Fight vs. dengue to continue despite covid-19 pandemic–experts

THIS is that time of the year, the wet season as we call it, when dengue, that viral disease spread by mosquitoes, particularly the Aedes aegypti kind, appears from around May to November. Rains bring volumes of water, where much of it becomes stagnant in homes whether in cans, rain gutters, pails, tires, even puddles in the backyard. These then become the home of infected mosquitoes that spread dengue to humans through their bite.

Around 35,000 dengue cases have already been reported by the Department of Health (DOH) from January to May this year, with 180 denguerelated fatalities to boot. This number is 23 percent higher compared to the 28,336 cases logged during the same period last year.

Just two weeks ago, Cebu City reported an “alarming rise in cases of dengue” compared to last year, which is surprising since dengue cases dropped during the lockdown periods of the pandemic.

All these are happening while the country is still in the middle of a debilitating Covid-19 pandemic.

Controlling dengue while in a pandemic

DURING the latest “Stop Covid Deaths” webinar titled “Dengue Alert sa Panahon ng Pandemya” organized by the university of the Philippines, up Manila NIH National Telehealth Center and up Philippine general Hospital (UP-PGH), Dr. Evalyn Roxas, Associate Professor, Department of Microbiology, College of Public Health, up Manila and Clinical Associate Professor, Division of Infectious Diseases, Dept. of Medicine, UP-PGH, said that while there are programs and guidelines, including informational initiatives in combating dengue, the DOH adopted strategies and other dengue control programs during the Covid-19 pandemic.

Dr. Roxas said that the DOH made use of the digital age to distribute advisories to the Centers for Health Development (CHD), particularly the regional offices, to provide guidance. “We also shifted to the virtual program implementation reviews with the CHDS to discuss policy directions and operational strategies. The information, communication and education campaign materials were also enhanced and disseminated to various media, whether via radio, TV, newspapers or the internet.”

The DOH, she said, also implemented innovations and other best practices, one of which was program enhancement by coming up with Clinical Case Management and Dengue Rapid Advice guidelines. Also adopted were international best practices on dengue through Administrative Order No. 2021-0009, which helped establish dengue Centers of Excellence in tertiary hospitals in January 2021 to provide and identify resources and even collaborate with the Commission on Higher Education in the development of standardized training programs.

While in the midst of a pandemic, Dr. Roxas mentioned at least four priorities for action by the DOH, namely, coverage of service and data, quality of care, integration and response, and health financing. The latter shall focus on the improvement of health care packages as an integral part of the development of Republic Act (RA) 11223 or the universal Health Care Act, particularly the review of the Dengue Philippine Health Care Insurance Benefit Packages.

The Cebu dengue experience

FOR Dr. Belle Ranile, Pediatric Infectious Disease Specialist from Cebu City, she shared the city’s experience in private and public hospitals with regard to dengue, including outpatient management. She said that the spike in the number of dengue cases did not come as a shock because it is already expected with society’s increased mobility, the rain volume, particularly with the spate of typhoons that hit the city. “The onset of the pandemic showed a decrease in dengue and other infectious diseases, but as mobility increased, we expect more of these infections to resurface.”

She said the number of cases in Cebu during the past few weeks rose significantly. However, because of the fear of Covid-19, the health-seeking behavior of parents were affected that led to late checkups and hospitalizations according to the chief of the CCHD. The majority of the dengue cases, says Dr. Ranile, were among children one to 10 years of age from January to May 2022, in four private and two government hospitals in Cebu.

Still, Dr. Ranile emphasized the importance of early and rapid screening, prompt recognition, appropriate management and prevention strategies, all vital in reducing the burden of the disease. “However, we believe that community participation is still key in the control of dengue.”

Addressing dengue despite Covid-19

FOR his part, Dr. Sergio Zelig Javier, Division Head for Environmental Health and Sanitation of the Cebu City Health Department (CCHD) and also its former dengue coordinator, said they already implemented Integrated Vector Management (IVM) comprised of entomology survey, which is part of the surveillance process, larvicidal activity to prevent development of larvae to adult mosquito, ultra Low Volume Misting (ULVM), done in areas where adult mosquitoes are present, Curtain Chemical Impregnation is done in house where chemical treated nets cannot be installed, and the distribution and installation of Insecticide Treated Nets (ITNS) in order to prevent infection, particularly in public schools.

They also used the Philippine Integrated Disease Surveillance and Response (PIDSR) system, which is used nationwide to monitor 25 diseases and syndromes that have the potential to cause an outbreak and warrants an immediate response. “The system categorizes diseases into three, whether they are epidemicprone, of which dengue is classified; targeted for eradication or elimination; or other diseases or conditions of public health importance,” Dr. Javier said.

Dr. Javier said they also continued the DOH’S “4S” strategy, which is “Search and Destroy,” “Self-protection,” “Seek Early Consultation,” and “Support misting during outbreaks,” which was discontinued since the Department of Environment and Natural Resources banned fogging, which is similar to misting.

He, however, noted that there were limitations in the implementation of the dengue control program as the Covid-19 pandemic called for the realignment of personnel to address Covid-19, limited fever surveillance and face-to-face consultation, and delayed health-seeking behaviors. “Fortunately, community quarantine played a role in the decrease of cases.”

Dr. Javier suggested the strengthening of the dengue prevention and control program while maintaining public health standards, and also called for the implementation of the Targeted Indoor Residual Spraying (TIRS) or Targeted Residual Spraying (TRS), a new strategy done by the DOH to eliminate cases in malariaendemic areas.

“I believe these interventions can be beneficial and as effective, if not more effective, than the ULVM since these target the resting places of adult mosquitoes such as behind cabinets, under tables and chairs, appliances, under sinks and even toilets, and the chemical used can’t be washed out as well. What’s important is that dengue intervention should be unhampered despite Covid-19. We can continue the program by maintaining minimum health protocols.”