Dengue Strain 3 is on the rise!

With schools re-opening after a long time, there could be many mosquito breeding sites in the premises such as inside pipes, in car parks, in nooks and corners of the buildings. Therefore, Dr Deepal Perera, Consultant Paediatrician at the Lady Ridgeway Hospital for Children, stated that it was very important these sites were thoroughly cleaned. “Not only in schools, even in houses every area should be thoroughly cleaned inside and outside. Especially areas like the pipelines in roofs and other areas where water could be collected. Even neighbouring areas should be kept clean. Sometimes there could be construction sites in the vicinity which could also be mosquito breeding sites. PHIs should be informed and such areas should be cleaned,” he shared. If mosquito breeding sites aren’t cleaned and removed, there is a risk of children getting infected with diseases like dengue. According to Dr Perera, Dengue strain 3 is on the rise as it currently accounts for 39% of dengue cases while strain 2 which has been the primary strain in Sri Lanka for the past few years accounted for 41% of dengue cases. According to the Epidemiology Unit, 502 cases of dengue have been reported so far in 2022.

“Since dengue is endemic to Sri Lanka, it is very common to see it in many patients especially in very young children, those below 7 years of age. Currently, it is a cause for concern as we see more patients progressing to severe dengue stage very early on,” revealed Dr Perera. Usually, around day 4 or 5 after the onset of dengue, the patient would go into either dengue haemorrhagic fever or dengue shock syndrome but currently, more patients go into this condition on day 2 or 3 after the onset. He noted that samples of every dengue patient does not undergo the strain identification process, so it cannot be stated clearly that this was a feature of strain 3. 

Early symptoms of dengue

• Headache
• Fever
• Body ache, joint pain, pain inside and around the eyes, abdominal pain
• Skin rashes
• Nausea 

Testing for dengue

• 24h after onset- Dengue Antigen Test 
• 3- 4 days after onset- Full Blood Count
• 5 days after onset- Dengue Antibody Test

Dr Perera noted that it was important that the testing was done at the correct time because if the antibody test is done in the early stages, the test would not help determine dengue as the antibodies would not be present until 5 days after onset. “It is extremely important to detect dengue early using proper testing methods. In the early stages, the antigen test mostly comes positive. The platelet count and white blood cell count also will be low at the beginning. We monitor the patient’s fluid intake, urine output, blood pressure, pulse rate. If the blood count is low, we do an ultrasound scan and see if there is a leakage. If there is a leakage, the child has to be monitored carefully because the child can go into shock,” Dr. Perera explained. He also stated that research is currently underway regarding dengue vaccines but currently no vaccines were available against dengue.

He shared that mortality rate of dengue had dropped drastically, and it currently at 0.1% but 20- 30 years ago it was at 10%. “The mortality rate and the disease severity can be lowered if dengue is detected early. Parents are afraid to bring the children to the hospital due to the COVID-19 protocols like PCR and RAT testing, but we urge parents to bring in the child immediately if he/she has early symptoms of dengue,” he said. 

However, Dr Perera emphasized on the importance of keeping surroundings clean and free from mosquito breeding sites to prevent dengue. He encouraged thorough cleaning and usage of bio-control methods such as gappi fish that eat mosquito larvae, rather than using fogging and chemical insecticides. “Parents should remember that if someone is infected with dengue, certain species of mosquitos can transmit the dengue virus from the infected individual to someone else,” he said, emphasising on prevention.