Explained: How India Is Fighting The Dengue Outbreak

The Union health ministry has appointed central teams of experts in around nine states and union territories (UTs) to assist them in managing the outbreak of dengue. Expert teams include officials from the National Centre for Disease Control and National Vector Borne Disease Control Programme.

These teams will provide technical guidance, including public health measures, to health authorities in states. The decision was taken in view of the dengue outbreak in different parts of the country.

How did it become an outbreak?

Considerably, the large number of cases were first reported in September this year in India¡¯s most populous state, Uttar Pradesh. As per the reports of India Today, the number of dengue cases has reached 6,488, out of which 70 per cent of cases were reported in the months of August and September. The most affected area is Firozabad, where more than 60 people have died so far. However, according to the local reports the death toll is as high as 100.

The government denies the numbers and attributes zero dengue deaths in the district which, experts believe, is because of poor disease surveillance in Uttar Pradesh.

Only those patients who were tested and confirmed to be infected with dengue before they died are officially counted as dengue deaths. Even then, districts hold a death audit meeting to assess whether dengue was the cause of death.

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While the monsoon season typically sees some cases of dengue, lack of precautionary measures and poor management by the authorities have led to a sharp rise in the cases this year.

Similarly, the cases have since September been detected in the nearby state of Madhya Pradesh along with Haryana, Punjab, Kerala, Rajasthan, Tamil Nadu, Uttar Pradesh, Uttarakhand, Delhi and Jammu and Kashmir also witnessing the surge.

Further, the disease has also claimed 33 lives in Chandigarh. In fact, the number of cases reported in October this year is even higher than the annual caseload in the previous three years across the tricity. The emergency wards in hospitals are overflowing with patients suffering from fever.

"A total of 15 states/UTs are reporting their maximum cases in the current year; these states contribute 86% of the country¡¯s total dengue cases till October 31," the Centre said in a recent press release.

How is Delhi coping?

Over 1,530 cases of dengue have been reported in Delhi this year so far, of which nearly 1,200 were recorded in October alone, the highest count for the month in the last four years.

Moreover, cases of malaria, chikungunya and viral fever are also rampant during this season. The data collated by the municipal body of Delhi show a total of 57 cases of malaria and 32 cases of chikungunya have been reported in the capital so far.

How does it spread, and what are its symptoms?

Dengue is transmitted by several species of mosquitoes within the genus Aedes (Ae.). Aedes is a day time feeder and can fly up to a limited distance of 400 meters.

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Symptoms include fever, headache, muscle, and joint pain, and a characteristic skin rash that is similar to measles. There are four types of dengue strains, and type II and IV are considered to be more severe and normally require hospitalisation. According to experts, the aedes mosquito breeds in clean stagnant water.

Every year, from July to November, an upsurge in cases of dengue is observed. The disease has a seasonal pattern, i.e., the peak comes after monsoon and it is not uniformly distributed throughout the year. Dengue mosquitoes can¡¯t breed once the temperature falls below 16 degrees.

Which tests are conducted to detect dengue?

IgM and IgG antibodies test and NS1 antigen test. Both are done through ELISA kits and hence are popularly known as the Elisa test.

IgM and IgG test for dengue antibodies detected in an initial blood sample, meaning that it is likely that the person became infected with dengue virus within recent weeks.

This test is normally done after 3-7 days of fever while NS1 antigen test is a test for dengue, which allows rapid detection on the first day of fever, before antibodies appear. Both tests are card tests which give instant results.

The Punjab government has fixed a cost of Rs 600 for these tests in private hospitals while they are free in government hospitals. However, there are limited kits in government institutions, which is forcing patients to run to private labs.

How to control the spread?

The main strategy to control the spread of dengue is vector control, which aims to reduce the size of mosquito populations. Around 25,000 mosquitofish have been released into ponds and lakes in Western Uttar Pradesh. Each mosquitofish can eat up to 150 larvae in only eight hours. It is important that this is complemented by an intensified environmental management strategy to destroy any potential breeding sites, such as the removal of any container that can collect water.

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Some districts in East Delhi have launched widespread campaigns of insecticide spraying, known as 'fogging', while other districts continue with inaction as the situation grows progressively worse. Close monitoring and surveillance of the situation is critical to mitigate the outbreak and prevent further spread to neighbouring regions, and an urgent strategic response is required by the government to contain the dengue outbreak, especially during the Covid-19 pandemic.

Is there a vaccine for dengue?

No. There's no vaccine for dengue in India. However, as per the Centres for Disease Control and Prevention (CDC), a dengue vaccine is available in the US for children aged 9 to 16 years.

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