The economic cost of dengue. Learn more about hidden dengue expenses.

Uncovering the hidden economic cost of dengue

Estimating the economic cost of dengue has never been easy. After all, in addition to the cost borne by public healthcare systems, there’s also families’ economic loss to consider. And for patients who don’t attend health facilities, the disease and its cost often remain hidden. A recent study used data gained from dengue vaccine trials to look at the cost of dengue in the children participating in that trial, comparing findings between those who had been vaccinated against the disease and those who hadn’t.

Over the years we’ve regularly looked into the burden of dengue. Our 2016 infographic on the cost of dengue, estimated the average cost of an individual dengue case to be US$151, with a total annual global cost of US$8.89 billion.

Back further, in 2009, World Health Organisation Guidelines for dengue diagnosis, treatment, prevention, and control quoted research into the economic cost of dengue conducted in eight countries in the Americas and Asia in 2005 and 2006. Looking only at visible cases, it noted that “a treated dengue episode imposes a substantial expense on both the health sector and the overall economy.”

Making use of secondary data

Last July, we discussed a novel opportunity for examining the true burden of dengue: dengue vaccine trials.

A recent study published in the American Journal of Tropical Medicine and Hygiene made the best use of one such opportunity. “Resource Use and Costs of Dengue” analyzed data relating to 1,279 confirmed dengue cases in children gathered during two trials that were part of a dengue vaccine phase III efficacy study of more than 30,000 children aged between 2 and 16 years in which some of the children received the dengue vaccine.

“We evaluated the difference in dengue costs between vaccinated and not vaccinated children based on data gathered during a dengue vaccine efficiency trial,” said Laurent Coudeville, senior researcher at CRESGE (Université Catholique de Lille) and modeling director at Sanofi Pasteur. “Because of that, the children may have been treated a little differently to how they would have been treated in clinical trials.”

The trials took place across five countries in the Asia-Pacific region (Indonesia, Malaysia, Philippines, Thailand, and Vietnam) and five countries in Latin America (Brazil, Colombia, Honduras, Mexico, and Puerto Rico). During the 25-month dengue surveillance period, both vaccinated and unvaccinated children contracted dengue: of the 901 confirmed cases of dengue among children aged nine years and above, just 373 of cases were in vaccinated children.

Beyond public costs

The report examined both the cost to public healthcare systems and the losses families suffered. After all, when a child catches dengue, they need an adult to look after them until they recover and that person will often need to give up work during that time.

To calculate average costs for both healthcare systems and families, it gathered information on:

• where the child received medical help
• how they got there – by ambulance, taxi, car, motorbike or public transport
• any consultations, examinations, medications or tests they received
• the school days they missed, and the days their caregivers missed from work

“We documented not just cost but also resource utilization: whether someone went to the hospital, how many consultations they had and whether someone had to stop working,” says Laurent.

These were then adapted to take account of the cost of living in the country where the child lived. “We adapted the costs based on each country, for example, how much one hospitalization day or one consultation would cost there,” says Laurent. “What you can get with a US dollar (US$) varies from one country to another so to be able to compare costs, we used the international dollar (I$), which aims to correct for that.”

The economic costs of dengue: what the study found

Of the 1,279 confirmed cases, 901 were in children aged between 9 and 16. In the 528 of the 901 cases where the child had not been vaccinated against dengue fever, the disease led to:

• 0.5 days in hospital at an average cost of 2014 I$147.79
• 2.5 consultations with an average total cost of 2014 I$168.70
• 2.2 missed school days
• 0.5 lost workdays for parents or carers with an average lost wage of I$88.01 (2014)
• I$4.30 in travel costs (2014)

In the remaining 373 cases, the child had been vaccinated against dengue. The disease resulted in:

• 0.3 days in hospital at an average cost of 2014 I$77.90
• 2.4 consultations with an average total cost of 2014 I$160.05
• 1.8 missed school days
• 0.5 lost workdays for parents or carers with an average lost wage of 2014 I$68.31
• I$4.07 in travel costs (2014)

The study confirmed the WHO view that “If a vaccine were able to prevent much of this burden, the economic gains would be substantial.” It found that for each dengue case, vaccination led to an average:

• 43% drop days in the hospital, reducing costs by an average 47%
• 4% drop in consultations, reducing costs by an average 5%
• 18% drop in missed school days
• 33% drop in lost workdays for parents or carers, reducing lost wages by an average 22%
• 5% drop in travel costs

The incidence of dengue was also lower in the vaccination group, further reducing overall costs to that group of children.

We want to hear about your experience with vaccine prevention tools. How successful were they in your fight against dengue?

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Multiple serotypes increasing risks in dengue outbreak in Burkina Faso

A dengue outbreak in Burkina Faso that began in early August has resulted in more than 12,000 infections and 24 deaths. The country’s National Epidemic Management Committee is addressing the inadequate dengue surveillance and limited access to dengue diagnostics tools. But this outbreak is very different from past outbreaks in the African nation: there are now three different dengue serotypes at work – increasing the risk of severe dengue.

Health facilities in Burkina Faso began seeing a rise in dengue cases early in August following Burkina Faso’s rainy season. Mosquito breeding areas were plentiful, especially in cities. The World Health Organization (WHO) Africa Region identified “uncovered water drums, flowers pots, backyard orchards and banana plantations” as just some of the many sites suitable for mosquito breeding in its Week 44: Weekly Bulletin on Outbreaks and Other Emergencies published on 3rd November.

Image mapping the incidence of dengue fever in Burkina Faso in 2017.

Image via WHO Africa

By the end of September, the Ministry of Health had officially declared an outbreak of dengue in the country. Since then, the disease has spread outwards from Ouagadougou, the country’s capital and the area most affected by the outbreak. Health facilities in all the country’s 13 health zones are now reporting cases.

The true extent of the dengue outbreak in Burkina Faso is to be determined. The WHO believes that “the disease has been spreading in the community for some time, without being noticed” and has found it “difficult to determine the true burden of the disease at this stage”.

In a risk assessment of the situation in its November 6th Disease Outbreak News, the WHO outlined some of the main hurdles that need to be overcome to tackle the outbreak: “This outbreak is occurring in the context of an improved but still limited dengue surveillance system in Burkina Faso. The weekly case incidence has been on the rise since the detection of the outbreak in week 31 and is likely underestimated.”

This is somewhat of an improvement on 2016 when the WHO noted, “low establishment of dengue surveillance in Burkina Faso”. It found “many health facilities do not have access to dengue RDT [Rapid Diagnostics Test]” and that “awareness of the disease among healthcare workers and prevention is lacking.”

