JIIMS final.cdr


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Dengue fever is fast emerging as one of the 

common arthropode borne diseases. Viral 
th

aetiology of dengue was established in 20  

century but dengue like illness could be 

traced back 200 years. In 1950s the infection 

was being reported by 9 countries, today a 

wide array of countries, report regular 

outbreaks. Pakistan is one of those countries 

which have been in the grip of outbreaks 

since 1990s. First reported epidemic could 

be traced back to 1994. It is evident that 

dengue fever is not a very recent phenomena 

in Pakistan. It has had its history but 2011 

witnessed hyperbole and press hype of 

gigantic magnitude. This created scare and 

irrational response to the outbreak. 

Somehow the outbreak was pinned on or 

attributed to collapse of health services, 

whereas established wisdom attributes this 

emergence of dengue fever to uncontrolled 

population growth, rapid urbanization and 

s l u m  f o r m a t i o n ,  i n a p p ro p r i a t e  a n d  

inadequate waste water management, 

refugee movement and to erosion of vector 

control program, non of this falls in the 

domain of health sector. The hype created by 

the press this year was a cause of daily 

headlines on the news channels, resultant 

response to this outbreak could at best be 

described as misdirected. 

Lot of fallacy and misplaced response was 

undertaken. For example, cases of fever 

were subjected to virological diagnoses with 

resultant increase in cost and unnecessary 

effort. Similarly isolation wards were put up 

in hospitals and a pressure created by fever 

patients to get admitted in them. A 

misplaced efficacy of platelet transfusion in 

every case was advocated with the result 

that demand for cell separators and platelets 

skyrocketed. Health education on the lack of 

specific treatment was not common 

knowledge and this outbreak was somehow 

thought of as fault of medical and health 

professionals and a cause of consternation 

for the profession in the country in general 

and Lahore in particular.
Dengue fever outbreak was reported not for 
the first time and surely it will not be for the 
last time. As we square upto the fact that 
dengue fever epidemics are here to stay, it is 
already recognized that the countries 
reporting dengue fever outbreaks suffer 
from the same every five to six months in 
different regions and report major outbreaks 
every three years. It is hoped that the 
experience gained in 2011 will give rise to 
saner voices and prudent response after all 
the mayhem created by the press. A 
judicious response would have to be tailored 
for the long term and most of the action has 
to be taken by the government functionaries 
other than the health and medical 
professionals. Some of the steps that need to 
be advocated are, firstly population 
management and population control and 
policies to curb rapid urbanization and slum 
f o r m a t i o n ,  s e c o n d l y  g e a r i n g  u p  o f  
municipal services in the cities and slums to 

EDITORIAL

Dengue Fever Outbreak
Maqsood-ul- Hassan

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DR. MAQSOOD-UL-HASSAN
DPH, MCPS, MSC(Med Adm)

Islamic International Medical College
Rawalpindi



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avoid waste water accumulation and 
ensuring appropriate drainage in and 
around human habitations.
In case of outbreak the press will also have to 
be tutored to play its role of educating the 
general public on general and personal 
protective measures rather than be a 
harbinger of scare. People will have to be 
told before and during outbreaks to manage 
water collections in and around their 
residences, be it waste water or fresh water, 
and role of press can be invaluable. There is 
also a need to have a robust vector control 
program in terms of mosquito surveillance 
and surveillance of its larvae to map out 
areas with high density of vector, so as to 
undertake selective spraying of locales with 
high density so as to be aware of areas at risk 
of outbreaks and avoid consequences of 
environmental degradation and insecticide 
resistance of universal spraying. These are 
measures to be taken by sectors other than 
health and medical professionals, in case of 
outbreak through an important role is to be 
played by medical professionals in 
managing the cases. Health/ medical 
professionals will have to propagate 

conventional wisdom that not every case 
needs virological confirmation once 
epidemiological data and testing of index 
and initial cases have confirmed the 
outbreak. Primary health care physician will 
have to be trained on risk management of 
cases, in that most of the cases will be treated 
outdoors, but high index of suspicion on 
bleeding diathesis due to platelet lowering 
and or evidence of leaking plasma causing 
dengue shock syndrome be readily 
recognized. As these merit hospital 
handling of the cases. The public and 
medical profession will have to be made 
aware of screening fever cases so as to avoid 
mosquito bites both in the houses as well as 
hospitals. Use of Aspirin during the 
outbreak will have to curbbed/stopped.
A proactive approach though may not 
eliminate dengue fever, dengue shock 
syndrome, dengue hemorrhagic fever but 
can minimize its consequences. Society as a 
whole, needs to make concerted efforts to 
prevent outbreaks of the disease. A political 
will to undertake measures prior to 
outbreak is imperative.