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On Dengue: “If you have fever for 2 days and paracetamol isn’t helping, go to a specialist,” says expert

An infectious diseases expert tells us why dismissing dengue symptoms and putting off a checkup could be detrimental to our health, and why Dengvaxia isn’t our best option for now
Rhia Diomampo Grana | Aug 10 2019

Many people, especially the laboring class, tend to ignore the warning signs of dengue, and this has led to severe dengue cases among adults, Dr. Bernadette Seludo, an infectious diseases specialist at Victor R. Potenciano Medical Center observes. “There are those who are experiencing on-and-off fever or headache and a general feeling of discomfort or uneasiness, but simply ignore it. This is not good, because for all you know, it could be symptoms of dengue,” Dr. Seludo points out.

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According to a report issued by the Department of Health (DOH), dengue has three general classifications: dengue without warning signs, dengue with warning signs, and severe dengue.

“Dengue without warning signs” means that a previously well person with acute febrile illness (sudden fever) of 2-7 days experiences two of the following symptoms—headache, body malaise (the feeling of general discomfort, uneasiness, or pain), myalgia (pain in a muscle or group of muscles), arthralgia (pain in a joint), retro-orbital pain (pain behind the eyes), anorexia (lack or loss of appetite for food), nausea (a feeling of sickness with an inclination to vomit), vomiting, diarrhea, flushed skin, and rash.

Now that there are rampant cases of dengue all over the country prompting the DOH to declare a national epidemic, Dr. Seludo says it’s best to have oneself checked by an expert if any of the dengue symptoms are observed. “If you’re having fever for two days and paracetamol is not helping, have yourself checked, go to a specialist,” she advises. “Early detection is the key to combatting dengue.”

An adult specialist, Dr. Seludo says that the productive age group (ages 21 and above) are susceptible to dengue infection because they are the ones who travel and do field work. Among children, it’s the students, because they go to school and other places,” she says.

 

Is Dengvaxia the answer to the current epidemic?

“I have attended conferences in Singapore a few years back regarding Dengvaxia’s efficacy and the findings are not that impressive,” says Dr. Seludo. “The goal of the World Health Organization (WHO) is to reduce dengue morbidity by 25% and mortality by 50% by the year 2020. The efficaciousness of this vaccine is only about 79% on patients with history of dengue, and 38% on patients with no history of dengue. That is why up to now, trials are still being done, to see if they can come up with a better dengue vaccine.”

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Dr. Seludo says the recommendation was to give it to patients who has had dengue before. And considering this premise, there should be a pre-vaccination screening to determine if a person has a history of dengue before Dengvaxia is administered. At present, the most widely used method for diagnosing dengue is the enzyme-linked immunosorbent assay (ELISA test), which measures anti-DENV IgM or IgG antibodies in patient serum. “With a vaccine like Dengvaxia, your body is supposed to develop antibodies, but there is no 100% assurance that you won’t get infected by dengue. You will only mitigate the effects of dengue fever,” she explains.

Asked if she personally recommends Dengvaxia to her patients, Dr. Seludo said she is waiting for results of studies that will further prove its efficacy. “Perhaps in the future. I’m waiting for the results of five more trials. Also, there are other vaccines being developed for dengue, those could be better. In a few year’s time, there could be a new vaccine,” she says.

For now, she says our best option is to take extra caution and always maintain cleanliness in our homes, workplaces, and communities. “If you store water at home, always cover the container. Wear long sleeves, socks, and pants. Avoid areas where there is high incidence of dengue cases, and those with stagnant water. Gardens where there is still water could be a breeding ground for dengue carrying mosquitos,” she points out.

She reiterates that this national health concern should be talked about in communities, schools, and offices. “Everyone should be involved. Have small group discussions. Mobilize communities, because dengue infection can be avoided. The role of local government units is important here. Information campaigns should be done not only when there’s high incidence of dengue, but all year round.”