Dengue - Are We Doing Enough

Dengue - Are We Doing Enough? Dept Of Community Medicine

OBJECTIVES To create high index of suspicion about Dengue fever. To provide information about the procedure for Notification of Dengue fever .

9 months old baby Female Wt : 7.75 kg Tirupur Referred by Dr. X D.O.A : 14.08.2004 Pediatric ward Presenting complaints Fever 1 Week Cough and cold

H/O PRESENT ILLNESS High grade fever Cough and cold 1 episode ? Seizure Drowsiness Not recognizing mother Urine output adequate No bleeding manifestations

Past history : Nil significant Immunizations : Adequate Family history : No other affected Social & Environmental history : Lower socio – economic status Sleeping habit – inside home Personal protection against mosquito- nil Awareness of parents about Dengue - poor

Role Of Environment In The cause

General examination : Irritable Febrile – 102oF Erythematous rashes Pallor + No icterus Peripheral pulses weak and thready Vital signs : HR - 120/ min RR -30/min BP -74/40 mm of Hg

CNS : NAD CVS : NAD RS : NAD ABDOMEN : Distended Liver palpable 5 cm Spleen just felt Free fluid (+)

R.C.M

Investigations: Platelet count - 49,000 cells/cu.mm Serology for Dengue : positive

DENGUE FEVER IN PEDIATRICS WARD

DENGUE FEVER CASES IN COIMBATORE HUD 14

No.of cases

12 10 8 6 4 2 0 Jan-Feb

Mar-Apr May-Jun

Jul-Aug

Months 2003

2004

Sep-oct

Nov-Dec

HUD

2003

2004

TIRUPUR

27

19

DARAPURAM

3

1

ERODE

12

7

OOTY

0

1

KARUR

3

2

Levels Of Prevention Failed : Primary and Secondary

Breeding Sites Of Aedes Aegypti

Contd….

Create Awareness To The Public

Probable Dengue : ( WHO ) Acute febrile illness with 2 or more of following Head ache Retro orbital pain myalgia Arthralgia Rash Hemorrhagic manifestations Leucopenia and Supportive serology

Occurrence at the same location and time as other confirmed cases of dengue

Confirmed cases :

A case confirmed by lab criteria

Reportable cases Any probable or confirmed cases

Guidance For Diagnosis Of DHF / DSS ( WHO) Clinical : High fever of acute onset Hemorrhagic manifestation Hepatomegaly Shock Laboratory Thrombocytopenia (< 1,00,000 cells/cu. mm) Haemoconcentrtion

The first two clinical observations, plus one of the laboratory findings ( or at least a rising hematocrit ) are sufficient to establish provisional diagnosis of “Dengue Hemorrhagic Fever ” Source : WHO

NOTIFICATION Advantage Of Notification Home Visit – find out breeding sites Containment Measures Source reduction Fogging.

Fogging

Dengue - How To Notify ? FORMAT FOR MEDICAL OFFICER FOR REPORTING DENGUE FEVER CASE

District ____________Village _________________ House No _________Head of Family ___________ Date of survey _____________________________ Particulars of patient Name _______________ Age (Years ) ______ Sex : M / F Fathers Name ________ Date of onset of illness ________ Recovered / Still suffering / Died on __________________ Date of investigation ____________ informant _________ Contd….

Symptoms Fever (more than 100o F ) Headache Hemorrhagic manifestation Tourniquet test Enlarged liver Shock

: Yes / No : Yes / No : Yes / No : Positive / Negative : Yes / No : Yes / No

Other signs _______________________ Similar illness in family / neighborhood Laboratory investigations Hematocrit (%) Platelet count Contd….

Sample sent for confirmation and result if available Acute sera sent: Yes / No, Date of collection Convalescent sera sent Yes / No

Date

Name of PHC / Hospital

Signature Name and designation

Whom To Notify ? Local Health Authority Municipal areas : Executive authority Health or Sanitary inspector Non Municipal areas: PHC Medical officer Health or Sanitary inspector Village head man

Protocol In Some Hospitals Hospitals

Who reports

When reported

CMCH

Ward Incharge M.O

On the same day

Masonic

Nursing superintendent Health Inspector

On the same day

H.I Collects only AFP

Week end

K.G PSG

Week end

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AIDS Chicken pox Cholera Cerebro spinal fever Diphtheria Dengue fever Enteric fever Hansen’s disease Malaria Epidemic Influenza

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Measles Poliomyelitis Plague Rabies Small pox Scarlet fever Tuberculosis Tetanus Whooping cough Infectious hepatitis Viral Encephalitis

Notify Cases Early To Prevent Large Outbreak

Prevention Is Better Than Cure