Dengue outbreak in Burkina Faso, the numbers

Thankfully, the number of new cases reported each week is now starting to decline, down to around 1,500 cases a week mid-November from 2,500 new cases a week late in October.

The WHO Africa Region’s Week 46: Weekly Bulletin on Outbreaks and Other Emergencies published on 17th November reported 12,087 cases (including 7,418 testing positive) and 24 deaths as of 11th November. Just two weeks earlier, the Week 44 edition reported 8,904 (5,721 testing positive) cases and 18 deaths as of 29th October. Two weeks before that, the Week 42 edition published on 20th October reported 4,098 (2,888 testing positive) cases and 11 deaths as of 17th October.

Weekly reported dengue cases and deaths in Burkina Faso

Table showing data on the Dengue outbreak in Burkina Faso 2017.

Data source WHO Africa

Those weekly case numbers are likely to be an underestimate with surveillance of dengue in Burkina Faso falling short of what it needs to be, according to experts.

Severe dengue risk

This year’s dengue outbreak in Burkina Faso is notably different to the outbreak in 2016 when the country reported 1,266 cases (including 1,061 testing positive) cases and 20 deaths by mid-November. That outbreak was also less widespread than 2017 (spreading only to three regions including capital city Ouagadougou) and also only involved one serotype: DENV-2.

This year, the Viral Haemorrhagic fever (VHF) reference lab in Burkina Faso has identified three dengue virus serotypes in circulation. While around three-quarters of the specimens it analyzed were the DENV-2 serotype, it found the DENV-3 serotype in a significant number of specimens and the DENV-1 serotype in a small number of cases.

The WHO has warned multiple serotypes in circulation could “lead to the occurrence of more severe cases.” But why?

Anyone who has previously had dengue is protected against the serotype from that infection but at increased risk of severe dengue from other serotypes. If you, for instance, were infected with DENV-2 last year and caught DENV-1 this year, you would be at higher risk of severe dengue.

A coordinated response to managing the outbreak

When the Ministry of Health officially declared a dengue outbreak in Burkina Faso, it set the country’s National Epidemic Management Committee in motion. Responsible for coordinating the response to the outbreak, the committee is focusing on four goals: strengthening surveillance, identifying and treating patients promptly, intensifying vector control and raising awareness.

To strengthen surveillance:
• An Early Warning System provides prompt notification of dengue cases, daily in Ouagadougou and weekly in the other provinces.

To accelerate diagnosis and treatment:
• Regional health centers and hospitals have received 1,500 rapid diagnostic tests.
• Along with 1,500 long-lasting insecticidal nets to prevent the spread of dengue from patients to mosquitoes and mosquitoes to patients.
• Patients with severe dengue can access free medical care and treatment.
• Staff numbers have been increased at the national reference hospital in Ouagadougou.
• The hospital is also receiving training for its laboratory staff and medicine.
• Healthcare providers have received treatment guides and posters.

In terms of vector control:
• Sites in Ouagadougou with high densities of Aedes aegypti are being sprayed as part of an intensive vector control programme.
• 5,500 community volunteers in Ouagadougou have been trained to identify and destroy mosquito breeding sites in homes.

And when it comes to raising dengue awareness:
• A public information campaign is disseminating information about dengue via radio, TV and social media.
• The press has been briefed to increase the coverage and accuracy of messages around the prevention and control of dengue.

These activities are aligned with WHO’s view that “active surveillance, effective vector control, case management, and social mobilization are particularly critical for the control of this outbreak.”

But, even though case numbers are gradually coming down, the WHO still has some concerns: “Specifically, there is a lack of financial resources to continue vector control activities, including the campaign currently ongoing in Ouagadougou.”

As we have seen in other cases, combating dengue requires a combination of approaches: surveillance, vector control, case management and community mobilization. With the help and support of the WHO and other relief organizations, we are hopeful that the situation in Burkina Faso will continue to improve.

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Dengue disasters: why storms and earthquakes boost mosquito populations and risks

Hurricanes, earthquakes, tsunamis, typhoons and other natural disasters continue to claim their victims long after they strike. Weeks and even months after their initial devastation, disaster-hit areas face a rise in cases of dengue fever and other vector-borne diseases. With a series of natural disasters fresh in our minds, let’s take a closer look at the link between hurricanes, earthquakes, and potential dengue disasters.

While Atlantic storms hit the Americas between May and November every year, the 2017 season was particularly devastating. Between mid-August and early October, Hurricanes Harvey, Irma and then Maria brought winds strong enough to knock down trees and tear buildings apart.

Dengue disasters followed in the wake of the hurricanes that hit countries in 2017.

Image via weather.com

After Hurricane Harvey battered Southern Texas, Hurricane Irma hit the Caribbean then made its way north towards Florida. Not long afterward, Hurricane Maria took a second swipe at the Caribbean before heading north west.

Dengue disaster: devastation across Puerto Rico

Puerto Rico’s fragile infrastructure was particularly badly damaged. An article in the New England Journal of Medicine notes, “As of 16 days after the hurricane, 25 hospitals were working, only 9.2% of people had power, 54% had water, 45% had cell phone service.”

We spoke with Dr. Dawn Wesson, associate professor at the Tulane University School of Public Health and Tropical Medicine. She explains why the hurricane has led to an increased risk of dengue, “There are problems with electricity and lack of access to clean water in Puerto Rico. Any opportunity they get, people are storing water. When you start storing water, Aedes aegypti start breeding, and their population increases.”

The New England Journal of Medicine article confirms: “The potential development of infectious disease outbreaks and reactivation of dengue, Zika, and chikungunya epidemics is one major concern… This hurricane might well increase the mosquito population, and people may not pay attention to prevention messages or be willing to modify behaviors that affect their seeking of food, water, and gasoline or repairing of their homes.”

With hospitals and roads closed, keeping transmission at bay and keeping track of disease is all the more difficult – whether water-borne, food-borne or mosquito-borne. Cases of water-borne leptospirosis, for instance, appear to be on the rise.

“There is such as lack of infrastructure right now that, unless someone was really ill, they probably wouldn’t attempt to get to a hospital,” says Dr. Wesson. “That could increase the risk of disease transmission to others.”

Mexico hit hard too

During September, the Americas faced yet another natural disaster: on the 19th an earthquake with an estimated magnitude of 7.1 hit Central Mexico. More than 40 buildings collapsed, 370 people were killed and more than 6,000 were injured. This earthquake followed an 8.2 magnitude earthquake in southern Mexico less than two weeks earlier.

map showing the earthquake in Mexico during 2017.

Image vie @latimesgraphics

Earthquakes, like hurricanes, increase the risk of dengue outbreaks. People are displaced from their homes or no longer have access to running water. “When people have to store water, the potential for Aedes aegypti populations growing increases exponentially,” says Dr. Wesson.

