Dengue Fever Outbreak in Pakistan: Prevention, Precaution, and Treatment

Introduction

A mosquito-borne disease, dengue fever is found in tropical and subtropical regions of the world. Dengue viruses belong to the family Flaviviridae, specifically the genus Flavivirus. The dengue virus is part of this genus, which also contains several other viruses that cause illnesses in humans and are spread by mosquitoes and ticks. According to estimates, 40–50% of the world’s population is at risk for dengue in tropical, subtropical, and, more recently, temperate regions after the disease’s incidence has skyrocketed in recent decades. Dengue in Pakistan is an ever-expanding threat that needs urgent addressing.

Pioneers in Dengue Virus Discovery

Susumu Hotta and Ren Kimura identified the dengue virus for the first time in 1943. These two researchers examined patient blood samples collected during the dengue outbreak in Nagasaki, Japan, in 1943. Walter Schlesinger and Albert B. Sabin isolated the dengue virus a year later. Four closely related viruses—DEN-1, DEN-2, DEN-3, and DEN-4—cause dengue illnesses. Because each of these four viruses interacts differently with the antibodies in human blood serum, they are referred to as serotypes.

Rising Dengue Fever Cases Around the Globe 

More than 8500 dengue-related deaths and more than 13 million illnesses have been reported worldwide since the start of 2024. Over 11 million cases were recorded in 2024, with 53% of those instances being laboratory-verified, making the WHO PAHO region the site of the majority of illnesses worldwide. There have been almost 6,000 deaths in PAHO as a result of dengue illnesses (case fatality rate: 0.057%). With almost 9.5 million cases reported in 2024, Brazil has led the pack, followed by Argentina, Mexico, Paraguay, and Colombia. As of September 2024, France, Italy, and Spain have reported autochthonous cases in mainland Europe.

Find more statistics at Statista

Preventive Strategies

Some basic rules are suggested by national health institutions and authorities for the prevention of dengue. These include the following:

Put On Protective Clothing

Wearing long sleeves, long pants, socks, and shoes when approaching mosquito-infested areas is advised.

 Apply Insect Repellant

Applying permethrin to bed nets, shoes, clothes, and camping equipment helps ward off mosquitoes. Clothing that already has permethrin in it is also available for purchase. Using a repellent with a minimum of 10% DEET concentration is recommended for healthy and protected skin.

Eliminate Mosquito Breeding Sites

Reducing mosquito populations can be achieved by removing areas where mosquitoes deposit their eggs. Empty and clean containers that store standing water, such as flower vases, animal dishes, and planting containers, at least once a week. When not in use, the containers collecting water should be covered with a lid to avoid contact with mosquitoes.

Current Status of the Dengue Outbreak in Pakistan

On October 12, 2024, the Punjab Health Department verified that 149 new dengue cases had been reported in the province within the previous 24 hours. With the discovery of 997 new cases in the last week, Punjab now has 3,285 cases of dengue for 2024. With 134 cases, Rawalpindi continues to be the most affected, followed by Bahawalpur with three and Lahore with two. One case was recorded by each of the following: Sheikhupura, Jhelum, Faisalabad, Attock, Kasur, Mianwali, Khanewal, Nankana Sahib, and Narowal.

After a large number of were reported in Rawalpindi last week – 103, raising concerns of a disease outbreak, the Punjab Government proclaimed a health emergency in the city to stop the increase. A district emergency response committee made up of national and provincial parliamentarians was established in Rawalpindi on Thursday by the Punjab health minister to oversee the anti-dengue campaign.

Symptoms

The majority of dengue patients recover in 1-2 weeks and have minimal or no symptoms. Dengue can occasionally prove fatal.

If symptoms appear, they typically start 4–10 days after infection and go away in 2–7 days. High temperature (40°C/104°F), an intense headache, pain behind the eyes, joint and muscular aches, nausea, vomiting, enlarged glands, and rash are some possible symptoms. People who get dengue for the second time are more likely to get severe dengue.

Several dengue virus infection symptoms appear once the fever has subsided. The symptoms include severe stomach discomfort, frequent vomiting, fast breathing, bleeding gums or nose, exhaustion, restlessness, blood in the stool or vomit, extreme thirst, and cold or pale skin.

Mode of Dengue Transmission

Through Mosquito Bites

People are susceptible to dengue viruses by being bitten by an infected Aedes species mosquito (Aedes aegypti or Aedes albopictus).

