OUTBREAK INVESTIGATION OF DENGUE FEVER IN SUNDIA, CHAKAISER, SHANGLA, PAKISTAN–2008

Authors

  • Nighat Murad
  • Rana Jawad Asghar
  • Mohammad Zaheen
  • Rashda Shawali

Abstract

Background: From October 1-6, 2008 media reported increased fever cases along-with some deaths in a village that were found positive for dengue IgM antibody. The provincial health authorities ordered an investigation. Our investigation aimed to determine the magnitude of disease, understand the epidemiological characteristics, and recommend preventive measures. Methods: The study was to investigate an epidemic through a descriptive study followed by a case-control study in the village Sundia from October 14th to Nov 2nd, 2008. A case defined as: “Anyone from the village with fever and any one of the symptoms including bone breaking fever (arthralgia, myalgia), rash, bleeding from nose and gums from 21st Sept 2008 to 2nd Nov 2008. For comparison, controls (n=183) i.e., those who did not fulfil the case definition criteria: Systematic random sampling technique was used and data was collected on a pro forma. Blood samples were also collected from those who had fever for the last 3 days or more. Results: A total of 113 (33%) households were surveyed out of 339 among which 156 (46%) cases were selected based on case definition and all the rest (183) were taken as controls. There were 84 (54%) males and 72 (46%) females. Mean age was 30 (range between 1-80 years). Beside fever, other predominant symptoms were joint pains 94 (60%) and headache 91 (58%). Seventy samples were collected and tested for dengue IgM on ELISA method and 12 (17.14%) were found positive. Logistic regression was done and uncovered water containers (p-value <0.05) to (adjusted OR=1.8; p=0.008), surrounding marshy land (p=0.03) to (adjusted OR=1.75; p=0.02) & tap water (p=0.001) to (adjusted OR=3.2964; p=0.0012) were found to be associated with the fever. Conclusions: Investigation showed presence of different risk factors which also pertain to other countries. The gaps in communication lead to the increased number of fever cases. Dengue prevention and control program, capacity building and a strong surveillance system is crucial. Keywords: Dengue, Shangla, KPK, Arthralgia, Myalgia

References

Siddiqui FJ, Haider SR, Bhutta ZA. Endemic Dengue Fever: a seldom recognized hazard for Pakistani children. J Infect Dev Ctries 2009;3(4):306–12.

Tsai JJ, Chokephaibulkit K, Chen PC, Liu LT, Hsiao HM, Lo YC. Role of cognitive parameters in dengue hemorrhagic fever and dengue shock syndrome. J Biomed Sci 2013;20:88.

Hakim ST, Tayyab SM, Qasmi SU, Nadeem SG. An Experience with Dengue in Pakistan: An Expanding Problem Ibnosina J Med BS 2011, 3(1):3–8.

Joint WFP/UNICEF rapid emergency food security and nutrition assessment. November 2005 at http://one.wfp.org/country_brief/asia/pakistan/assessments/wfp080934.pdf accessed on 20/5/2009

District Profile-Shangla Earthquake Reconstruction and Rehabilitation Authority Prime Minister’s Secretariat, Islamabad http://www.erra.pk/Reports/KMC/ShanglaProfile200907.pdf accessed on 20/5/2009.

District Shangla available at www.http://en.wikipedia.org/wiki/Shangla_District accessed on 20/5/2009

Pakistan National Human Development Report 2003 available at http://un.org.pk/nhdr accessed 17/06/2009.

Chakaiser retrieved from www.http://en.wikipedia.org/wiki//chakesar accessed on 17/06/2009.

Sample size http://www.openepi.com/Menu/openEpiMenu.htm accessed on 20/05/2009

Herrera-Basto et.al Reported Outbreak of Classical Dengue Fever at 1700 meters above sea level in Guerrero State, Maxico, June 1988 available on http://www.sciclo.br/pdflea/v22n64/en_ao5v2264.pdf accessed on 12/05/2009.

Shu PY, Chen LK, Chang SF, Yueh YY, Chow L, Chien LJ et al. Potential Application of Nonstructural Protein NS1 Serotype-Specific Immunoglobulin G Enzyme-Linked Immunosorbent Assay in the Seroepidemiologic Study of Dengue Virus Infection: Correlation of Results with those of the Plaque Reduction Neutralization test. J Clin Microbiol 2002;40(5):1840–44.