According to Mexico News Daily article from 6th October: “About 4 million people lost their water supply after the [September 19th] quake.”

Officials acted quickly to mitigate the risk of dengue outbreaks after the earthquakes in Mexico. The state government office in the Morelos region near to the epicenter advised on its @GobiernoMorelos Twitter account: “We are reminding people to take preventive measures to take care of the health after the earthquake in #Morelos”.

Preventative measures aimed at avoiding an increase of insect-transmitted diseases such as dengue, chikungunya, and Zika, according to an article in The News, included “buckets, washbasins, water tanks, cisterns, vases and any container that [is] used to store water should be properly covered.”

Image showing how to reduce the dengue burden through traditional vector control methods.

Image courtesy of Malaria Consortium

Dengue spike after Padang earthquake

While it is still too early to know whether the Mexico earthquakes will lead to an increase in dengue, an earthquake that struck Padang, West Sumatra on September 30th, 2009 did: the number of reported cases of severe dengue spiked in late 2009, almost immediately following the earthquake.

A chart indicating dengue disasters followed earthquake in Malaysia.

Image via International Journal of Collaborative Research on Internal Medicine & Public Health

More than that, study author David Fanany from La Trobe University, Bundoora, VIC, Australia noted why the earthquake increased the risk of dengue in his paper Dengue Hemorrhagic Fever and Natural Disaster: The Case of Padang, West Sumatra. “While dengue is a chronic problem in this area, the earthquake created a set of factors that enhanced transmission of the disease and also led to a set of circumstances in which prevention was unusually difficult.”

The Padang earthquake caused significant damage to government, commercial and residential buildings, many of which were abandoned in the following months. Cleanup of earthquake rubble was at best slow; the departed owners of abandoned sites were left to clear their properties up.

The earthquake in Indonesia led to a dengue disaster in Pedang.

Damage from the 2009 Padang earthquake. Indonesia 2009. Photo via AusAID

As in Mexico, the earthquake also disrupted water supplies, leading residents to collect rainwater and store large amounts of water around their homes.

While the change in the living environment increased viable breeding locations for mosquitoes, the timing of the earthquake increased their capacity to breed: the earthquake occurred at the beginning of the rainy season. Mosquito activity increased along with contact between humans and mosquitoes.

Dr. Wesson also emphasized the importance of geography and timing when she spoke with us: “Hurricane Sandy hit the North West of the US late in the season a couple of years ago, but the region didn’t experience any mosquito-borne disease problems in the aftermath.”

Preventing dengue

Improving infrastructure is one of the critical factors when it comes to reducing the impact of natural disasters – from all perspectives. If buildings can withstand natural disasters, lives will be saved. Furthermore, people will not be made homeless and exposed to the elements and disease-carrying insects. If water supplies can be maintained, people will not need to store water.

Robust infrastructure is, therefore, vital for reducing the risk of dengue following earthquakes, hurricanes, and other natural disasters. Take Southern Texas as an example. Solid infrastructure meant the impact of Hurricane Harvey on utilities was less significant. People there, however, still faced an increased risk of dengue: out rebuilding their homes, they were more exposed to the Aedes aegypti mosquito.

Some of the newer vector control technologies, including Wolbachia-infected mosquitoes and sterilized male mosquitoes, could also play a role. As the Miami Herald reports, the US Department of Agriculture recent eliminated the deadly American screwworm fly from the Florida Keys by releasing hundreds of thousands of sterile flies over a six-month period.

“If you could quickly bring in sterile males or the Wolbachia-infected insects, that would improve your capacity to respond to the dengue threat after a hurricane, earthquake or another natural disaster,” says Dr. Wesson. “It would be another nice thing to have in your toolbox to fight dengue.”

Dengue vaccination could also play a key role in minimizing the risks of infection in the aftermath of a natural disaster. “If a population was already vaccinated against dengue, you would be less concerned in a situation like Puerto Rico.”

We want to hear your stories. How is your community taking the fight to dengue?

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Wolbachia programs in Asia: different approaches to fighting dengue

In the first article in our two-part series on Wolbachia, we looked at how Wolbachia-infected mosquitoes hold the key to reducing dengue outbreaks. In fact, an increasing number of communities across Asia are embarking on Wolbachia programs. In this second article, we compare the differences and similarities between Asia’s Wolbachia programs.

The number of Wolbachia programs across the world is growing rapidly – across Asia in particular. Countries are taking different approaches to Wolbachia: some release both male and female mosquitoes infected with Wolbachia, while others release only males.

The World Mosquito Program (formerly Eliminate Dengue) has released both male and female Wolbachia-infected Aedes mosquitoes in Vietnam, Malaysia, and Australia. This ‘replacement’ approach aims to grow the percentage of Wolbachia-infected mosquitoes until the population is high enough to sustain itself without further releases. The program explains:

“The World Mosquito Program’s Wolbachia method is unique because it is self-sustaining and does not need to be continually reapplied, making it an affordable, self-sustaining, long-term solution. Our method reduces the ability of mosquitoes to transmit dengue, Zika, and chikungunya on to people, without suppressing mosquito populations and potentially affecting ecosystems.”

These Wolbachia programs release the infected mosquitoes in two different ways: either releasing adults from public areas near homes or placing mosquito release containers on residents’ properties. These containers hold mosquito eggs. The eggs hatch and develop into adult Wolbachia mosquitoes over a two-week period, then fly into the environment to breed with wild mosquitoes.

An alternative approach

The Verily (the life sciences arm of Google’s parent company Alphabet) ‘Debug’ Wolbachia program, on the other hand, is only releasing male Wolbachia-infected Aedes in its California intervention, again over a period of weeks. When the males (bred from MosquitoMate’s Wolbachia-infected mosquitoes) mate with wild females, the eggs produced won’t hatch, ‘suppressing’ rather than ‘replacing’ the mosquito population in the region.

“After receiving official and community approval we will begin releases of sterile males to show that we can significantly reduce or possibly eliminate the local population of Aedes aegypti mosquitoes.”

However, the World Mosquito Program argues that a suppression approach “requires the release of a large number of male mosquitoes to reduce the overall mosquito population. As with insecticides, this technique would need to be reapplied over time as the population of mosquitoes gradually returns.”

Nevertheless, Verily is not the only company exploring using ‘sterilised male mosquitoes’ to suppress Aedes populations. The Bill and Melinda Gates Foundation is also exploring a similar idea, working with UK-based Oxitec developing genetically modified male ‘friendly mosquitoes‘ whose offspring should in theory never reach maturity. Incidentally, The Bill & Melinda Gates Foundation is also working with the World Mosquito Program.

