Context

The advent of a new tetravalent vaccine against the dengue virus has thrown new light into the evidence-based management of dengue.

Why the holistic approach is needed

• Apart from promoting the use of the vaccine, gaining control over dengue will also require a holistic approach that has to include within its ambit vector control and proper case management.
• Tetravalent vaccine: The vaccine is tetravalent i.e. it provides protection against all the four types of dengue viruses.
  • The vaccine confers about 80% protection to children vaccinated between 4 and 16 years of age without any major side effects.
• Climatic factors: It is essentially a tropical disease that occurs in the countries around the Equator; hot weather and intermittent rainfall favour the sustenance of Aedes aegypti.
  • Aedes eggs can remain dormant for more than a year and will hatch once they come in contact with water.
• Risk factors: Urbanisation, poor town planning, and improper sanitation are the major risk factors for the multiplication of such mosquitoes.
  • Aedes eggs can remain dormant for more than a year and will hatch once they come in contact with water.
  • Aedes mosquitoes cannot fly beyond a hundred meters. Hence, keeping the ambiance clean can help prevent their breeding.
  • Further, these mosquitoes bite during the daytime, so keeping the windows shut in the day hours is also useful.

What needs to be done?

• Source reduction activities: Activities like preventing water stagnation and using chemical larvicides and adulticides.
  • These chemicals need to be applied in periodic cycles to kill the larvae that remain even after the first spray.
• Dealing with the manpower shortage: The number of skilled workers available for such measures is low; many posts in government departments remain vacant despite there being a dire public health need.
  • Due to this deficiency of manpower, active surveillance is not being done in India, says the National Vector Borne Disease Control Program.
• Ending the Under-reporting: Dengue cases are often under-reported due to political reasons and also to avoid spreading panic among the common people. Under-reporting needs to be dealt with.
• Increasing coordination: There is a lack of coordination between the local bodies and health departments in the delivery of public health measures.
  • A comprehensive mechanism is required to address these issues.
• Need for epidemiological measures: Any communicable disease needs the epidemiological approach. Singapore uses one successful model of mapping and analysing data on dengue, using Geographical Information System (GIS).
  • The use of GIS involves mapping the streets with dengue cases for vector densities.
• Emphasis on the WHO guidelines: Fluid management in the body is the cornerstone in the management of severe diseases like dengue hemorrhagic fever and dengue shock syndrome.
  • According to the guidelines, coagulation abnormalities are not due to a reduction in the number of platelets alone.
  • This is why the WHO recommends fresh whole blood or packed cell transfusion in the event of bleeding.
• Caution in using alternative medicine drugs: Modern medicine is not against any complementary medicine; when such a medicine is approved after rigorous testing.
  • However, in the absence of evidence, the efficacy of such medicines remains in the realm of belief instead of science.
  • So, medicines like Nilavembu kudineer and papaya leaf extract are only belief based.

Conclusion

The communicable nature of Dengue and its asymptomatic nature requires the holistic approach to successfully tackle the disease.

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