The dengue outbreak in India, now slowly subsiding since the start of November, which had at last count infected nearly 30,000 people this year, could in fact be much bigger than these numbers. Huge under-reporting of the incidence of the disease is hampering the response intervention and exposing many to danger, health experts say.
Dengue also called backbone fever because it sometimes causes severe joint and muscle pain that feels as if bones are breaking, is regularly raising its ugly head in the country since the last about a decade. The dreaded infection is transmitted to humans through mosquito bites, a specific species of mosquito usually Aedes Aegypti which generally bites during morning hours and just before sunset. According to the Union Ministry of Health and Family Welfare (MHFW), 20,000 confirmed cases of dengue were reported every year on average between 2006 and 2012. There were 75,808 cases in 2013, and 40,571 in 2014.
However, a landmark 2014 study by the government’s National Institute of Health and Family welfare (NIHFW), New Delhi, found that India could have had an annual average of 5,778,406 clinically diagnosed dengue cases, or 282 times the officially reported number per year between 2006-2012. The study reported that the National Vector borne disease control programme (NVBDCP) captures only 0.35 per cent of the annual number of clinically diagnosed dengue cases in the country.
In 2013, an assessment by a team of 18 researchers from seven countries, published in the British Journal ‘Nature’ said India alone contributed 22-44 million dengue infections in the world which suggested that the Union Health Ministry’s estimate could be off by a 1000 times. However, the Indian Council of Medical Research (ICMR), which is launching a programme to estimate the actual burden of dengue in the country, says that nobody really knew the real burden of the disease, and the truth lay somewhere between the 282-times more and the 1000-times-more estimates.
The World Health Organization (WHO), while estimating that some 3.9 billion people in 128 countries are at risk of dengue globally, says India is today the epicenter of the global epidemic of dengue, harboring the largest number of dengue infections in the world. According to the WHO, dengue had become hyper-endemic in India, whose incidence had increased 30 folds in the past few decades.
Some of the discrepancies in data could be due to the fact that the government records only laboratory confirmed cases as dengue, with a very large majority of cases going unreported, and seen as routine viral infections. The under-reporting has major implications on the way dengue is treated, since repeat infections, usually due to a different strain of the virus, can be far more debilitating as compared to the primary infection. Researchers point out that India’s surveillance systems are just not configured to capture the full spectrum of dengue from the large number of patients who remain asymptomatic to the ones who get hospitalized.
The National Institute of Health and Family Welfare (NIHFW) study, by nine researchers, published in ‘The American Journal of Tropical medicine and hygiene’ estimated the total direct annual medical cost of the dengue burden at $548 million (Rs 3,600 crore), and the total economic cost to be in the order of $ 1.11 billion.
Treatment for dengue fever in a reputed private hospital could cost over Rs 1.2 lakh. About half the bill for by platelet infusion and another quarter is room rent, as most patients have to stay in the hospital for about four to five days. Most private hospitals ask for single donor platelets, which are more expensive but boost platelet counts by 20000 to 30000 per pack. In private blood banks and some high-end hospitals, the cost could be as high as Rs 15000 to Rs 18000 per pack, and patients need three to four packs.
The less expensive variety is random platelets, sourced from multiple donors, which cost about Rs 1500 to Rs 2000 per pack. But it boosts platelet counts by about 5,000 per pack and hence could require 20 to 25 packs, thus costing Rs. 30000 to Rs. 50000.
Other than cases which require platelet transfusion, or serious complications needing admission in the Intensive Care Unit (ICU), there is no specific treatment for dengue other than rest and plenty of fluid intake along with regular monitoring of the platelet count, yet, even this would cost anywhere between Rs 30000 in a mid-level hospital and Rs 80000 in a high-end one. In such cases, room rent is the biggest chunk, roughly 35 per cent to 50 per cent of the total bill.
Sheer numbers of dengue infected people in India annually, make it imperative that public health measures aimed at controlling the breeding of mosquitoes are adopted. Health experts emphasized the importance of primary health services in the management of epidemics. Prevention should be the main focus of disease control, but nowadays little effort is made on this front, they bemoaned.
Experts point out that primary healthcare in India has been suffering from many issues and its basic concept has been misunderstood. Primary health centres (PHCs) are understaffed, inefficient and inadequate quantitatively and qualitatively. Due to lack of ‘growth opportunities’ and their general nature, PHCs are the least attractive destination for doctors. Disease like dengue and malaria are easy to prevent by targeting mosquito breeding. Poor implementation of the National Vector borne disease control programme has resulted in seasonal outbreaks of vector borne diseases, particularly mosquito-transmitted infections. Building more AIIMS-like facilities is important for quality healthcare, but there is no substitute for a robust primary healthcare system, experts insist.
The increasing menace of dengue infection in recent years, is liked to hot and humid weather conditions. The WHO has warned that dengue is the fastest growing disease in the world, and climate change will only exacerbate the problem.
(The writer is a freelance journalist)
