Dengue cases on a rise but Indian Medical Association says nothing to panic about

Indian Medical Association in New Delhi on Tuesday released guidelines to avoid dengue and also said that people had no reason to panic as everything was under control.

Dengue is known to have four serotype out of which type four and type two are supposed to be most dangerous. The national capital this year is said to be exposed to type four dengue although it is not as fatal as the one which was detected in 2013. AIIMS has said that the type four strain of the disease has emerged as the dominant type for the first time in New Delhi, along with dengue type two, both of which are said to be dangerous.

IMA's guildelines also mention the symptoms of type four dengue which include fever with shock and a drop in platelets while type two causes a severe drop in platelets, hemorrhagic fever, organ failure and dengue shock syndrome. While type 4 also carries the risks of hemorrhagic fever, the severity of dengue is higher in type two. The classic dengue fever which is common during the season has symptoms like headache, retro orbital pain, and marked muscle and joint pains. The symptoms are seen to develop between four and seven days after the bite of an infected mosquito and the incubation period typically remains for three to 14 days while the fever lasts for five to seven days. Adults will be shown having symptoms like fatigue that will last for days to weeks. And among females, joint pain, body aches, and rashes will be prevalent.

Though, complications rise after the fever is over. Doctors say that the two days after the last episode of the fever are crucial and during this period, a patient should be encouraged to take plenty of oral fluids mixed with salt and sugar as the main complication is leakage of capillaries and collection of blood outside the blood channels which leads to intravascular dehydration which is why giving fluids orally or by intravenous at the right time can save complications.

As doctors continue to make people aware of the cause and precautions to be taken, Dr K K Aggarwal, Padma Shri Awardee and Honorary secretary General IMA said in New Delhi that only suspected severe dengue cases should be given medical attention and admission and that others can be managed as OPD care. For this reason, IMA has refused platelet transfusion unless the patient has active bleeding and a platelet count less than 10,000. 

IMA has said that the reliable test for the disease is haematocrit and not platelet count as platelet counts by machine readings are not reliable and can have an error of up to 40,000. They have also said that most cases can be managed without testing and by only measuring difference between upper and lower blood pressure, which should be kept over 40 mm Hg.
 
Appeals have been made to the public to not panic and not force doctors to admit them unless it is important. "Do not fill beds with patients not requiring admission. Make beds available for severe dengue cases” added Dr Aggarwal. Dr V K Monga and Dr R N Tandon from IMA said that most dengue patients can be managed with oral fluids and so unnecessary admissions and overcrowding of hospitals could end up infecting the hospital itself.

The rise of type four dengue cases has even shocked the doctors as strains of it were not found in Delhi except for a few cases in 2003 after which it wasn't even actively circulating in the national capital. Doctors have said that if a dominant strain remains for a long period, it will be seen that a significant population will get immuned to the disease, however type four was not seen in Delhi. 

AIIMS lab is also suspecting the birth of a new serotype this year in addition to the four. Researchers who collected samples during an outbreak in Malaysia's Sarawak state in 2007 found that this serotype is different from the other four and that the antibodies produced against the new type are also different from those used in the previous treatments. But the occurrence of this type was found only once in humans.