Dengue, Global Village and Pakistan

We are now global village and in village things spread/shared quickly. Solution is always present in or around the problem.

Dengue fever is the most prevailing mosquito borne viral disease in the human. The virus is transmitted by the tiger mosquito (Aedes aegypti). Around 40% of the world population is at risk of infection with Dengue virus. Every year 50 million people get infected with the virus, causing classical dengue fever (DF) such as hemorrhagic fever and shock syndrome. Traditionally, Southeast Asian countries have major outbreaks of Dengue every 3-5 years. Outbreaks increasing because of relocation of people from rural to cities or vice versa.

The origin of the word dengue is not clear, but one theory is that it is derived from the Swahili phrase "Ka-dinga pepo", meaning "cramp-like seizure caused by an evil spirit". The Swahili word "dinga" may possibly have its origin in the Spanish word "dengue" meaning fastidious or careful, which would describe the gait of a person suffering the bone pain of dengue fever. Alternatively, the use of the Spanish word may derive from the similar-sounding Swahili.  The first record of a case of probable dengue fever is in a Chinese medical encyclopedia from the Jin Dynasty (265–420 AD) which referred to a “water poison” associated with flying insects. The first recognized Dengue epidemics occurred almost simultaneously in Asia, Africa, and North America in the 1780s, shortly after the identification and naming of the disease in 1779. The first confirmed case report dates from 1789 and is by Benjamin Rush, who coined the term "breakbone fever" because of the symptoms of myalgia and arthralgia.

Possible factors of its outspread are stagnant water and increased international travel (recreational, business or military) to those areas where disease is endemic. All these factors must be addressed to control the spread of Dengue. During World War II, the movement of troops, most were susceptible host, to the war theater for short periods of time provided the virus with a large supply of new susceptible hosts of a continuous basis and increasing the incidence of disease in Southeast Asia.  Similarly, movement of hosts, or war machinery or both facilitated the civilization of virus serotype throughout the region. The post world war-II situation in SEAsia represented yet another combating factor and regard to water supplies and sewerage systems that had been destroyed during World War II, which might resulted in good breeding places for the mosquito. During 1950’s, the average annual number of cases had been 908 but from 1980-98 the average was 514,139 (WHO) report.

In Pakistan, resurgence of mosquito is possible and in very short period of time due to lack of proper sewerage system and awareness. Public awareness in this regard always play a major role for the management of Dengue Fever and vector Aedes aegypti . Most of the focus of the regularity authorities is towards urban areas, but as explained earlier, movement of people (from cities to rural areas) especially on EID back towards their homes will play a major factor for spreading of the virus and vice versa. It will be impossible to stop reverse pressure of the disease. This is the time, for long term planning.

Surveillance of the rural areas is much more necessary as of urban areas. For that purpose, Biology teachers and professors in local Government High Schools and Colleges can be trained for identification of mosquito at adult and larval stage and each student can do larval sampling every week from their respective nearby area allocated to them. IT labs in school or college can play a major role in building this database of sampling which can be shared with UC and District Govt. It will develop a database at UC level and tracking will be easy. Every high school and college has science or biology laboratories, which can be used for temporarily rearing of mosquito larvae, sampled which would require only a small ice cream cup/glass jar/ bottles and a muslin cloth at the opening to block escape of mosquito. The sampled larvae after identification can be killed by putting in boiling water. The infected area can be brought into notice of UC for larval control measures. It would have two impacts, awareness at root level and identification of mosquito.  It will encourage the younger generation to be prepared for any situation in future and to play their role for country.  

For personal protection, eucalyptus oil has been known for hundreds of years as antibacterial, antifungal and antiseptic in nature. Eucalyptus Oil has been placed under GRAS (Generally regarded as Safe) by Food and Drug Authority (FDA) of USA and classified as non-toxic. Currently, 3 to 5 thousand tones of eucalyptus oil are traded every year in international markets and around 2/3^rd of this is produced by Australia. Eucalyptus is repellent for mosquitoes and its plantation is at larger area in Pakistan. Oil of Eucalyptus can be extracted using steam distillation process. Adding few drops of this oil in any lotion/cream used at home can serve as homemade remedy to protect ourselves from mosquito bite or can be used as diffuser. Currently, DEET based products are available in the market as protection against mosquito and questions have been raised regarding its affect in child.  Scientist in research institutes should also focus to develop good products from already available information in the scientific world and this research can be co-partnered with private companies. NAPHIS needed to be strengthened and quarantine rules should be implemented in true manner as it is practiced in Australia or other developed countries to prevent entry of pathogen from endemic areas.

Insects in history have also remained a weapon of war, dated back Mayans, where bees were concealed in the heads of manikins, when smashed open, resulted in the releasing of the insects causing torture. We shouldn’t close our eyes from West Nile Virus or other mosquito borne diseases, because “ We are now global village and in villages things spread/shared quickly”.

(Information given above is based on scientific papers searched from major Databases)

JURehman