The COVID-19 epidemic has not slowed the onset of seasonal dengue fever across the country. The country has been battling dengue fever since early this year, at a time when state resources have been spent on curbing the COVID-19 outbreak. The similarities between dengue fever and COVID-19 symptoms have also complicated efforts to mitigate the annual spike in cases. The island of Java has contributed the highest average number of dengue hemorrhagic fever cases each year. In recent years, Bali and Borneo (Kalimantan) have had the highest incidence.

Beyond Corona: Dengue Fever Cases in Indonesia, how can we interact?

A Covid-19 patient can also get dengue fever, which is also caused by a virus and for which there is no known cure. Vaccines are not effective against dengue fever.

However, symptoms of dengue fever are different from those of Covid-19.
Dengue occurs is spread by mosquito bites and is due to the infection by a flavivirus which is transmitted by the bite of the ***Aedes aegypti mosquito. This mosquito bites during the daytime.

General information

In 2020, there were 35,315 reported cases of dengue fever and dengue hemorrhagic fever in Indonesia. This was a steep increase from the number of cases reported in 2019, which was 15,998. The reported cases do not reflect by far the real number of Dengue cases because a huge part of the population living in rural areas do not all have a birth certificate, identity card or family record book!

Dengue fever is typically a self-limited disease with a mortality rate of less than 1% when detected early and with access to proper medical care. When treated, severe dengue has a mortality rate of 2%-5%, but, when left untreated, the mortality rate is as high as 20%. This mortality rate of 20% is that in force in the most rural and poorest regions. Those where access to care is almost inexistent, economic resources at the lowest.

Dengue fever is most common during the rainy season (November-May) as Aedes mosquitos require clean standing water to reproduce. The peak of the season is usually from March through May.

Dengue haemorrhagic fever (DHF) was first recognised in Indonesia in the cities of Jakarta and Surabaya in 1968. There is no vaccine against dengue fever, though several are in development. This mortality rate of 20% is that in force in the most rural and poorest regions. Those where access to care is almost inexistent, economic resources at the lowest.

Key facts about Dengue

1. There is no specific treatment for dengue/severe dengue;
2. Dengue isn’t spread from person to person;
3. Dengue is spread by infected mosquitoes, usually the Aedes aegypti and Aedes albopictus varieties;
4. These mosquitoes bite during the day, usually early in the morning or in the early evening before dusk. They’re often found near still water in built-up areas, such as in wells, water storage tanks or in old car tyres;
5. The global incidence of dengue has grown dramatically in recent decades. About half of the world’s population is now at risk. There are an estimated 100-400 million infections each year;
6. Dengue prevention and control depends on effective vector control measures. Sustained community involvement can improve vector control efforts substantially;
7. Dengue fever can cause spontaneous bleeding, such as nosebleeds, red spots, and bleeding gums. Only around 10 to 15 percent of patients develop a cough and, unlike Covid-19 patients, they don’t experience respiratory problems;
8. Dengue fever symptoms also include eye pain, headache, continuous vomiting, increased red blood cells, and a low platelet count (under 100,000 platelets*);
9. The disease can infect people of all age groups, but most dengue fever patients in Indonesia this year in 2020, have been teenagers;
10. A lot of teens suffering from dengue fever come to the hospital already in critical condition. Many of them are in hypovolemic shock or lacking fluid. They refuse drinks because it makes them vomit so they suffer from dehydration.

Dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS)

A rare complication of dengue fever, DHF occurs most often in small children and elderly adults. If DHF occurs, it will usually do so by day 3-5 of infection. The relationship between DHF and previous dengue infection has not been clearly established, but previous exposure to dengue is correlated with subsequent DHF. Uncontrolled bleeding distinguishes DHF from fever accompanying a dengue infection. Bleeding can occur from the gums, nose, intestine, or under the skin as bruises or spots of blood, especially under a tourniquet.

In children, the progression of the disease is not always characteristic. A relatively mild first phase with an abrupt onset of fever, malaise, vomiting, headache anorexia, and cough is succeeded 2-5 days later by weakness and, sometimes, physical collapse. Frequently, spots appear on the forehead, arms, and legs, along with spontaneous bruises and bleeding from punctures where blood was taken. A seriously ill child may breathe rapidly and with considerable effort; the pulse may be weak, rapid, and thready.

The criteria for DHF are a platelet* count of less than 100,000 and a **hematocrit 20% greater than normal. Children with similar blood indicators should be hospitalised immediately and managed for potential DSS. The syndrome can be lethal and requires rapid in-hospital management with assiduous correction and replacement of fluid, electrolytes, plasma, and sometimes fresh blood/platelet transfusions. Mortality due to DHF and DSS ranges from 5-30% in the untreated Indonesian population, with the highest risk category being infants under one year of age.

Symptoms of dengue – Usually develop suddenly, about 5 to 8 days after you become infected

1. A high temperature, or feeling hot or shivery
2. A severe headache
3. Pain behind the eyes
4. Muscle and joint pain
5. Feeling or being sick
6. A widespread red rash
7. Tummy pain and loss of appetite
8. The symptoms normally pass after about 1 week, although you may feel tired and slightly unwell for several weeks afterwards.

Treatment

1. There is no preventative treatment for the dengue virus. Its symptoms can and should be treated, but there is no medicine or commercially available vaccine for the virus. Vaccine candidates are going through clinical trials in many countries, but a safe vaccination protocol is not expected for some time.
2. It has been suggested that DHF is more likely if the patient has previously been infected by dengue fever within the last 8-12 months and that the likelihood of DHF relates to this previous “sensitization”.
3. To avoid getting dengue fever or DHF, you must avoid getting bitten by day-biting mosquitos.
4. Convalescence can take weeks, and bed rest and antipyretics and analgesics are required. An attack produces immunity for a year or more, but only to one of the four flavivirus strains responsible for the initial illness.
5. In an epidemic, the emergency control measure is mosquito insecticide applied outside by vehicle-mounted or portable ultra-low-volume generators a minimum of twice a day at ten-day intervals;
6. Take paracetamol to relieve pain and fever. Do not take aspirin or ibuprofen, as these can cause bleeding problems in people with dengue;
7. Drink plenty of fluids to prevent dehydration – if you’re currently abroad, only drink bottled water from a bottle that was properly sealed;
8. Get plenty of rest

Prevention

1. There are currently no vaccines;
2. The best method of prevention is to avoid mosquito bites;
3. Use insect repellent – products containing 50% DEET are most effective, but a lower strength (15 to 30% ****DEET) should be used on children, and alternatives to DEET should be used on children younger than 2 months;
4. Treatment is possible if diagnosis occurs before the patient develops DSS or DHF;
5. If you live in Indonesia, have your home sprayed. If you’re visiting Indonesia, hati-hati (be careful);
6. Common sense precautions can protect you from this day-biting mosquito;
7. Be aware of your environment – Mosquitoes that spread dengue breed in still water in urban areas;

Fair Future and its teams make a lot of prevention. Give explanations to communities in order to avoid illness, especially for young children.