Wolbachia programs in Asia

As we speak, interest in Wolbachia-based dengue interventions is growing across Asia. In Cambodia, India and Sri Lanka, local authorities are holding discussions with the World Mosquito Program, exploring options for using Wolbachia-based Aedes as a new tool in their fight against the dengue alongside other viruses, including Zika. Discussions are also underway in the Pacific Islands of Fiji, Kiribati, Vanuatu and New Caledonia.

Meanwhile, the World Mosquito Program continues to release both genders of mosquito while optimising its strategies around the choice of the Wolbachia bacteria strain in Australia, Indonesia, and Vietnam. According to the World Mosquito Program website:

In Australia, Wolbachia is still self-sustaining in northern Queensland after six years, with no evidence of local spread of dengue in those areas.
Trial releases began in Indonesia in January 2014. Further trials are helping the program develop its method for large-scale, low-cost releases of Wolbachia mosquitoes across entire cities.
Vietnam first released Wolbachia mosquitoes in a trial in 2013. After early successes, trials were expanded to more locations and continue today.

Outside of the World Mosquito Program, China, Malaysia and Singapore are also embarking on Wolbachia programs as part of their fight against dengue:

A project from the Sun Yat-Sen-Michigan State University Joint Center for Vector Control for Tropical Disease is releasing male Wolbachia mosquitoes in China.
In Malaysia, the Health Ministry announced in March that its Institute for Medical Research released 16,000 male and female Wolbachia-infected mosquitoes.
Singapore is carrying out a small-scale study to explore using Wolbachia-carrying Aedes males on the recommendation of its National Environment Agency’s Dengue Expert Advisory Panel. The suppression strategy is in line with Singapore’s goal to eradicate the mosquito.

Community engagement

While approaches may differ across Wolbachia programs in Asia, there are also some distinct similarities between them: the local community always plays a key role in their success, in particular. After all, the programs are releasing the Wolbachia-infected mosquitoes into people’s backyards.

Image from one of the Wolbachia programs in Asia of a woman in Indonesia being shown the variety of mosquitoes caught during a monitoring program.

A member of the World Mosquito Program team in Indonesia shows a resident the different mosquito species caught in a mosquito monitoring trap. Image via World Mosquito Program

A study into the risks associated with Wolbachia releases highlighted how releasing mosquitoes affects communities around the release sites and that interventions must involve communities throughout the process. If the community is not engaged adequately from the outset, it could lead to community opposition and prevent releases. Wolbachia programs in Asia should, therefore, develop a communication strategy tailored to the local community, listening to and addressing community concerns.

The World Mosquito Program’s teams work with community leaders and residents in each of its projects. In Indonesia, for example, the team “spent many months talking with community leaders and residents at the district, village and hamlet levels to gauge support before releasing Wolbachia mosquitoes.” Meanwhile, the Singapore NEA has a Wolbachia FAQ webpage with answers to specific questions and webchat where people can ask any others.

The community isn’t just the key to ensuring programs go ahead; it also plays a vital role in actually releasing the Wolbachia-infected mosquitoes. In Australia, for example, Eliminate Dengue developed an educational program called Wolbachia Warriors that allows school children to take part in the releases. In Indonesia, the community held a release ceremony to launch the field trials.

As the number of Wolbachia programs increases across the globe, we want to hear your stories about your local program.

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El Estado de Paraná State despliega la oleada final de su programa de inmunización del dengue

Las autoridades sanitarias del Estado de Paraná de Brasil se están embarcando en la tercera etapa de un programa público de inmunización frente al dengue dirigido a individuos de 9-44 años, la primera iniciativa pública de este tipo en las Américas. La campaña de vacunación basada en comunidades comenzó el 20 de Septiembre y durará hasta finales de Octubre en 30 municipios de Paraná donde la carga de dengue ha sido elevada, de acuerdo con el Secretario de Salud local.

Más de 300,000 personas han recibido la vacuna del dengue en las dos campañas previas como parte del programa público de vacunación que inició la batalla de Paraná contra el dengue hace un año. Con un objetivo inicial de 500,000 personas, Paraná reportó una tasa de cobertura del 60% para la primera dosis.

Casi 2,3 millones de personas sufrieron del dengue en 2016 en América Latina. El dengue, a menudo apodado ‘fiebre rompe huesos,’ puede llevar a una dolorosa dolencia marcada por fiebre, dolor de Cabeza y un duradero malestar. Hoy, no hay tratamiento específico para el dengue, que puede deteriorar de forma impredecible a dengue severo que puede ser mortal.

La Organización Mundial de la Salud recomienda estrategias integradas de prevención y gestión en países endémicos. Como parte de las intervenciones de salud pública integradas contra la enfermedad, el valor e impacto potenciales de la vacunación de dengue son significativos. La OMS ha recomendado que los países con altas cargas de dengue consideren introducir la vacuna.

La primera y única vacuna contra los cuatro serotipos de dengue vino al mundo en 2015, siendo registrada en México, el país con uno de los números de casos más elevados de las Américas. La vacuna ha sido aprobada en 19 países del mundo y está ahora disponible en siete naciones Latino Americanas: Brasil, Costa Rica, El Salvador, Guatemala, México, Paraguay, y Perú.

El programa de inmunización del dengue en Paraná: una inversión en salud pública

Brasil cuenta con un 65% de los casos reportados en la región, pero también hay cientos de miles de casos a través de las Américas incluyendo en México, Colombia, Paraguay, Perú y los países de América Central y el Caribe. Los informes de casos de dengue indican que, en México y Brasil, el 90% de los casos de dengue ocurren en individuos a partir de 10 años de edad, que representan un segmento altamente móvil y social de la comunidad.

Las personas infectadas de dengue pierden, de media, seis días de trabajo. En adición, hasta seis meses después de contraer el dengue, los individuos reportan síntomas post-infecciosos como fatiga y debilidad severas, que afectan su calidad de vida. En las Américas, el coste anual del dengue, incluyendo pérdidas debidas a falta de productividad en el trabajo, se estiman en torno a 1,7 billones de dólares.

Los modelos económicos muestran que los programas amplios de vacunación en poblaciones indicadas tienen el potencial de reducir la carga de la dolencia del dengue en un 50% en 5 años.

Michele Caputo Neto, Secretario de Salud en el estado afirmó que invertir en el programa de vacunación del dengue de Paraná se amortizará al reducir el gasto en cuidado hospitalario además de mantener a las personas en el trabajo y protegiendo la industria turística.

