Dengue in Nepal

Dengue is a viral infection transmitted to humans through the bite of infected Aedes mosquitoes (to a lesser extent, Ae. albopictus). Dengue is widespread in tropical and subtropical climate globally. Dengue is caused by a virus dengue virus from a Flaviviridae family. There are four distinct, but closely related, serotypes of the virus that cause dengue:- DENV-1, DENV-2, DENV-3 and DENV-4). Recovery from infection is believed to provide lifelong immunity against that serotype. However, cross-immunity to the other serotype safter recovery is only partial, and temporary. Subsequent infections (secondary infection) by other serotypes increase the risk of developing severe dengue.

Dengue should be suspected when a high fever (40°C/104°F) is accompanied by 2 of the following symptoms during the febrile phase (2-7 days):

• Severe headache
• Pain behind the eyes
• Muscle and joint pains
• Nausea
• Vomiting
• Swollen glands
• Rash. 

Severe dengue

A patient enters what is called the critical phase normally about 3-7 days after illness onset. During the 24-48 hours of critical phase, a small portion of patients may manifest sudden deterioration of symptoms. It is at this time, when the fever is dropping (below 38°C/100°F) in the patient, that warning signs associated with severe dengue can manifest. Severe dengue is a potentially fatal complication, due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment.

Warning signs that doctors should look for include:

• severe abdominal pain
• persistent vomiting
• rapid breathing
• bleeding gums or nose 
• fatigue
• restlessness
• liver enlargement
• blood in vomit or stool. 

Treatment

There is no specific treatment for dengue fever. Patients should rest, stay hydrated and seek medical advice. Depending on the clinical manifestations and other circumstances, patients may be sent home, be referred for in-hospital management, or require emergency treatment and urgent referral.

Supportive care like fever reducers and pain killers can help to control the symptoms of fever, muscle aches and pains.

• The best options to treat these symptoms are acetaminophen or paracetamol.
• NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen and aspirin should be avoided. These anti-inflammatory drugs act by thinning the blood, and in a disease with risk of hemorrhage, blood thinners may exacerbate the prognosis.

For severe dengue, medical care by physicians and nurses experienced with the effects and progression of the disease can save lives – decreasing mortality rates to less than 1% in majority of the countries.

Based on the situational analysis of Epidemiology and Disease Control Division (EDCD) published on 27th of September, the trend of dengue cases in Nepal is shown in the chart below:

The number of dengue cases reached highest in the year 2022. The cases are highest in Bagmati province followed by Lumbini province.

The number of dengue cases in this year is highest in Kathmandu Metropolitan City followed by Lalitpur and Makwanpur.

References:

1. https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

2. https://edcd.gov.np/news/situation-update-of-dengue-2022