Patz JA, Martens WJ, Focks DA, Jetten TH. Dengue Fever Epidemic Potential as projected by General Circulation Methods of Global Climate change. Environ Health Perspect 1998;106(3):147–53.

Li CF, Lim TW, Han LL, Fang R. Rainfall, abundance of aedes aegypti and dengue infection in Selangor, Malaysia. Southeast Asian J Trop Med Public Health 1985;16(4):560–8.

Schultz GW. Seasonal abundance of dengue vectors in Manila, Republic of the Philippines. Southeast Asian J Trop Med Public Health 1993;24(2):369–75.

Hurtado-Díaz M, Riojas-Rodríguez H, Rothenberg SJ, Gomez-Dantés H, Cifuentes E. Short communication: impact of climate variability on the incidence of dengue in Mexico. Trop Med Int Health. 2007;12(11):1327–37..

Dengue fever retrieved from: http://www.health.qld.gov.au/dengue/dengue_fever/mosquito.asp accessed on 9/07/2009.

Preventing Dengue Fever in Travelers retrieved from http://wonder.cdc.gov/wonder/prevguid/p0000443/p0000443.asp accessed on 12/07/2009.

Tick-Borne Encephalitis among U.S. Travelers to Europe and Asia 2000—2009 retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5911a3.htm accessed on 12/07/2009.

Guidelines on Mosquito Control and Prevention against Dengue Fever retrieved from http://www.cuhk.edu.hk/health_promote_protect/oldsars/preventive.htm accessed on 7/07/2009

Tun-Lin W, Burkot TR, Kay BH. Effects of temperature and larval diet on development rates and survival of the dengue vector Aedes aegypti in north Queensland, Australia. Med Vet Entomol. 2000;14(1):31–7.

Barrera R, Amador M, Clark GG. Ecological factors influencing Aedes aegypti (Diptera: Culicidae) productivity in artificial containers in Salinas, Puerto Rico. J Med Entomol. 2006;43(3):484-92.

Khan E, Kisat M, Khan N, Nasir A, Ayub S, Hasan R. Demographic and clinical features of dengue fever in Pakistan from 2003-2007: a retrospective cross-sectional study. PLoS One. 2010 Sep 13;5(9):e12505.

Jahan F. Dengue Fever (DF) in Pakistan. Asia Pac Fam Med. 2011 Feb 24;10(1):1

Marten GG, Reid JW. Cyclopoid copepods. J Am Mosq Control Assoc. 2007;23(2 Suppl):65–92

Dengue Fever Information retrieved from http://www.oasisdesign.net/health/dengue.htm accessed on 7/7/2009.

Acharya A, Goswami K, Srinath S, Goswami A. Awareness about dengue syndrome and related preventive practices amongst residents of an urban resettlement colony of South Delhi, J Vect Borne Dis 2005;42(3):122–7.

Vanzie E. Assessment of the Impact of Climate Change on Belize’s Health Sector: Dengue and Dengue Hemorrhagic Fever Belize Second National Communication (SNC) Project. 2008, available from: http://www.hydromet.gov.bz/downloads/Vulnerability_Adaptation_Assessment_Health.pdf

Misni Sulaiman S, Othman H, et al The Repellent Activity of Piper aduncum Linn (Family: Piperaceae) Essential Oil against Aedes aegypti Using Human Volunteers, J Trop Med Parasitol. 2008; 31:63-9.

Protecting Children against Dengue Fever in Philippines by wearing mosquito repellent patches available at http://www.xooarticles.com/Protect-children-against-Dengue-Fever-in-Philippines-by-wearing-mosquito-repellent-patches.html, accessed on 12/11/2010

Mazine CA, Macoris ML, Andrighetti MT, Yasumaro S, Silva ME, Nelson MJ, Winch PJ. Disposable containers as larval habitats for Aedes aegypti in a city with regular refuse collection: a study in Marília, São Paulo State, Brazil. Acta Trop 1996;62(1):1–13

.Measuring Inter Epidemic Risk in a Dengue Endemic Rural Area Using Aedes larval Indices http://medind.nic.in/iaj/t06/i3/iajt06i3p187.pdf accessed on 25/7/2009

Published

2014-12-01