Dice que el programa de inmunización del dengue complementa – más que reemplazar – otras medidas anti-dengue como campañas de concienciación públicas y estrategias de control del vector. El Secretario de Salud dijo estar orgulloso de ser pionero en integrar la vacunación en el arsenal anti-dengue de Paraná.

Descubre más acerca del coste real del dengue (Infografía)

‘Sabemos que Paraná tiene la capacidad técnica e infraestructura apropiada para incorporar una nueva vacuna en el sistema público,’ dijo. ‘Tenemos uno de los mejores sistemas públicos de salud de este país, y nuestras campañas de vacunación obtienen la mayor cobertura. Todo esto nos da las credenciales para innovar y avanzar en el control de la enfermedad en el Estado.’

How Wolbachia-infected mosquitoes are reducing dengue outbreaks

A naturally-occurring bacteria, Wolbachia can be found in around 60% of insect species, including some types of mosquito. Wolbachia, however, it is not usually found in the Aedes aegypti mosquito. But artificially infecting an Aedes population with Wolbachia reduces the mosquitoes’ ability to transmit dengue (and other diseases) to humans. In this, the first in our two-part series on Wolbachia, we look at how Wolbachia-infected mosquitoes hold the key to reducing dengue outbreaks.

Whenever Wolbachia bacteria infects an Aedes population, the bacteria significantly reduces the risk of a dengue outbreak. The Wolbachia bacteria, as you can read here, compete for the resources that the dengue virus needs to thrive (amongst other things), stopping the virus forming infections inside the mosquito.

Chart showing how Wolbachia-infected mosquitoes reduce the spread of dengue.

How the World Mosquito Program’s Wolbachia method works. Image via the World Mosquito Program

So, how can we help Wolbachia bacteria invade an Aedes population? By releasing Wolbachia-infected mosquitoes into a wild Aedes population over a period of a few weeks. The mosquitoes then breed with the wild mosquito population, passing the bacteria from generation to generation and replacing the wild mosquito population over time. When the invaders mate with the local population:

The female Wolbachia-infected mosquitoes transmit the Wolbachia to all of their offspring, which are mostly female.
The male Wolbachia-infected mosquitoes’ partners produce eggs that don’t hatch – a phenomenon known as cytoplasmic incompatibility.

Not all Wolbachia are the same

The Wolbachia’s ability to invade an Aedes population depends on several factors, including the specific strain of Wolbachia and the temperature of the environment where the Aedes larvae are reared.

Researchers have shown cytoplasmic incompatibility is less likely to occur in infected larvae reared between 26°C and 37°C with certain Wolbachia strains. Some eggs still hatch and grow into mosquitoes that can transmit dengue. The researchers also found that, at similar temperatures, females infected with some specific strains of Wolbachia did not pass the bacteria to their offspring.

The researchers concluded: “These findings have implications for the potential success of Wolbachia interventions across different environments and highlight the importance of temperature control in rearing.”

Scientists running dengue elimination programs need to choose Wolbachia strains carefully. In Malaysia, The Star reports that Australia, Brazil, Indonesia, Colombia, and Vietnam have released Aedes infected with the wMel strain of Wolbachia, but China is using the wMel-Pop strain. It also notes: “The wMel-Pop strain is a good dengue blocker, but it was found to cause high mortality among adult Aedes mosquitoes”.

A high mortality rate means the Wolbachia-infected mosquitoes may struggle to increase their numbers amongst the wild Aedes population, preventing them from suppressing the dengue-transmitting mosquitoes.

Numbers are important too

It’s not just the strain of Wolbachia that’s important, the number of Wolbachia-infected mosquitoes released is also critical to success.

A recent study found between that 20% and 30% of the Aedes population needs to be infected with Wolbachia for the bacteria to take hold among the population. Below that threshold, the Wolbachia-infected mosquitoes will gradually reduce in number and be lost in time. Researchers note: “As a patch of Wolbachia-infected mosquitoes gets smaller, the proportion of individuals within that patch that are immigrants from surrounding Wolbachia-free populations gets larger.”

There are believed to be two reasons why the larger proportion of immigrants leads to a continued decline in Wolbachia-infected mosquitoes. Firstly, when the levels of Wolbachia are low in an Aedes population, wild females rarely mate with the Wolbachia-infected males, and so they continue to produce Wolbachia-free offspring.

Also, female mosquitoes with Wolbachia are not quite as fertile as their bacteria-free counterparts; they don’t produce as many offspring. When Wolbachia levels are low, the Wolbachia-free females continue to outbreed the females mosquitoes with Wolbachia until the Wolbachia eventually disappears.

The World Mosquito Program also failed to establish Wolbachia-infected Aedes mosquitoes when it tried to replace the wild population in a small area because Wolbachia-free mosquitoes from surrounding locations migrated into the area. It also found that roads, rivers, and forests could get in the way, hindering mosquito movement.

Any downsides to using Wolbachia-infected mosquitoes?

One of the main concerns around Wolbachia programs is that they could make communities complacent. A study into the risks associated with the release of Wolbachia-infected Aedes mosquitoes into the environment to control dengue found there was a small risk that households would decrease their mosquito control efforts if they felt dengue transmission was less likely. It felt projects could address this concern by increasing community education.

Other studies have raised concerns that Wolbachia could increase some vector-borne pathogens in insect populations. Research published in 2014 found that Wolbachia enhances West Nile Virus (WNV) Infection in the Culex tarsalis mosquito. The main message coming from the study was that we need to keep an eye out to ensure Wolbachia doesn’t increase a mosquito population’s ability to transmit one virus as we employ it to lessen the population’s ability to transmit another. It also notes that Wolbachia can transfer from one insect species to another, so we also need to ensure we don’t end up with any unforeseen consequences as a result of that happening.

Look out for the second half of our series on Wolbachia when we compare the differences and similarities between Asia’s Wolbachia programs.

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Dengue in Cambodia: Using guppies and growth hormones to fight disease

Image of fighting dengue in Cambodia using the guppies in transport.

Image courtesy of the Malaria Consortium

Dengue in Cambodia is endemic all year round. But budgets are tight. For some time, The World Health Organization (WHO) and Asian Development Bank (ADB) have been helping the authorities search for a cost-effective and sustainable way to tackle dengue in Cambodia. A more recent research project (funded by UKAID and Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) with WHO as a partner) combined guppy fish, a larvicide based on disrupting growth hormones and COMBI (Communication for Behavioral Impact) activities.

Traditionally, Cambodian’s fight against dengue involves using chemicals to control the Aedes aegypti mosquito. But fogging hasn’t always had the desired impact. In 2015, for instance, there were 15,000 cases of dengue in Cambodia.

