Asia's Rising Dengue Threat

Mark Cajutol was in unbearable pain on the evening of Aug. 17, bleeding from the nose and mouth. By midnight, he was jerking in his sleep. By early morning Wednesday, he lapsed into a coma. Shortly after noon, Mark Cajutol died.

Cajutol was the latest victim in a dengue plague sweeping the Philippines. Although dengue fever has long been endemic to the country, it has taken off. Reported cases have risen by more than 50 percent in the first half of this year across the Philippines, health officials say, and particularly the southern island of Mindanao, which has been hit hard. In General Santos City alone, more than 566 dengue cases were recorded within the first seven months of this year, resulting in at least five deaths, excluding Mark's case.

In South Cotabato, health officials in the province said, dengue cases have already reached an all-time high of 1,191 incidents from January to July, up from 425 in 2008 and 991 in 2009. In the first six months of this year, 4,065 cases were reported in Northern Mindanao, with 15 deaths. In Davao city alone, 77 have died while 2,782 people were diagnosed from January to July.

The death of Cajutol, a rock drummer with the MIGS band and an employee of the Sarangani provincial government, exemplifies dengue's deadly nature. Cajutol was admitted to the General Santos City Doctors Hospital Saturday after complaining of high fever. His condition quickly deteriorated. On Tuesday evening, his platelet count had continued to drop despite massive blood transfusions. When he lapsed into coma and was put on a respirator, his platelet count was at 22, fatally low, prompting his doctor to tell his parents it was up to Mark to survive. Unfortunately he did not.

Rising cases

Dengue is prevalent throughout the tropics and subtropics, according to MedicineNet, which tracks infectious diseases, with recent outbreaks in the Caribbean including Puerto Rico, the US Virgin Islands, Cuba, and Central America. They are being imported back via tourists returning from areas with widespread dengue, including Tahiti, Singapore, the South Pacific, Southeast Asia, the West Indies, India, and the Middle East. Dengue in fact is now the leading cause of acute febrile illness in US travelers returning from the Caribbean, South America, and Asia, the World Health Organization says.

Statistics show it may be increasing not only in the Philippines but across Southeast Asia with Thailand, Vietnam, Singapore, and Malaysia all reporting increased cases. While more than 100 countries are now reporting dengue cases, only nine reported them as late as 1991, according to the WHO. According to the US Centers for Disease Control and Prevention in Atlanta, Ga., there are an estimated 100 million cases annually, with several hundred thousand cases turning into dengue hemorrhagic fever requiring hospitalization.

The incidence has grown dramatically around the world in recent decades, the WHO says, with 2.5 billion people – two fifths of the world's population – now at risk. The WHO estimates there may be 50 million dengue infections worldwide every year. It now spans Africa, the Americas, the Eastern Mediterranean, South-east Asia and the Western Pacific.

Southeast Asia and the Western Pacific are the most seriously affected. An outbreak in Malang regency in East Java in Indonesia in January killed five people, with 550 infected in the regency in three months. Of the 550, 382 were infected in January, health authorities said. Another four died in Mojokerto, also in East Java.

The virus is contracted from the bite of a striped Aedes aegypti mosquito that has previously bitten an infected person. The mosquito flourishes during rainy seasons but can breed in water-filled flower pots, plastic bags, and cans year-round, meaning it is of critical importance for householders and authorities to ensure that all such receptacles be emptied . Even flower vases inside houses can serve as breeding grounds. One mosquito bite can inflict the disease although the virus is not contagious and cannot be spread directly from person to person. There must be a person-to-mosquito-to-another-person pathway.

Those inflicted with the disease are hit with fever, headaches, muscle and joints pain, with most patients exhibiting rashes on their lower limbs and chests. If not diagnosed and treated early, it can develop into hemorrhagic fever, with tiny blood vessels erupting and causing severe blood loss. When progressing into dengue shock syndrome, the disease can be fatal with a very high mortality rate although proper medical care early on can reduce the death rate to 1 percent, according to the World Health Organization.

The rapid rise of dengue cases prompted General Santos City Mayor Darlene Antonino-Custodio to establish a special dengue ward at the city's district hospital and, in a worse cast scenario, designate the city-owned Lagao Gym as a possible reserve dengue ward if the number of patients continues to escalate.

"All private hospitals are now fully loaded, leaving no option for other patients but the city hospital, which is already crowded," the mayor said in a press statement.

The South Cotabato sanitary inspector's office theorized that the increase in dengue incidents could be attributed to dramatic change in the region's weather patterns. Cases used to rise at the onset of the rainy season when disease-carrier mosquitoes are most active, especially after a prolonged dry spell. However, over the last two years, dengue cases have been reported steadily throughout the year.

Nonetheless, Paulo Pantojan, chief of the DOH Region 11 Epidemiology and Surveillance Unit, refused to characterize the rise of dengue incidents as an epidemic. Health officials are urging residents to clean their surroundings and make sure no stagnant waters are stored where the virus-bearing mosquitoes could lay their eggs. Prevention and early treatment is the best way to fight the disease, health officials say.

Edwin Espejo blogs under the name Chronicles from Mindanao by a Mindanao Journalist for Asian Correspondent, with whom Asia Sentinel has a content-sharing agreement.