Dengue fever cases still on the rise despite seasonal change

We care a lot of Dengue cases, especially in poor villages

A Covid-19 patient can also get dengue fever, which is also caused by a virus and for which there is no known cure

Vaccines are not effective against dengue fever

Extract | The COVID-19 epidemic has not slowed the onset of seasonal dengue fever across the country. The country has been battling dengue fever since early this year, at a time when state resources have been spent on curbing the COVID-19 outbreak. The similarities between dengue fever and COVID-19 symptoms have also complicated efforts to mitigate the annual spike in cases. In a recent press statement, the Meteorology, Climatology and Geophysics Agency (BMKG) said that while 51.2 percent of the country had entered the dry season, the rest of the archipelago was expected to experience prolonged rain for the next two to four months.

Beyond Corona: Dengue Fever Cases in Indonesia, how can we interact?

However, symptoms of dengue fever are different from those of Covid-19.

Dengue occurs is spread by mosquito bites and is due to the infection by a flavivirus which is transmitted by the bite of the ***Aedes aegypti mosquito. This mosquito bites during the daytime.

General information

In 2020, there were 35,315 reported cases of dengue fever and dengue hemorrhagic fever in Indonesia. This was a steep increase from the number of cases reported in 2019, which was 15,998. The reported cases do not reflect by far the real number of Dengue cases because a huge part of the population living in rural areas does not all have a birth certificate, identity card, or family record book!

Dengue fever is typically a self-limited disease with a mortality rate of less than 1% when detected early and with access to proper medical care. When treated, severe dengue has a mortality rate of 2%-5%, but, when left untreated, the mortality rate is as high as 20%. This mortality rate of 20% is that in force in the most rural and poorest regions. Those where access to care is almost inexistent, economic resources at the lowest.

Dengue fever is most common during the rainy season (November-May) as Aedes mosquitos require clean standing water to reproduce. The peak of the season is usually from March through May.

Dengue haemorrhagic fever (DHF) was first recognised in Indonesia in the cities of Jakarta and Surabaya in 1968. There is no vaccine against dengue fever, though several are in development. This mortality rate of 20% is that in force in the most rural and poorest regions. Those where access to care is almost inexistent, economic resources at the lowest.

Key facts about Dengue

  1. There is no specific treatment for dengue/severe dengue;
  2. Dengue isn’t spread from person to person;
  3. Dengue is spread by infected mosquitoes, usually the Aedes aegypti and Aedes albopictus varieties;
  4. These mosquitoes bite during the day, usually early in the morning or in the early evening before dusk. They’re often found near still water in built-up areas, such as in wells, water storage tanks or in old car tyres;
  5. The global incidence of dengue has grown dramatically in recent decades. About half of the world’s population is now at risk. There are an estimated 100-400 million infections each year;
  6. Dengue prevention and control depends on effective vector control measures. Sustained community involvement can improve vector control efforts substantially;
  7. Dengue fever can cause spontaneous bleeding, such as nosebleeds, red spots, and bleeding gums. Only around 10 to 15 percent of patients develop a cough and, unlike Covid-19 patients, they don’t experience respiratory problems;
  8. Dengue fever symptoms also include eye pain, headache, continuous vomiting, increased red blood cells, and a low platelet count (under 100,000 platelets*);
  9. The disease can infect people of all age groups, but most dengue fever patients in Indonesia this year in 2020, have been teenagers;
  10. A lot of teens suffering from dengue fever come to the hospital already in critical condition. Many of them are in hypovolemic shock or lacking fluid. They refuse drinks because it makes them vomit so they suffer from dehydration.

Dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS)

A rare complication of dengue fever, DHF occurs most often in small children and elderly adults. If DHF occurs, it will usually do so by day 3-5 of infection. The relationship between DHF and previous dengue infection has not been clearly established, but previous exposure to dengue is correlated with subsequent DHF. Uncontrolled bleeding distinguishes DHF from fever accompanying a dengue infection. Bleeding can occur from the gums, nose, intestine, or under the skin as bruises or spots of blood, especially under a tourniquet.

In children, the progression of the disease is not always characteristic. A relatively mild first phase with an abrupt onset of fever, malaise, vomiting, headache anorexia, and cough is succeeded 2-5 days later by weakness and, sometimes, physical collapse. Frequently, spots appear on the forehead, arms, and legs, along with spontaneous bruises and bleeding from punctures where blood was taken. A seriously ill child may breathe rapidly and with considerable effort; the pulse may be weak, rapid, and thready.

