic fever 

A person infected with the dengue virus can experience symptoms such as:

  • Unexplained, sudden high fever
  • Severe headache
  • Nausea
  • Vomiting
  • Rash on the skin
  • Rashes on the eyes
  • Severe weakness
  • Fatigue
  • Acute bone, joint and muscle pain
  • Easy bruising or bleeding
  • Mild bleeding
  • Pain behind the eyes
  • Swollen glands

A person may be recovering from these dengue symptoms and might develop severe new symptoms, which could indicate dengue hemorrhagic fever. These symptoms include:

  • Restlessness
  • Sudden rise in body temperature
  • Bleeding or bruising under the skin
  • Vomiting and nausea
  • Severe abdominal pain
  • Nose bleeding
  • Cold skin
  • Lower blood pressure

People at high risk of developing dengue hemorrhagic fever

  • Infants
  • Small children
  • Pregnant women
  • Elder people
  • People with a weakened immune system

Diagnosis of dengue hemorrhagic fever

The doctor will check for symptoms and analyse the type of virus that has infected. The first primary infection will be diagnosed and then studied further to detect dengue hemorrhagic fever. The doctor might also conduct a few tests to diagnose the infection, these tests or checks include:

  • Blood pressure
  • Skin, eyes, and glands
  • Blood tests
  • Chest X-ray

Moreover, you would need to specify medical history, family history, lifestyle, recent travels, etc.

Treatment of dengue hemorrhagic fever

There is no specified treatment or vaccination for dengue or dengue hemorrhagic fever. However, the treatment objective is to manage symptoms and prevent the infection from worsening further. These treatments include:

  • Intravenous fluids
  • Over-the-counter pain medications
  • Electrolyte therapy
  • Transfusion of blood
  • Blood pressure monitoring
  • Oxygen therapy
  • Attentive nursing care

Moreover, the doctor will suggest rest and frequent hydration keep the symptoms from getting worse. Symptoms of dengue hemorrhagic fever are most difficult to manage since they are more intense and appear at a faster rate.

Prevention of dengue hemorrhagic fever

The best way to prevent dengue hemorrhagic fever is to stay away from mosquito bites and stop the birth and breeding of Aedes mosquito. The following preventive methods can help stop the breeding of the dengue carriers:

  • Get rid of any containers placed under the air conditioners or coolers
  • Do not store water in containers – inside or outside – and leave them open
  • Maintain distance from anything that has stored clear stagnant water
  • Change the feeding bowls for pets
  • Pour fresh water in flower vases every day
  • Remove any excess water in flower pots or plates
  • Check your water tanks for proper seal
  • Use mosquito repellents and mosquito nets all the time
  • Wear fully covered clothes
  • Use air conditioners to keep mosquitoes away
  • Keep all windows and doors closed
  • Do not apply strong perfumes or soaps, since smell attracts mosquitoes
  • Do not walk outside at dawn or dusk
  • Do not take shelter under the trees at dawn or dusk

Further, protect the patient (from any further mosquito bite) that has been infected by the virus, since that could cause the spreading of the virus if the infected mosquito, in turn, bit another person. 

Complications of dengue hemorrhagic fever

Dengue hemorrhagic fever can cause:

  • Seizures
  • Damage to brain
  • Blood clots
  • Liver and lung damage
  • Heart problems
  • Shock
  • Death

However, the dengue hemorrhagic fever can be treated effectively provided it is detected early.

That said dengue hemorrhagic fever is a very severe condition and must be diagnosed and treated early to prevent complications.

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