Over the years, researchers have tried other ways of reducing the Aedes population, with limited success:

Initially releasing Mesocyclops (a crustacean that preys on mosquito larvae) into water containers where Aedes larvae live looked promising, but larvae numbers crept up over time. Also, people didn’t like crustaceans.
Bacillus thuringiensis israelensis (Bti), a soil-dwelling bacterium, were found to significantly reduce larvae numbers in containers with river and well water, but only for two or three months.
Jar covers with long-lasting insecticidal netting (LN) treated with deltamethrin eliminated two-thirds of adult Aedes, but they degraded over time, and children regularly used them as toys.

Hungry for larvae

One other approach, however, has had more success at decreasing the number of Aedes mosquitoes in Cambodia: guppy fish.

Between April 2006 and April 2007, a USAID-funded project tested the use of guppy fish in domestic water containers in 14 villages in the Kampong Speu province of Cambodia. Local volunteers bred and distributed the fish. On average, each guppy ate more than 100 mosquito larvae each day, significantly reducing the number of Aedes mosquitoes. After a year, only 10% of containers with guppies contained mosquitoes, compared with 50% of containers without fish.

A scientist inspects guppies in water tanks being used to control mosquito larvae.

Image via Malaria Consortium

“Guppies live quite well in Cambodia’s very hot and dry conditions,” says John Hustedt epidemiologist for the Malaria Consortium in Cambodia. “And they eat whatever larvae are in the water container.”

Following this success, the WHO and ADB funded a larger-scale IVM Guppy Fish Project, combining guppy fish with Communication for Behavioral Impact (COMBI) activities. COMBI uses communication and mobilization to improve the community’s behavior – rather than just attitude – towards water use and vector-borne disease prevention.

“They wanted to learn how to mobilize the community,” said John. “And to help the community understand how and why they’re using guppies.”

Tackling smaller breeding sites

The project, however, had its limitations: other Aedes breeding sites, including containers too small for guppies to survive in, still needed to be tackled.

A product based on Pyriproxyfen (PPF), a growth hormone that prevents juvenile Aedes mosquitoes from developing into adults, looked promising. When studied in Cambodia in 2003, it stopped 90% of Aedes larvae maturing for 20 weeks. During the study, researchers placed a controlled-release formulation of pyriproxyfen consisting of cylindrical resin strands in concrete water storage jars between 400 and 500 liters in size.

However, maker Sumitomo Chemical never released this specific solution for technical reasons. The company has since reformulated the PPF-based solution, developing and releasing the slow-release formulation called SumiLarv® 2 MR.

The local community can use this controlled-release disk in water jars too small for guppy fish while cutting the cost of larviciding since it only needs to be distributed once every six months – the whole rainy season. John explains: “Normally, you’d put larvacide pellets into water containers up to six times a year. This controlled-release disk can, therefore, save on operational costs.”

Added to that, SumiLarv® 2 MR can work at very low levels. “It doesn’t kill the mosquitoes; it’s just a growth inhibitor that messes with the mosquitoes’ hormones,” says John.

A combined approach

John and his team initiated a trial to study how effective combining guppies, PPF and COMBI activities would be. The study site included approximately 6,000 households, divided into three groups:

1. Guppies, PPF and COMBI activities
2. Guppies and COMBI activities
3. Standard vector control activities from the Ministry of Health

Groups one and two placed two guppy fish into water containers bigger than 50 liters; their COMBI activities included health education sessions, posters, banners, t-shirts, and songs. Group one also placed one SumiLarv® 2 MR disk in containers of between 10 and 50 liters.

Image: a meeting on fighting dengue in Cambodia using guppies.

Image via Malaria Consortium

Guppies accepted well

Local people tended to like using the guppies, even if they hadn’t used them before. Not only are fish were seen as lucky, but the people of Cambodia traditionally use fish for health interventions.

Even though previous studies have shown guppies don’t significantly increase e.coli or other bacteria in water jars, a few people – mainly foreigners – still questioned the practice. “We talked to them about how there were fish in the lake where they get their water,” says John. “It was then no longer an issue.”

John is also very conscious that some outsiders are concerned that the guppies could upset the balance of the local ecosystem. “While introducing a non-native fish species into the ecosystem could hurt the local fish and deplete oxygen levels, guppies have been here in Cambodia for many years,” says John. “I haven’t seen any peer-reviewed scientific evidence of harm in Cambodia.”

“I think it’s a valid concern, which we should think about; but without evidence to the contrary, I don’t think it’s a reason why we shouldn’t use guppies,” John continues. “You could potentially distribute only fish from one sex, so they don’t breed if they do get into the water.”

Religious concerns

Local people, however, were more concerned about using the PPF devices. “We created COMBI messages that local volunteers could use to explain that PPF is at a very low level that doesn’t kill the larvae and isn’t harmful to people,” says John. “After a while, their reservations were gone.”

People’s main concern, however, was grounded in their religion. Older people with strong religious beliefs didn’t want to use guppies or PPF to kill the larvae because they were living creatures and it would be frowned upon. “We explained that, while it’s important for us to treat living creatures nicely, if you don’t get rid of the mosquitoes then dengue transmission will continue and some children will die – even children in your community,” says John. “We told them, ‘You have to choose between getting rid of the larvae or people becoming sick and possibly dying’.”

Dengue awareness image showing why dengue is spreading.

Image courtesy of Malaria Consortium

The researchers also explained that they didn’t want people to kill the larvae, just to introduce this fish. “We told them that the fish are part of the normal eco-system and this is how the fish need to survive,” says John. “It’s part of the normal circle of life.”

So far, so good

Throughout the study, which ran from October 2015 to September 2016, the number of adult Aedes females per household was significantly higher in the group using traditional methods. The study, which won the 2017 Break Dengue Community Action Prize, also found that people accepted guppies well and liked the SumiLarv® 2 MR devices, though the community needed to understand how PPF works and the role of the adult mosquito in the transmission of dengue in Cambodia. Furthermore, a tailored engagement approach and communication materials using COMBI led to high levels of community acceptance and participation.

On the question of sustainability, while it is probably too early to say if it will be sustainable in the long run, the guppy fish are still there. “We were able to follow-up thanks to prize money from Break Dengue. We met with the guppy bank and the health center folks using the guppy bank. People are still enthusiastic about it, but we need to see how it progresses with time,” concludes John.

How is your community taking the fight to dengue? We want to hear your stories.

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Global Dengue VOICE: amplifying the worldwide chorus against dengue

Break Dengue is excited to play a central role in bringing together dengue experts from around the world

One in two people lives in areas at risk of dengue fever. Behind this startling statistic are billions of people trying to live their lives in the face of a real and present health threat.

