The fight against dengue

Dear Senator Maceda,

We find your article in the Philippine STAR last Aug. 30, 2011 on Dengue very relevant to our efforts to prevent and combat the disease. Your concern for the rising dengue deaths is also our great concern. Let me however inform you of the steps the DOH has taken to address dengue as well as take this opportunity to correct certain misconceptions contained in your latest column.

Our campaign efforts parallel the occurrence of dengue in the country, which is all year round. Nothing is too late for every agency or even communities to work together whenever there is opportunity to do so. As early as January 2011, the Department of Health organized a dengue summit in which local government units, DENR, DepEd, DILG, MMDA and private practitioners committed to do their part to lower the incidence of this disease. Recognizing dengue as a common and significant threat among ASEAN countries, the ASEAN health ministers, myself included, has declared the 15th of June of every year as ASEAN Dengue Day in a meeting last July 2010 in Singapore. During the first ASEAN Dengue Day, June 15, 2011, held in Caloocan City, the DOH partnered with the League of Barangays, wherein barangays have pledged to use part of their funds for dengue preventive measures, such as clean up drives in their respective jurisdictions. This event also highlighted the need for schools, churches and markets to do their share in keeping the surroundings free of mosquito breeding sites.

The key to preventing dengue deaths starts with preventing cases. This means communities together with government should sustain an integrated mosquito control whenever feasible, practical and affordable. Our past experience with this approach has not been quite what we would have expected since many efforts always appear reactive and sometimes too late to prevent outbreaks and deaths. We still don’t have complete understanding why some areas have marked increases in cases compared to other places. Thus, we always tried to explore options for every situation. We are exploring the use of modern technology, such as SMS, as a means to monitor communities and inform them to take measures even before cases increase dramatically.

Let me alert you to the fact that Mr. Florizel de Pano, the source of your information, is a distributor of apheresis machines.

Because some people think platelet transfusion can save lives, then absence of apheresis equipment or failure to transfuse platelets to a seriously ill patient, is a kind of negligence. Not so, if we mention current evidence on how the disease behaves.

Deaths from dengue occur because of delayed recognition of warning signs and inadequate fluid administration or resuscitation. It is therefore critical that patients are sufficiently monitored for warning signs which include rapidly declining platelets count. A rapidly declining platelet count plus hemoconcentration is evidence for plasma leakage, the primary reason why patients deteriorate and suffer from shock, or severe hemorrhage, or organ failure. Platelet replacement until recently, was routinely encouraged, thus this practice continue to prevail. New guidelines from the WHO state that there is little evidence to support the practice of giving platelet concentrates or fresh frozen plasma except when patients exhibit signs of bleeding.

We believe though that there is a need to assess current management practices so that deaths can be further reduced. This we can do off hand. Of course, again, preventing dengue cases with integrated mosquito control will bring down deaths. This we cannot do alone because communities ultimately determine their dengue burden.

Right now, hospitals are doing their best to manage these cases and hopefully prevent deaths.

Perhaps, we can work together so that we can have a permanent solution in our hands. After all, it is the dengue virus and the mosquitoes which carry them, that are the enemy.