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There has been a common belief in India for decades that dengue is a seasonal infection spreading only during and immediately after the monsoon between July and October. Conditions like stagnant rain water, humidity and floods were believed to be responsible for the breeding of mosquito larvae, and with the onset of winter there was a sharp decline in cases. But the epidemiological data and health ministry reports of the last few years have completely destroyed this traditional cycle.
According to the latest data from the National Center for Disease Control (NCDC) and the National Vector Borne Disease Control Program (NVBDCP), dengue cases are now being recorded continuously in the metros and towns of the country, from the winter of January-February to the scorching heat of May-June. In major urban centers like Delhi, Bengaluru, Mumbai, Chennai, Hyderabad, Kolkata and Lucknow, dengue has taken the form of a ‘perennial’ i.e. endemic disease that remains active throughout the year. This change has emerged as a new and serious challenge for public health policy, doctors and ordinary citizens.
Climate change and urbanization: the changing nature of mosquitoes and the science of indoor breeding
The biggest reasons behind dengue becoming perennial from seasonal are uncontrolled urbanization and rapidly changing climatic conditions. The ‘Aedes aegypti’ mosquito, which is the carrier of dengue, has proven to be a highly adaptable insect, which has completely adapted itself to human lifestyle.
The main factors responsible for this changed behavior of mosquitoes and their proliferation throughout the year:
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Micro-Climate and Indoor Breeding: In modern urban homes, temperature and humidity controlling appliances such as air conditioners (ACs), water coolers, defrost trays of refrigerators, indoor plants (such as jars of money plants), and potted plates placed in balconies provide mosquitoes with an ideal indoor temperature of 25°C to 30°C and clean water, 365 days a year.
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Unseasonal rain and global warming: Shortening of winter period and unseasonal rains in February-March or November-December have increased the incidence of open water logging. Eggs of Aedes mosquito can survive by remaining dormant on the walls for months even in extreme drought conditions and turn into adult mosquitoes in a few days as soon as a drop of water is found.
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Urban Heat Islands: Due to concrete and asphalt roads in cities, the night temperature also remains higher than normal, due to which the breeding cycle of mosquitoes does not stop completely even in winter.
Four different serotypes: the fear of DENV-2 and the serious risk of re-infection
Dengue is not a single virus, but is caused by four different serotypes—DENV-1, DENV-2, DENV-3, and DENV-4—of the Flaviviridae family. When a person is infected with one serotype (such as DENV-1), they get lifelong immunity against that specific serotype, but only a few months of partial protection against the other three serotypes.
This is where the biggest danger of dengue begins, which is called ‘antibody-dependent enhancement’ (ADE) in medical science. If a person gets infected with a different serotype (especially DENV-2 or DENV-3) a second time in his life, the old antibodies help the new virus enter his cells instead of killing it. As a result:
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Dengue Hemorrhagic Fever (DHF): Plasma starts leaking from the blood vessels, causing rashes under the skin, bleeding from the gums or nose.
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Dengue Shock Syndrome (DSS): Blood pressure drops rapidly and the supply of oxygen to the patient’s vital organs stops, creating a risk of multi-organ failure. The widespread presence of DENV-2 strains in India in recent years has increased the number of severe and fatal cases.
Myth of platelets vs reality of hematocrit: Know the correct medical protocol
The biggest confusion and panic spread in the society regarding dengue is about ‘Platelet Count’. There is a perception among the general public that dengue only means falling platelets and the only treatment is to increase platelets by drinking papaya leaves or Giloy juice.
According to AIIMS (AIIMS) and World Health Organization (WHO) guidelines, platelet count is more important than platelet count in dengue. ‘Hematocrit’ (Hematocrit / PCV) And ‘Plasma Leakage’ Have to monitor:
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Plasma leakage is the real villain: The main attack of dengue virus is on the inner walls of the blood vessels (Endothelium), due to which the liquid part of the blood (plasma) starts leaking and accumulates in the lungs (pleural cavity) and stomach (ascites). Due to this the blood starts thickening and the hematocrit level increases by more than 20%.
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Fluid management is life saving: There is no specific antiviral treatment for dengue. 95% of its treatment is to maintain fluid balance in the body by giving oral rehydration salts (ORS), coconut water, lemon water or intravenous normal saline (IV fluids) in the right amount at the right time.