The criteria for DHF are a platelet* count of less than 100,000 and a **hematocrit 20% greater than normal. Children with similar blood indicators should be hospitalised immediately and managed for potential DSS. The syndrome can be lethal and requires rapid in-hospital management with assiduous correction and replacement of fluid, electrolytes, plasma, and sometimes fresh blood/platelet transfusions. Mortality due to DHF and DSS ranges from 5-30% in the untreated Indonesian population, with the highest risk category being infants under one year of age.

Symptoms of dengue – Usually develop suddenly, about 5 to 8 days after you become infected

  • A high temperature, or feeling hot or shivery
  • A severe headache
  • Pain behind the eyes
  • Muscle and joint pain
  • Feeling or being sick
  • A widespread red rash
  • Tummy pain and loss of appetite
  • The symptoms normally pass after about 1 week, although you may feel tired and slightly unwell for several weeks afterwards.

Treatment

  • There is no preventative treatment for the dengue virus. Its symptoms can and should be treated, but there is no medicine or commercially available vaccine for the virus. Vaccine candidates are going through clinical trials in many countries, but a safe vaccination protocol is not expected for some time.
  • It has been suggested that DHF is more likely if the patient has previously been infected by dengue fever within the last 8-12 months and that the likelihood of DHF relates to this previous “sensitization”.
  • To avoid getting dengue fever or DHF, you must avoid getting bitten by day-biting mosquitos.
  • Convalescence can take weeks, and bed rest and antipyretics and analgesics are required. An attack produces immunity for a year or more, but only to one of the four flavivirus strains responsible for the initial illness.
  • In an epidemic, the emergency control measure is mosquito insecticide applied outside by vehicle-mounted or portable ultra-low-volume generators a minimum of twice a day at ten-day intervals;
  • Take paracetamol to relieve pain and fever. Do not take aspirin or ibuprofen, as these can cause bleeding problems in people with dengue;
  • Drink plenty of fluids to prevent dehydration – if you’re currently abroad, only drink bottled water from a bottle that was properly sealed;
  • Get plenty of rest

Prevention

  • There are currently no vaccines;
  • The best method of prevention is to avoid mosquito bites;
  • Use insect repellent – products containing 50% DEET are most effective, but a lower strength (15 to 30% ****DEET) should be used on children, and alternatives to DEET should be used on children younger than 2 months;
  • Treatment is possible if diagnosis occurs before the patient develops DSS or DHF;
  • If you live in Indonesia, have your home sprayed. If you’re visiting Indonesia, hati-hati (be careful);
  • Common sense precautions can protect you from this day-biting mosquito;
  • Be aware of your environment – Mosquitoes that spread dengue breed in still water in urban areas;

Fair Future and its teams make a lot of prevention. Give explanations to communities in order to avoid illness, especially for young children.

DHF: Dengue Hemorrhagic Fever – DSS: Dengue Shock Syndrom;
*Platelets, or thrombocytes, are small, colorless cell fragments in our blood that form clots and stop or prevent bleeding. Platelets are made in our bone marrow, the sponge-like tissue inside our bones. Bone marrow contains stem cells that develop into red blood cells, white blood cells, and platelets;
**Hematocrit is the percentage by volume of red cells in your blood. Blood is made up of red blood cells, white blood cells and platelets, suspended in plasma. Together, those included about 45% of the volume of our blood, but the specific percentages of each can vary;
***Aedes Aegypti is a genus of mosquitoes originally found in tropical and subtropical zones but now found on all continents except Antarctica. Can spread dengue fever, chikungunya, Zika fever, Mayaro, and yellow fever viruses.
****DEET: N, N-Diethyl-meta-toluamide, also called DEET or diethyltoluamide, is the most common active ingredient in insect repellents. It is a slightly yellow oil intended to be applied to the skin or to clothing and provides protection against mosquitoes, ticks, fleas, chiggers, leeches and many biting insects.
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Some more Information

The impact of COVID on mental health… And how we can help each other

Understanding COVID-19 will help us all to stay safe. Find out more about COVID, and how to protect yourself and your community. The mental health impact of COVID… and how we can help each other. COVID-19 Health Information. Understanding the difference: Malaria & COVID-19. What is ‘long COVID’? Latest COVID-19 Data: Sources: WHO, December 2021. 4.8 Million Deaths: Deaths from COVID-19 are continuing to rise. Let’s do what we can to help stop the spread. 5.4 Billion Vaccine doses given: Doses are not being shared equally around the world. #OnlyTogether can we end the pandemic.

