Dengue Fever
While nearly 4,000 cases of dengue have been confirmed in Tamil Nadu this year, at least five children have died in the past two months.
Doctor and patient at ICH, Egmore/ Image for representation/ PTI

Even as dengue cases have been on the rise this monsoon season with nearly 4000 people testing positive for the virus in the state, two more children succumbed to the virus in Tamil Nadu. Two school students, 11-year-old Divya from Vellore district and 5-year-old Kiran Kumar from Tirupathur district were confirmed dead on Tuesday. Both children had been receiving treatment for dengue. Last week, 9-year-old Vaishnavi, a resident of Karur succumbed to the virus following the dengue death of a 11-month-old baby in Thiruvallur district on October 11. In September, an eight-month-old boy from Maduravoyal too had passed away in Chennai, reportedly due to the virus.

While 3,900 cases of dengue have been confirmed in the state as of Wednesday, about five deaths have occurred over the past two months, all of which are young children. This poses an important question: Are children particularly more at risk for contracting the virus or have fever symptoms and early detection been neglected in these cases? And what can parents do to protect their children?

The phases of dengue

“Generally speaking, yes, children and elderly patients are more susceptible to dengue for age-related reasons. Young kids may not have the same immunity as an adult. So in that sense, it definitely puts children at a higher risk of contracting dengue,” explains Dr Arasar Seeralar, former Director of the Institute Of Child Health and Hospital for Children in Chennai.

The dengue virus infects a person when they are bitten by the Aedes aegypti mosquito which is the carrier of the disease. Clinical manifestations of dengue fever can be divided into three phases: febrile (when fever is present), afebrile (also called ‘critical; as the fever usually has reduced), and recovery.

It takes anywhere between three to five days for the fever to set in, marking the start of the febrile phase. In this phase, the classically expected symptoms such as high-grade fever and joint pains are seen in the individual.

“If the child is brought to the hospital after this time period (febrile phase) and the fever has subsided, it doesn’t necessarily mean that the child is showing improvement,” explains Chennai-based pediatrician Dr Rakesh K.

Detecting dengue in kids

Within the first three days of developing a fever, a test for an antigen called NS1 can be done to prove that the dengue virus has infected the body. NS1 antigen is a protein marker and appears in the body after exposure to the dengue virus. It is the standard method of diagnosing dengue.

“Many times children are brought to the hospital later than adults. Not all of them are brought in the febrile phase. [So] then we have to answer the more predominant question, ‘is this child suffering from dengue?’” points out Dr Arasar.

While there is no active fever during the afebrile phase, the child may have a number of symptoms such as nausea, vomiting, fatigue and even bleeding tendencies, which will lead doctors to suspect dengue fever. Platelet count may also dip, which in turn will lead to more bleeding. If this is not treated, it can lead to manifestations of physiological shock.

While the weaker immunity in children makes them vulnerable to the virus, doctors also point out that the febrile phase is self-limiting. This means that when the fever goes away on its own the child may either be improving or could be going into an afebrile (critical) condition. This is why it is important for children especially to be screened at the earliest, in case they develop a fever. It will better help determine the diagnosis and ultimate treatment course for the child.

Get the fever checked early: Govt

Earlier, state Health Minister C Vijayabaskar had stressed the importance of ensuring that dengue is diagnosed and treated early to avoid worsening of symptoms. Following a visit to government hospitals across the state which have been reporting the highest number of dengue cases, the Minister noted that many had delayed treatment because they were under the impression that the fever would subside on its own.

The Minister also recommended that early admissions and prolonged stay in the hospital for treatment would help those diagnosed with dengue to recover more quickly. All government hospitals have separate fever wards and intensive care units (ICUs) set up to care for those who may be affected, he said.

Prevention and care

There are a few things which you can do to protect yourself and your loved ones from dengue fever. The most important thing is to ensure that the environment is clean and hygienic. Keep water from gathering and stagnating, which will help to curb the mosquito population. Furthermore, using protective netting will help keep mosquitoes out of the household. Use of mosquito repellants, creams, and coils is also recommended.

Dengue fever is caused by one of the five serotypes or strains, of the dengue virus. The Aedes Aegypti mosquito is the vector which transmits the virus to humans via a bite. The incubation period following exposure to the virus is anywhere between 3 to 5 days. The most commonly seen symptoms of dengue are high-grade fever, joint pain, muscle pain and general fatigue. There is no vaccine against the virus, as a result of which treatment is largely based on controlling the symptoms an individual has.