To help combat the possible spread of dengue due to stagnant waters brought by the recent heavy rains that devastated the province, the School-on-the-Air (SOA) Tarabay iti Pagtaengan, Pagbiagan, Salun-at (TIPPS), ken Dadduma Pay takes part in creating public awareness on this disease.

The lecture on Dengue Fever was conducted on August 2021 with Ms. Mary Ann Magtoto of the College of Health Sciences (CHS), Nursing Department.

According to Ms. Magtoto, the issue on dengue is a year-round concern. It is possible that dengue carrying mosquitos lurk in corners and shady areas especially where there are stagnant waters especially those collected in cans, tires, broken pales, and other similar wastes. However, dengue cases rise during the rainy season especially from June to September due to the abundance of water, hence a conducive breeding season.

The following information were lifted from the lecture of Ms. Magtoto in the SOA Program. 

Dengue Fever

Dengue Fever is a disease caused by dengue viruses spread by the Aedes aegypti mosquito, usually more rampant in the tropical and subtropical areas of the world. The dengue virus (DENV) is a member of the flaviviridae family, genus flavivirus. Four strains called serotypes (DENV 1 to 4) are mainly responsible for dengue fever. Dengue is a single-stranded positive sense virus in the genus flavivirus.

Dengue Transmission

Mrs. Magtoto pointed out salient conditions in the transmission of the dengue virus. She shared that this virus is primarily transmitted through the bite of a striped Aedes aegypti mosquito from a person already infected with the virus. It is not contagious from one person to another, since the primary vector in transmission are mosquitoes.

What happens? Transmission happens when after feeding on a DENV-infected person, the virus replicates in the mosquito midgut, before disseminating to secondary tissues, including the salivary glands. In order to the transmitted to human host during the next blood meal, the DENV must ultimately infect the salivary glands and be shed in the saliva.

The Ae. Aegypti mosquito is well-adapted to an urban environment and is a highly competitive vector due to its anthropophilic nature. This anthropophilic nature means that these mosquitoes are attracted to humans. It thrives in close proximity to humans and is an intermittent feeder implying a high frequency of multiple host contacts during a single feeding. Because of this multiple hosting for feeding, the female mosquito can infect multiple persons in order to complete a single blood meal.

Usually, mosquitoes are usually up for blood meal in the morning, at least two (2) hours after sunrise (around 8:00 am) and two hours before sunset (around 4:00 pm). Avoiding areas where they may be hiding is essential in reducing chances of dengue transmission. 

Moreover, measures to eliminate possible breeding areas of mosquitoes are recommended. Mosquitoes, especially the Aedes aegypti, breed inside homes, especially in dark and humid areas such as closets, under beds, bathrooms, and other similar spots.

Signs and Symptoms of Dengue Fever 

Symptoms of dengue fever usually appear from the four to six days after infection and may last for up to 10 days. Symptoms include the following:

• Severe headache
• Sudden onset of high, recurring fever, sometimes reaching up to 40 °C or 104 °F
• Recurring fever
• Pain behind the eyes
• Severe joint and muscle pain
• Low back pain
• Skin rash, which appears two to five days after the onset of fever

Danger signs of dengue fever also include severe headache, stomach pain, and vomiting.

In addition to these, Mr. Magtoto also shared that the Department of Health forwards three classification of dengue fever: 1) Dengue without warning, 2) Dengue with Warning, and 3) severe dengue. Dengue without signs can be further classified into three laboratory sign and symptoms and laboratory tests: a) suspect dengue, b) probable dengue, and c) confirmed dengue. Suspect dengue cases assume a previously well and healthy person with acute fibral illness from 1-7 days with at least two dengue symptoms surfacing such as headache, body malaise, retro-orbital pain or the pain when moving the eyes, myalgia or muscle pains, arthralgia, anorexia, nausea, diarrhea, or rashes. Probable Dengue are suspect dengue case intensified by laboratory tests, Dengue NS-1 antigen test and CBC showing low white blood cell count. Confirmed dengue cases are suspect or probable cases with positive result of viral culture.

Dengue with warning signs assumes a previously well and healthy person with acute fibral illness form 1-7 days coupled by any of the following: abdominal pain or tenderness, persistent vomiting, fluid accumulation in the abdomen, mucosal bleeding, bleeding of gums, lethargy, liver enlargement, increase of hematocrit, and the decline of platelet count.

