- por Nicholas Brooke

Tackling dengue in India, what can be done?

We-are-all-equal-in-the-eyes-of-dengueWorking as an Internist in India, Dr. Pratit Samdani has treated up to 10 new patients with dengue fever in his clinics every day for the last three weeks.
“In India, dengue is completely endemic, it’s terrible, it’s disastrous,” he says.
This isn’t an entirely new situation. Over the past four years he has observed the prevalence of the disease wax and wane, with 2013 and 2011 having notably high occurrences. And while the virulence is worrying, the change in the way it manifests is also a cause for concern.
Believing that mutations have led to new strains of the virus, Dr. Samdani has seen the symptoms of dengue continue to evolve over the past four years, with liver ailments and lower heart rates adding to the normal plethora of symptoms (which includes severe back and head pain, and mild bleeding).
“The heightened awareness among medical professionals and the general public here, together with faster treatment, is lowering the incidence of mortality,” Dr. Samdani shares. But there is still a period of immobility for those who contract the illness and, as with all things, the situation can be further improved.
What can be done?
“There is always more room and more scope for improvement; things at a municipal level, things at a personal level, and things at a medical level,” says Dr. Samdani.
With such heavily populated and relatively unhygienic cities in India such as Mumbai and Delhi, Dr. Samdani believes that there are simple key things that can be done to keep the virus at bay. These include keeping the environment clean, spraying with insecticides, discarding stagnant water, and taking individual precautions such as using repellents and mosquito nets.
Public awareness could also be vastly improved. Municipalities in the country have some literature about the disease and the benefits of maintaining a clean environment, but increased awareness on social media as well as through the government and municipalities could definitely help.


Internist Dr. Pratit Samdani does his rounds in 5-6 private hospitals on a daily basis

“For medical professionals prompt recognition helps decrease the chance of complications, while adequate hygiene and hydration are also imperative for any patient with suspected dengue fever, as an increase in fluids helps to lower the chances of complications,” Dr. Samdani adds.
Encountering obstacles
But it’s not quite that simple. While misdiagnosis is not usual in India, the three most common diseases – dengue fever, malaria, and typhoid – all present in such a similar fashion that making a clinical judgment between them can be difficult until the lab results are returned. Additionally, the tests themselves can give a false negative result (with some antibodies not presenting for five days) and thus need to be repeated if the virus is still suspected. However, the precautions you would take for each one can help your system fend off the disease.
Misinformation of the public can also hamper attempts to cure those with the virus. Untrained people posing as physicians selling inappropriate “cures” are not uncommon in the country. Dr. Samdani shares that “almost two patients a day ask me about the benefits of papaya leaf juice. And I tell them that it is probably harmless (being hydrated is key), but it won’t necessarily increase your platelet count. The truth is once the virus is shed, your platelets will naturally go up.”
When asked how he believes the situation could improve, Dr. Samdani stressed the need to keep the cities clean and raise awareness.
“It is a dream that we will get a dengue vaccine and that it will be eradicated some day and I am sure it is not far away, yet not reachable at this moment. For now, we need to take concrete steps.”