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Dengue still major threat despite lower death rate
Dengue infection remains a major health threat in Indonesia due to difficulties in diagnosis and treatment, while the incidence of the mosquito-borne disease increases
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engue infection remains a major health threat in Indonesia due to difficulties in diagnosis and treatment, while the incidence of the mosquito-borne disease increases.
Sri Rezeki S. Hadinegoro, a professor of pediatric infectious diseases at the Department of Medicine at the University of Indonesia, said recently that dengue cases in Indonesia had steadily increased since the first case was reported in 1968.
“We have a growing number of dengue cases although we have been able to decrease the disease’s mortality rate,” she told The Jakarta Post on the sidelines of a three-day symposium titled “Human Genetics and Infection: Towards Better Management of Disease”.
The symposium was held by Eijkman Institute and the NITD-Eijkman Institute-Hasanuddin University Clinical Research Initiative (Nehcri).
Globally, more than half of the world’s population is living in areas at risk of infection, with the incidence growing 30-fold in the last 50 years.
Climate change is likely to make dengue spread more widely.
Sangkot Marzuki of the Eijkman Institute said changes in temperature and rainfall worldwide might create more conducive breeding grounds for disease spreading mosquitoes. “Increased rainfall as a result of climate change could lead to an increase of dengue cases,” he told the Post, adding that Queensland in the northern part of Australia recently experienced its worst dengue epidemic since WWII.
According to the Health Ministry, Indonesia’s dengue incidence rate in 2009 was 67 per 100,000 people, with a 0.86 percent mortality rate, lower than the 1 percent projected by the government.
The mortality rate these days, however, is still quite high, partly resulting from delayed diagnosis and treatment.
“It’s not easy to diagnose dengue due to the fact it is a dynamic systemic disease that has a wide clinical spectrum, from mild to severe,” said Sri Rezeki.
She said the lack of specific clinical parameters in dengue infection created difficulties in diagnosis.
Dengue has several signs and symptoms such as headache, muscle pain (myalgia), vomiting and abdominal pain, which can also be found in other viral diseases.
“In the early stages, dengue has similar symptoms to other infectious disease, such as high fever, which can be found in other viral diseases like measles and influenza,” she said.
Dengue can be accurately confirmed through a laboratory test. Mild and severe clinical dengue infections can also be confirmed through a rapid antigen detection test and antibody antidengue serological test, both of which are readily available here.
However, many people, especially those from low income families, might not be able to afford such examinations. A serological test, for example, costs Rp 200,000 (US$22).
“So, apart from the use of laboratory parameters, we should clinically monitor the illness through the febrile, critical and recovery phases, which is important to establishing a diagnosis of dengue infection,” said Sri Rezeki.
She added that people had an important role to play in preventing dengue infections by curbing the spread of the mosquitoes. “We have to root out all mosquito larvae by carrying out better vector control,” she said. “Eradication of larva breeding places is the most important thing.”
Isra Wahid of the Department of Medicine at Hasanuddin University in Makassar, South Sulawesi, said better vector control had decreased the number of dengue cases in Makassar.
Dengue was first reported in Makassar in 1975. The number of cases increased to 1,166 cases per year during 1999-2006, despite routine vector control.
However, a new vector control approach introduced in mid-2006 decreased reported cases to around 350 per year during 2007-2010.
This new vector control approach consists of an adjustment in fumigation practices so that fumigation is done before the peak dengue season and before cases are reported. (ebf)
