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Dengue,The Menace Which It Is Not!

There is a very thin line between increasing awareness and generating panic. Most of the discussions, especially on electronic media, on epidemics of diseases of larger public interest manage to cross this line. And in many of these discussions, the anchor forgets his role and assumes the role of dictating the discussion rather than moderating it. There is such a forceful attempt to force personal views that the spirit of discussion is the casualty.
The discussion on these diseases should focus on the preventive aspects, on dissemination of information of red flag or danger signs as they are called, to make people aware and report in time for a proper management that could stall the interminable progress of the disease.

Perspective on dengue!
Dengue is a viral illness and like any other viral illness is vastly a self limited and minor illness. The symptoms are very nondescript and non specific.And like so many viral diseases there is no specific medicine (Or ANTIDOTE, as people will certainly love to have one!) against the viruses (there are 4 of them) causing this.
Today about 2.5 billion people, or 40% of the world’s population, live in areas where there is a risk of dengue transmission. Dengue is endemic in at least 100 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean. The World Health Organization (WHO) estimates that 50 to 100 million infections occur every year, including 500,000 severe cases and 22,000 deaths, mostly among children. If I translate it in terms of probabilities, you have 40% risk of contracting dengue if you are in the elite at risk group,you have only 0.5% risk of developing a serious form of the disease which is now called serious dengue, and those of us who are unfortunate to not to recognize the march of events and allow the relentless progress, a 3-4% risk of dying. The proportion case fatality is 220 per million cases of dengue, 0.022%! Each death is important, I shall say each life is important, and more so if the death is preventable to a large extent, but to subject millions of people to the terror of what in the end is a trivial, self limiting disease is a gross exaggeration in trying to make people aware.

The focus should be on what are the red flag signs!
Dengue fever causes moderately high grade fever, rash with severe aches, mostly severe backache (colloquially called back breaking fever) pain behind the eyes. Following this there is an apparent phase of improvement and in severe forms there will be vomiting, pain in abdomen, some red spots appearing, and reduction in urine output, change in alertness and in some bleeding. The biggest problem in serious dengue is a leak in our minute blood vessels, the capillaries. The fluid starts leaking out in to various tissues, effectively reducing the volume that is in the circulation and causing a drop in blood pressure and its entire attendant sequel.
The erroneous emphasis has shifted on to platelet drop in Dengue. Everyone seems obsessed with the numbers. The blood donation camps send the signals that this is the most important aspect of management which is life saving! NO IT IS NOT! Platelets are required in only a very few cases of severe dengue, they may do more harm than good. When a patient has serious bleeding he may require other things than platelets.
The central theme is basically fluid management in severe dengue, monitoring patient’s urine output, blood pressure and his hemoglobin level.
The message should be loud and clear, do not panic! If you are suffering from dengue, take plenty of water and keep count of how many times you void. In case of any thing that bothers you see a doctor sooner than later. Do not get platelet count every day, do not worry about numbers.


Dr. Sanwar Agrawal is the Director of Ekta Institute of Child Health and a renowned pediatrician of the city. After completing his post graduation from PGIMER Chandigarh, one of the best institutions in the country, he contributed remarkably in the field of health.
Connect to your hero Dr. Sanwar at drsanwar50@gmail.com


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