Severe Dengue cases are characterized by severe plasma leakage that may cause shock and fluid accumulation with respiratory distress and accompanied by severe bleeding that may cause severe organ impairment. It may affect the liver, the central nervous system, heart, kidney, and other vital organs.

Dengue Infection and Progression

Dengue progresses in three phases: 1) the febrile phase, 2) the critical phase, and 3) the recovery phase.

• Febrile Phase. This phase lasts up to seven days. In this phase, there are mild haemorrhage manifestations, red dots in the skin, and mucosal membrane bleeding. Monitoring of warning signs is crucial to recognize its progression to critical phase. 
• Critical Phase. This is most dangerous phase of dengue fever. This is where one progresses into recovery or a more severe case. This is where defervescence occurs between 3-7 days of illness. This is period where the fever lowers to almost normal. Those who improve after defervescence will be categorized as Dengue without Warning Sings. Those who will deteriorate and manifest warning signs will be categorized as Dengue with Warning Signs or may even progress to severe dengue.
• Recovery Phase. This phase happens in the next 48 to 72 hours where the body fluids go back to normal. The white blood cell count will slowly rise after defervescence but the normalization of platelet count is usually later after the white blood cells.

Management of Dengue Fever

According to Ms. Magtoto, there are three management schemes for dengue fever: Group A, Group B, and Group C.

Group A are those patients who may be sent home because they are able to drink plenty of water, can pee every 6 hours, without warning signs of dengue yet, or has lowered fever, or when the hematocrit is still normal.

Group B are the patients who should be referred to in-hospital management. They have warning signs, without warning signs but with co-existing conditions that may make dengue or its management more complicated such as pregnancy, infancy. Old age, obesity, diabetes mellitus, hypertension, heart failure, renal failure, cell disease, and other auto-immune diseases.

Group C are patients with severe dengue requiring emergency treatment and immediate referral. The have warning manifestations of severe dengue because they are in the critical phase of the disease and have the following: severe plasma leakage leading to dengue shock and fluid accumulation with respiratory distress, severe hemorrhages, severe organ impairment such as liver, kidney, heart, and the brain.

For typical dengue, treatment is purely concerned with the relief of the symptoms, rest and fluid intake for hydration. Home care for dengue include adequate bed rest, adequate fluid intake, paracetamol for fever, elimination of mosquito breeding places, and tepid sponge for those with fever ranging from 37.8 to 38.5 °C. When a patient has dengue fever, avoid aspirin, mefenamic acid, steroids because these may aggravate bleeding.

Preventing Dengue Fever

According to Ms. Magtoto, cleanliness and sanitation are integral components in keeping the family and community safe from dengue-carrying mosquitoes and dengue. Regularly check on flower vases, trash cans, bins, tires, and other potential breeding places of mosquitoes. Setting a weekly cleaning for water containers to ward off possible larvae breeding in the water.

For personal protection, Ms. Magtoto also advised the use of long sleeves and long pants especially in the peak biting season and biting hours of mosquitoes and the use of mosquito-repellant sprays. For household protection, window screens are also recommended as well as insecticide-treated materials, and mosquito nets when sleeping.

When symptoms of dengue are observed, consulting a doctor is highly recommended.

Dengue Prevention 

In the end, Ms. Magtoto “Prevention is better than cure”. This adage highlights an initiative to combat the breeding and reproduction of dengue-carrying mosquitos. As such, she emphasized the 4S program of the Department of Health, locally known as the Oplan Taktak to securing a clean and safe environment. The 4S against Dengue stands for:

• Search and Destroy Mosquito Breeding sites. Remove stagnant waters in cans, tires, jars, and water accumulating wastes to lessen possible breeding areas of mosquitos. Proper disposal of wastes is also encouraged.
• Seek early consultation. When symptoms arise, immediate consultation with doctors and health workers is recommended.
• Secure self-protection measures. Use clothing that expose less skin and spray mosquito-repellants at home.
• Support fogging or spraying in hot spot areas. Fumigate possible breeding areas and corners where they may be hiding.

For the full recording of the airing, click at: https://bit.ly/3ztYewO

We also invite you to like and follow our Facebook Page, MMSU Extension Directorate (@MMSUExtensionOfficial), including our FB Account, Mmsu Extension Directorate (https://www.facebook.com/extension.directorate).

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