We need to do more to fight back against dengue. At Break Dengue, we are committed to bringing together the expertise and knowledge needed to meet this enormous challenge.

Dengue fever is a complex disease and while there are many experts seeking to reduce the burden of dengue, collaboration is not always easy. This can arise from a geographical distance or because researchers tend to work within their own areas of expertise rather than reaching across disciplines.

This must change. In November 2016, the Global Dengue VOICE committee gathered for the first time to initiate a movement in the fight against dengue and help achieve the objectives set by the World Health Organization (WHO) to reduce dengue-associated mortality by 50% and morbidity by 25%, by 2020.

Global Dengue VOICE is a group of dedicated dengue experts committed to working together to reduce the burden of dengue. It has the potential to bring the best expertise in the world to local communities grappling with the threat of dengue.

Since that pivotal kick-off event, progress has been seen at the national and regional levels. In Mexico, a national meeting of committed Global Dengue VOICE members kicked off in April with 54 delegates discussing awareness and prevention.

Earlier this year, 46 delegates from seven countries – the Philippines, Malaysia, Singapore, Thailand, Taiwan, India, and Pakistan – came together for a meeting of dengue fever experts in the Asia Pacific region.

Global Dengue VOICE: the next steps

Now this group of senior experts is preparing to meet again in Paris, France, to take this collaboration to the next level. More than 60 of the world’s leading figures will explore how they can build the effective coalitions required to beat dengue. The Global Dengue VOICE has the potential to become the go-to resource for dengue experts.

Break Dengue will be there, with founder Nicholas Brooke addressing delegates and moderating debates. Kamran Rafiq of the International Society of Neglected Tropical Diseases (ISNTD) – a member of the Break Dengue Editorial Board – will play a central role in proceedings, serving as chair and moderator of several Q&A sessions.

And I will be on hand to facilitate collaborative workshops and host a ‘Dengue Café’ during coffee breaks – conducting video interviews with experts which can be shared with the outside world.

Ongoing conversation

Bringing together experts from across disciplines and around the world is essential. Relationships are made, bonds formed, conversations started. But it cannot end there. that is why we are using the Global Dengue Lab – our online community of experts – as a forum for collaboration and discussion before and after the event.

This will provide opportunities to post materials and toolkits for preventing and treating dengue, as well as serving as a place where resources and experiences can be shared. Crucially, it will ensure that the progress and contacts made when experts meet are not lost: momentum can be maintained.

Learn more about the dengue vaccination toolkit

We look forward to playing our part in the Global Dengue VOICE and to bringing the fruits of this coalition to a wider audience. Together, we can amplify anti-dengue voices from around the world.

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Sri Lanka dengue outbreak: IFRC are joining forces to fight back

Image: Sri Lanka dengue outbreak response team from IFRC lend a hand.

Image via IFRC

Flooding last year and the arrival of a new serotype: the lethal combination behind this year’s dengue outbreak in Sri Lanka – the worst outbreak the country has ever seen. This Sri Lanka dengue outbreak has affected 15 out of Sri Lanka’s 25 districts, which are home to almost 600,000 people. By mid-August, the Sri Lanka Ministry of Health (MoH) had reported more than 134,000 new cases of dengue, including 38,835 new cases in July alone – a nearly fourfold increase on the previously recorded 10,715 cases seen during July 2016. Numbers are now decreasing, thanks to the combined efforts of the MoH, the Sri Lanka Red Cross, the International Federation of the Red Cross (IFRC) and the World Health Organization (WHO).

Deadly floods provide a home for Aedes

Dengue has been endemic in Sri Lanka for more than 30 years, maintained by the country’s annual monsoon rains. In fact, the severe flooding seen last year is likely to be a key factor in this year’s Sri Lanka dengue outbreak.

Why? According to dengue experts in Sri Lanka, the Aedes aegypti mosquito lays eggs in stagnant water, in this case, the stagnant flood waters from the heavy monsoon rains. Even why the flood plains dry out, these eggs can survive up to one year. They then grow into larvae as and when they come in contact with water; in other words, during the following year’s monsoon rains.

Gerhard Tauscher, Operations Manager with the IFRC stationed in Columbia, explains how this life cycle has played out in Sri Lanka: “Some of the districts of Sri Lanka that tend to see dengue were affected by flooding in May last year. The larva status mosquitos we see now are probably from eggs laid last year, triggered by this year’s monsoon rain, which started on the 25th of May. This pattern plays out every year.”

While the number of dengue cases was already high at the start of the year, by May, case numbers were spiraling out of control. “Almost 16,000 cases were reported in May,” adds Gerhard.

The arrival of a new serotype

So why what this year’s Sri Lanka dengue outbreak so much worse than other years?

One explanation is the arrival of a new serotype, as reported in a recent WHO news article:

“Dengue fever is endemic in Sri Lanka and occurs every year, usually soon after rainfall is optimal for mosquito breeding. However, DENV-2 has been identified only in low numbers since 2009 and is reportedly over 50% of current specimens which have been serotyped.”

Basically, the local population has built up long-term immunity to the serotypes normally seen in Sri Lanka. However, people’s resistance to DENV-2 is very low, meaning more people are getting sick when they’re infected. This, in turn, increases the Aedes aegypti mosquito’s ability to spread the disease – reflecting the high number of DENV-2 cases.

Furthermore, this recent Sri Lanka dengue outbreak started in the North and the East, which is where the new serotype is most likely to have reached the country.

Hospitals overwhelmed

Hospitals quickly became overwhelmed quickly; some of them had to convert other wards, including maternity wards, to dengue wards to accommodate the higher number. The WHO helped increase the number of beds available, creating three temporary wards in a hospital in the province of Gampaha, 38km north of Colombo. This was the first hospital to approach the Red Cross.

“The local branch of the Sri Lanka Red Cross immediately began to make their volunteers available to help the hospital cater for the large numbers of people arriving,” says Gerhard. “First aiders went there to help by providing social services: mainly moving patients, and bringing food and water.”

In addition, the IFRC team based in Sri Lanka launched its emergency response program towards the end of July after receiving 295,000 Swiss Francs of international funding from the IFRC Disaster Relief Emergency Fund earlier in the month.

The vital funds will support a six-month program that builds on current clean-up campaigns, raising awareness and providing emergency sanitation for stretched hospitals who asked the IFRC to provide additional water storage and toilets because of the high numbers of patients.

Image showing Sri Lanka Red Cross Society volunteers helping to prevent outbreaks of dengue.

IFRC volunteers in Sri Lanka Red Cross Society campaigning to prevent outbreaks of dengue.