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When is platelet transfusion necessary? According to doctors, unless the platelet count drops below 10,000 to 20,000 per microliter or the patient is actively bleeding, there is no need for platelet transfusion. Unnecessary platelet transfusions may increase the risk of infection and lung congestion.
Serious warning signs: Ignoring these symptoms can be fatal
The duration of dengue fever is usually 3 to 7 days. But the most dangerous phase is when the fever starts to subside (Critical Phase). As soon as the fever subsides, the patient and family members assume that the disease is being cured, whereas at this time the risk of plasma leakage is highest.
If the following symptoms appear in the patient after the fever subsides, he should be immediately admitted to the emergency ward of the nearest hospital without wasting a minute:
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Unbearable and continuous pain in the stomach.
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Vomiting continuously more than 3 times in 24 hours or not being able to digest anything.
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Excessive lethargy, restlessness, dizziness or confusion of the patient.
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Difficulty breathing or rapid breathing.
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Bleeding from the gums, nose, blood in vomit or black stool.
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No urination at all for 6 to 8 hours (low urine output).
Avoid Painkillers: Why is the consumption of ibuprofen and aspirin banned?
Severe headache, body ache and pain behind the eyes are common during dengue. But the patient should never buy painkillers (NSAIDs) from medical stores without doctor’s advice. Ibuprofen, Diclofenac, Aspirin, or Mefenamic Acid Should not be given.
These medicines thin the blood and damage the inner lining of the stomach. Dengue already has low platelets and weak blood vessels; In such a situation, consumption of these medicines can cause heavy internal bleeding in the intestines and stomach, which can directly lead to the death of the patient. To control fever and pain in dengue and only Paracetamol It should be used only in the dose prescribed by the doctor.
Indigenous vaccines and bio-technology: India’s new weapons against dengue
Indian scientists and drug makers are working on advanced technologies to tackle the year-long dengue crisis:
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Indigenous Tetravalent Dengue Vaccine: Late-stage human clinical trials of the four-serotype tetravalent DNA and live-attenuated dengue vaccine developed by Panacea Biotec and Serum Institute of India (SII) in collaboration with the Indian Council of Medical Research (ICMR) are progressing rapidly. This vaccine is being designed to provide uniform and long-term protection against all four serotypes.
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Wolbachia Technology (Wolbachia Mosquitoes): ICMR-Vector Control Research Center (VCRC) is conducting field trials of Aedes mosquitoes infected with ‘Wolbachia’ bacteria in Puducherry. When this natural bacteria is present inside the mosquito, it prevents the dengue virus from multiplying in the mosquito’s body and spreading to humans.
5 surefire home and personal rules to prevent dengue 365 days a year
Since dengue is no longer limited to any one season, it is essential to make prevention measures a part of daily lifestyle at individual and community level:
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Following ‘dry day’ once a week: Every Sunday, completely empty all the flowerpot trays, AC water collection bucket, back tray of the refrigerator and bird water pots in the house and scrub them dry with a brush. Aedes mosquito eggs stick even to dry soil and can only be removed by rubbing.
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Change the water of indoor plants every 3 days: It is mandatory to change the water of plants (Money Plants/Lucky Bamboo) planted in water for indoor decoration every third day.
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Protection from mosquitoes during day time: The Aedes mosquito bites mainly in the morning, 2 hours after sunrise and in the evening, before sunset, being most active. Therefore, use mosquito repellent cream, roll-on or patch even during the day and make children wear full sleeve clothes.
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Regular checking of overhead water tanks: Keep the lids of water tanks placed on the roof tightly closed and place a mesh on the vent pipe so that female mosquitoes cannot go inside and lay eggs.
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NS1 and CBC tests as soon as symptoms appear: Get an NS1 antigen test and complete blood count (CBC) done within the first 24 to 48 hours of fever so that the disease can be detected early and appropriate medical monitoring can be initiated.
The fact that dengue remains active for 12 months with the changing weather and urban environment proves that this deadly disease can no longer be fought by relying only on fogging and seasonal campaigns. Year-round monitoring of cleanliness, scientific fluid management, avoidance of painkillers and community vigilance are the strongest shield to keep every family safe from this new maze of dengue.