These mosquitoes tend to bite people and can be observed near people both indoors and outdoors. They usually lay their eggs in water-holding containers such as buckets, bowls, animal dishes, flowerpots, and vases. When a mosquito bites someone who has the dengue virus, the mosquito also catches the infection. Through bites, infected mosquitoes can subsequently transmit the virus to humans.

From Pregnant Mother to Fetus

If a pregnant woman catches the dengue virus, the infection can be transferred to the fetus either during pregnancy or shortly after delivery. Premature birth, poor birth weight, and fetal death are among the negative consequences of dengue.

Through Other Routes

Although the presence of dengue virus has been detected in breast milk, people are still advised to breastfeed despite the possibility of a dengue infection due to the advantages of nursing. Dengue is rarely transmitted in medical or laboratory settings through organ transplants or blood transfusions.

Treatment

This viral infection has no particular treatment. The goal is to treat the signs and symptoms of pain. Pain medication can be used to treat the majority of cases at home. Paracetamol, often known as acetaminophen, is frequently used to treat pain and break the fever caused by dengue virus. Aspirin and ibuprofen are examples of non-steroidal anti-inflammatory medications that should be avoided since they raise the risk of bleeding. Patients with mild dehydration brought on by a high fever and vomiting are advised to get oral rehydration therapy; hospitalization is sometimes required for those with severe dengue.

Diagnosis

Dengue is diagnosed using laboratory tests that include one or more of the approaches listed below to identify the virus, viral nucleic acid, antigens or antibodies, or a combination of these:

• The identification of dengue virus antigen in autopsy tissue by immunohistochemistry or immunofluorescence, or in serum samples by enzyme immunoassay (MAC-ELISA, IgG ELISA, nonstructural protein 1 [NS1] ELISA, EIA).
• In paired serum samples, reciprocal immunoglobulin G (IgG) or IgM antibody titers to one or more dengue viral antigens show a fourfold or larger change.
• Reverse-transcriptase polymerase chain reaction (RT-PCR) assay for the detection of viral genomic sequences in tissue, serum, or cerebral spinal fluid (CSF) samples: RT-PCR offers a more precise and early diagnosis. 
• CBC laboratory test should also done to check the number of platelets and WBC levels in the blood.

Global Strategic Plan by WHO

In order to combat dengue and other Aedes-borne arboviruses, the World Health Organization (WHO) introduced the Global Strategic Preparedness, Readiness and Response Plan (SPRP) on October 3, 2024. By encouraging a worldwide coordinated response, the Plan seeks to lessen the burden of disease, suffering, and fatalities from dengue and other Aedes-borne arboviral infections like Zika and Chikungunya.

The Plan provides recommendations for affected nations in a number of areas, such as disease surveillance, laboratory operations, vector control, community involvement, clinical management, and research and development, using a regional and whole-of-society approach. It also outlines priority actions to control transmission. 

The rapid spread of dengue and other arboviral diseases in recent years is an alarming trend that demands a coordinated response across sectors and across borders, according to Dr Tedros Adhanom Ghebreyesus, WHO Director-General. From maintaining clean environments to supporting vector control and seeking and providing timely medical care, everyone has a role to play in the fight against dengue.

Five Essential Elements Proposed by SPRP

The SPRP includes five critical elements that are necessary for dengue management and effective response to an outbreak: 

Coordinating Emergencies

Putting in place leadership and coordination initiatives; includes organizing people in groups so that everyone works together and in an organized way during an emergency situation.

Collaborative Surveillance

Developing and utilizing instruments for early dengue and other Aedes-borne outbreak identification and control, such as enhanced indicator and event-based monitoring, epidemiological analysis, laboratory diagnostics, and field investigations, is known as collaborative surveillance.

Community Protection

Involving communities via communication and localization of response and prevention strategies, such as controlling mosquito populations.

Safe and Scalable Treatment

Ensuring that clinical management is efficient and that health services are robust so that patients can get the treatment they need and avoid disease and death; 

Access to Countermeasures

Encouraging research and development for better cures and potent vaccines to prevent these illnesses.

Conclusion

One of the worst illnesses and a rising public health concern is dengue fever. Rapid unplanned urbanization increases mosquito breeding grounds, increasing the number of individuals at risk of being bitten by Aedes aegypti mosquitoes. As we know, till now there is no vaccine against it, we should take preventive measures to protect ourselves from the risk of dengue and create a lull in the rising dengue cases as well.

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