Part of the bigger machinery

The IFRC response builds on the MoH’s own emergency response. The army, police and civil defense forces are conducting house-to-house visits in high-risk areas, supported by health staff and teams of Sri Lanka Red Cross Society volunteers. These visits aim to raise awareness about dengue and mobilize the community: how to treat symptoms, prevent mosquito bites and get rid of waste and stagnant water. The Red Cross volunteers are also helping authorities identify and clean mosquito breeding grounds.

Read: Dengue home remedies. Do they really work?

Image of IFRC volunteers carry out dengue inspections in Sri Lanka.

IFRC volunteers carry out dengue inspections in Sri Lanka. Image courtesy of the IFRC

In fact, Sri Lanka has a relatively well-established public health inspector system with one person supporting around 3,000 families. While the inspectors, who know their neighborhood well, monitor all aspects of public health; their current focus is on dengue.

Efforts are paying off. The number of dengue cases reported fell significantly in August.

Sri Lanka dengue outbreak: long-term focus

The IFRC is now preparing to launch a longer-term program, once the country is no longer on high alert. This program will focus on dengue prevention during the dry period when Aedes aegypti eggs lie dormant in dried out flood plains.

Gerhard explains why: “Traditionally, people are not very proactive. Things are easily forgotten. If the number of new dengue cases drops for just a couple of weeks, dengue will no longer be in the headlines or media – and it will be out of everybody’s head.”

IFRC is launching an emergency appeal to raise funds for Sri Lanka, so the country will have for at least one year of funding to help on two fronts: firstly, to disrupt dengue lifecycle and, secondly, to ensure its preparation for the next Sri Lanka dengue outbreak. “We want to support the existing system so a public health inspector can get the extra hands he needs to go to all the houses where there is suspicion and bring that under control,” says Gerhard.

Dengue surveillance will also play a key role in this program. It will put a system in place where teams always follow up on anyone admitted to hospital with dengue, tracing back to their home and workplace to try to identify where the infected mosquitos came from. “That will be more of a mandate to really get on top of eliminating dengue,” adds Gerhard.

In addition to that, the Eliminate Dengue Program (EDP) has established a research partnership with the MoH to pilot Wolbachia bacteria infected mosquitos in Sri Lanka.

Impact on the local economy

With tourism a critical part of its economy, Sri Lanka is keen to ensure visitors are not deterred. After all, dengue is all around the equator in 100 countries. Whether there’s an outbreak or not, tourists are always a high-risk group in any of these tropical countries, simply because they haven’t built up any immunity to the disease.

“The situation for tourists has not changed dramatically,” says Gerhard. “As a tourist, you most likely don’t have any resistance against any of the dengue serotypes. You must use nets and repellent as standard when traveling to mitigate the risk of catching dengue.”

While the recent Sri Lanka dengue outbreak is the result of heavy rains, flooding and the arrival of the DENV-2 serotype, the key to breaking the annual dengue cycle in this dengue-endemic country likes in keeping dengue prevention high on the agenda all year round.

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Dengue home remedies: why they don’t work

With no known cure for dengue fever, many people turn to dengue home remedies in the hope these will cure them more quickly. But traditional dengue home remedies aren’t the answer. Dr. Professor Pratit Samdani, Honorary Associate Professor of Medicine and Head of the Medicine unit at G T Hospital and Sir J J Group of Hospitals in Mumbai, explains why people should be increasing their fluid intake and looking for signs of bleeding rather than drinking papaya juice and basil tea or eating kiwi and dragon fruit.

Dengue home remedies have been a traditional practice in many countries for hundreds of years; whenever someone contracts the disease, friends and family share tales of how fruits and drinks can speed recovery.

“With incidence of dengue high and no specific dengue treatment available, people turn to home remedies to aid their recovery,” says Professor Samdani. “Here in India, almost every dengue patient comes to me with a list of home remedies.”

From papaya leaves to wheatgrass juice

In India, drinking the juice from the papaya leaf is one of the most common dengue home remedies. People take fresh papaya leaves straight from the tree, soak them in water and grind them before drinking two or three spoons four or five times a day.

“I hear it’s got a bitter taste,” says Professor Samdani. “Nevertheless, most people take it. Every person admitted to hospital with dengue has a small bottle with green color in it. It will be papaya leaf extract or papaya leaf juice.”

Other common dengue home remedies include eating dragon fruit and other fruits such as kiwi fruit. People believe these remedies will increase their platelet count, which is often the biggest fear for patients with dengue. “An increase in hemoglobin has a worse outcome than a drop in the platelet count,” says Professor Samdani, “but many patients are more concerned with their platelet count.”

Some believe basil leaf tea and coriander leaf tea will have an anti-viral effect and improve circulation, which will in turn help relieve them of the dengue virus; others eat pomegranates, drink wheatgrass juice or consume foods rich in vitamin C.

Home remedies don’t help

But dengue is a self-limiting disease. The majority of patients simply recover with time. When it comes to dengue protection, home remedies don’t benefit them in any way.

“Home remedies for dengue certainly do nothing to speed or improve recovery,” says Professor Samdani. “They don’t help patients in terms of anti-viral activity, improving platelet count, decreasing hemoglobin, offering symptomatic relief or early recuperation.”

Yet patients are stuck because doctors have nothing to offer them besides symptomatic treatment. Most of them know that there is no treatment aside from the drugs that provide symptomatic treatment. Irrespective of how much doctors like Professor Samdani educate them, many patients continue to use home remedies for dengue. They feel that these will help them.

“I tell them home remedies do not help with getting better faster and back to work quicker,” says Professor Samdani. “But if you do want you can continue having them – just make sure they’re well-made and hygienic.”

Image courtesy of Malaria Consortium

Drink more fluids

So, what’s the problem? With the fruit and leaves being completely natural, home remedies for dengue don’t put people at risk for any serious side effects. If at all, papaya leaves may cause some nausea and vomiting because they are very, very sour.

There are, however, risks that come with dengue home remedies – the main risk being the immense confidence they give the patient and their families. Patients feel they are getting the complete holistic treatment they need; that they are preventing the drop in platelet count that they feel is the main risk from dengue.

“We need to raise awareness that it’s not the drop in platelet count that’s more dangerous; it’s the rise in hematocrit and hemoglobin that can lead to more complications,” says Professor Samdani. “It’s important they drink more liquid and look for signs of bleeding rather than concentrating on these small home remedies for dengue.”

Dengue home remedies are available, but they aren’t a cure for the disease. They don’t help you recover more quickly, and they do nothing to stop hematocrit and hemoglobin levels from rising.

Instead, if you are unfortunate enough to catch dengue, take these three simple steps: drink more, look for signs of bleeding and heed your doctor’s advice.

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