THOUGH already seen as endemic in the Philippines, dengue continues to be a serious threat to the health—and lives—of many people all over the world. Over the last 50 years, the incidence of dengue has increased 30-fold and has expanded its reach to more countries, with an estimated 100 to 400 million infections recorded annually, though 80 percent of them are seen as mild and asymptomatic.
Despite it being endemic already in the country, there are still dengue cases that become severe thereby causing deaths. This disease, transmitted by infected Aedes aegypti mosquitoes, will not go away, so what’s critical in avoiding dengue deaths are proper diagnosis, early intervention and clinical management, especially at its onset in the first few days.
Dengue in the PHL
DR. Rontgene Solante, Chairman of the Adult Infectious Diseases and Tropical Medicine section of the San Lazaro Hospital in Manila, said during the recent Stop C.O.V.I.D. Deaths webinar titled “Nakakamatay Ba Ang Dengue? Update on Clinical Management of Dengue” organized by the University of the Philippines, the UP Manila NIH National Telehealth Center and UP Philippine General Hospital (UP-PGH) that the country has always been a country considered as a threat for any increase in the number of dengue cases.
He said transmission has been documented all year round and even before 2003 up to 2013. During the rainy season, cases will be higher than expected. The Department of Health (DOH) said anyone is vulnerable, and the highly vulnerable ones are those 25 years and below.
Dr. Solante said in 2020, the World Health Organization (WHO) mentioned that the Philippines is one of those countries with the highest number of dengue cases during its 2019 surveillance report, with higher mortality and higher case fatality rate. “The WHO’s initial report in 2018 said one of the major gaps is the delay in the institution of appropriate therapeutic modalities. Overhydration among patients was also one of the causes of mortality. The DOH released an administrative order to update and form an informed standardized protocol for doctors, whether in private or government facilities in the diagnosis and treatments of dengue,” Dr. Solante pointed out.
Common causes of mortality
THE findings of the WHO Dengue Mission Activity in the Philippines in July 2018 revealed that the three most common causes of mortality are delay in presentation to the health care system resulting in delayed admission to tertiary centers where most of the time, patients are already in severe form of dengue, leading to delayed institution of appropriate rehydration, and delay in instituting appropriate rehydration measures in hospitalized patients, where there were gaps in fluid hydration; and fluid overload.
The report, he said, also emphasized important measures for consideration to alter and decrease mortality of suspected dengue patients. These involved the early diagnosis and indication for admission, early detection of plasma leakage and time-sensitive institution of fluid rehydration, the investigation and correction of common complications in case patients do not respond to conventional IV fluid therapy, the early detection of bleeding and early blood transfusion, then early diagnosis in cases with unusual manifestations, especially those with encephalopathy or the presence of co-morbidity or other superimposed bacterial infections.
Management gaps
HE ADDED that in 2020, the DOH formed a Technical Working Group to review some of these gaps in dengue management, one of which is the incorporation of innovative diagnostic modalities such as the Dengue NS1 antigen rapid diagnostic test. “This will somehow help us diagnose the patient with dengue and I think this has been implemented in the primary health care setting, that it should be readily available so that physicians will have a very good diagnostic tool to confirm it at the level of the primary care center.”
Dr. Solante also cited a journal of infectious diseases regarding lessons learned in case management of dengue that listed a host of problems and proposed solutions when it comes to clinical management to reduce dengue Case Fatality Rate (CFR). Some of those problems include improper diagnosis and triage of dengue, to be solved by earlier recognition and clinical/laboratory diagnosis, improper recognition and management of plasma leakage, with optimal fluid management as a solution, improper recognition and management of bleeding, with optimal transfusion as possible solution, while complications of multiple organ failure can be solved through earlier recognition and management of severe dengue to avoid prolonged shock.
“The key to dengue management has always been reducing mortality and morbidity by recognizing the disease phase the patient is experiencing. It is also essential that patients, parents or guardians, and clinicians are cognizant of the warning signs and symptoms. It is also important for clinicians to recognize early the presence of dengue and at the same time look for some of the warning signs that will somehow educate the patient and clinicians to anticipate so they should be appropriately managed,” he explained.
# # #
Image credits: Freepik.com