Taking a holistic approach to dengue
Mains Paper 2: Health
Prelims level : Dengue disease
Mains level : Issues relating to development and management of Social
Sector/Services relating to Health
- The advent of a new tetravalent vaccine against the dengue virus has
thrown new light into the evidence-based management of dengue.
- An article of New England Journal of Medicine revealed that this vaccine
confers about 80% protection to children vaccinated between 4 and 16 years
of age without any major side effects.
- It was a double-blind, placebo-controlled, randomised, multi-centre
trial which included 20,017 participants from the dengue-endemic countries.
- 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.
- Dengue is essentially a tropical disease that occurs in the countries
around the Equator; hot weather and intermittent rainfall favour the
sustenance of Aedes aegypti — the vector transmitting the dengue virus —and
Aedes albopictus, a minor contributor.
- Aedes eggs can remain dormant for more than a year and will hatch once
they come in contact with water.
- Urbanisation, poor town planning, and improper sanitation are the major
risk factors for the multiplication of such mosquitoes.
- Aedes mosquitoes cannot fly beyond a hundred metres. Hence, keeping the
ambience 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.
Shortage of skilled manpower
- Many other source reduction activities can be undertaken, including
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.
- 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.
- Also, dengue cases are often under-reported due to political reasons and
also to avoid spreading panic among the common people.
- 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 epidemiological measures:
- Moreover, epidemiological measures are essential in the management of
any communicable disease.
- Singapore uses one successful model of mapping and analysing data on
dengue, using Geographical Information System (GIS). This involves mapping
the streets with dengue cases for vector densities.
Type of infection:
- Dengue is mostly an asymptomatic infection, and only a very few develop
- Those very young or very old and those who have a chronic ailment are at
a greater risk of developing severe disease.
- But the worldwide case fatality rate is as low as 0.3%.
- The dengue virus has four serotypes and only a second infection with a
different serotype will cause a severe disease. \
- Fluid management is the cornerstone in the management of severe diseases
like dengue hemorrhagic fever and dengue shock syndrome.
- Here, the role of platelet depletion in exacerbating the condition of a
patient is overemphasised even by many medical personnel. \
- Contrary to the common belief, platelet transfusions are not needed even
in cases of active bleeding, as per the guidelines of the World Health
- Coagulation abnormalities are not due to a reduction in the number of
- This is why the WHO recommends fresh whole blood or packed cell
transfusion in the event of bleeding. The platelet count will increase
automatically as fever subsides.
Alternative medicine drugs:
- Despite the adequate and well-formed guidelines for the management of
dengue cases by the WHO and the Indian government, the usage of
complementary medicines like Nilavembu kudineer (a Siddha medicine) and
papaya leaf extract are rampant among the people.
- Nilavembu sooranam, which reportedly contains about nine different
substances, has been widely promoted for use to treat dengue fever despite
the safety of and complex interactions among its different constituents not
having been tested.
- The efficacy of Nilavembu kudineer in the management of several other
diseases is based on very primitive forms of research like case reports,
in-vitro studies, and animal studies.
- There are case reports where Andrographis paniculata, an active
constituent of Nilavembu sooranam, showed anti-fertility effects in animal
models, causing abortion.
- Even meta-analysis of various studies has shown that there is no
credible evidence for the use of papaya extract in dengue fever. \
- For unknown reasons, even some pharmaceutical companies are being
allowed to market papaya extract pills.
- In Tamil Nadu, complementary medicine practitioners often argue that a
proper double-blind, randomised, placebo-controlled trial cannot be
conducted as it involves huge money and manpower.
- Though this argument is partially correct, patients cannot be treated as
guinea pigs. For any medicine, safety is more important than efficacy. \
- Every modern medicine drug has come out after rigorous safety and
efficacy studies for around 10 years, with an informed declaration of the
- Hence, instead of carrying out distribution of medicines like Nilavembu
kudineer, the government can concentrate its energies on other public health
- Modern medicine is not against any complementary medicine; when such a
medicine is approved after rigorous testing, modern medicine will absorb it,
and there are many examples of that.
- However, in the absence of evidence, the efficacy of such medicines
remains in the realm of belief instead of science.
Q.1) With reference to the National Institute of Ocean Technology (NIOT),
consider the following statements:
1. It is an autonomous society under the Ministry of Earth Sciences,
Government of India.
2. Its headquarters is at Kochi.
Which of the statements given above is/are correct?
(a) 1 only
(b) 2 only
(c) Both 1 and 2
(d) Neither 1 nor 2
Q.1)Besides vaccination, what extent to involve efficient vector control and
proper case management to address the dengue disease. Comment.