Water Connections. The deep borehole of MbinuDita – Part#1

From the drilling site, here in East Sumba, MbinuDita village. In the middle of nowhere, at the foot of the hill that hosts our school in SD Mbinudita. Most of the work has started. Several phases will lead us to provide a clean water network to more than 200 families who have never had direct access to it. Where it’s complicated is that the groups of houses are sometimes several kilometers apart. This, therefore, makes the thing technically complex in terms of physical law! This action is fully linked to the “Water Connections” program, initiated by the Fair Future and Kawan Baik Indonesia foundations.

Medical assistance – Malaria in Indonesia, what we are doing?

Risk is present throughout the country, excluding urban areas, and excluding the areas specified: J akarta, Surabaya, Denpasar (Bali), and other large cities are risk-free, including the beach resorts in southern Bali. Sporadic cases of malaria in travelers have been reported from rural areas of Java, Bali (Padangbai area), Bintan, and Lombok islands. The WHO data does not take into account the situation in eastern Indonesia, which is linked to the lack of existing data. Nevertheless, malaria in the regions of Flores, Sumba Timur and Kupang is important in rural villages.

Dengue fever cases still on the rise despite seasonal change

The COVID-19 epidemic has not slowed the onset of seasonal dengue fever across the country. The country has been battling dengue fever since early this year, at a time when state resources have been spent on curbing the COVID-19 outbreak. The similarities between dengue fever and COVID-19 symptoms have also complicated efforts to mitigate the annual spike in cases. The island of Java has contributed the highest average number of dengue hemorrhagic fever cases each year. In recent years, Bali and Borneo (Kalimantan) have had the highest incidence.

Impact of air pollution on health in Indonesia!

Outdoor air pollution is a mix of chemicals, particulate matter, and biological materials that react with each other to form tiny hazardous particles. It contributes to breathing problems, chronic diseases, increased hospitalization, and premature mortality. In Indonesia, this is the cause 50% of morbidity nationwide. How is air pollution affecting Indonesia? More than 80% of the Indonesian population of more than 260 million inhabitants, is exposed to annual average concentrations of pollution, well above the WHO guideline. The country has the fifth-highest loss of years of life in the world due to particulate matter pollution.

Assistance to people in case of malnutrition problems

Social consequences of malnutrition. Undernourished children have weaker immune systems and are thus more susceptible to infections and illnesses. Long-term insufficient nutrient intake and frequent infections can cause stunting, whose effects in terms of delayed motor and cognitive development are largely irreversible.

Medical Assistance for Children’s in pandemic time

Fair Future notes that children are certainly the most affected by the indirect impact of the pandemic than by the viral infection itself. Indeed, we have noticed that the COVID-19 pandemic is having an impact on the health of children, but through the increase in poverty, the loss of education and the closure of schools -here in Indonesia the closure of schools since March 2020-, food insecurity, violence as well as increased pressure on health systems and reduced access to personal health care services.

Rumah Kambera Base Camp – Covid-19 fight and Clean Water updates

Management of the pharmacy, water supply, Covid-19 program, infrastructures, and day-to-day organizations.
Facing the crisis linked to the pandemic, the lack of water and vital resources, managing the organizational structure in order to optimize the social and medical assistance that we offer. The 24 hours that a day counts are not enough to do everything!

Covid-19 fight – Free vaccination day for 500 registered people – 26.09.21.

Vaccination is still not accessible to everyone! Fair Future and Kawan Baik Indonesia, in collaboration with Denpasar City Youth Organization, Denpasar City Covid Task Force, Health Office, Social Service, and several medical personnel volunteers, have the opportunity to be able to carry out free vaccinations. This day of free vaccination will be held on September 26, 2021, at Rumah Sanur Creative Hub, Fair Future Foundation and Kawan Baik Indonesia foundations Base camp in Denpasar.

Tomorrow 31.08.21, a 3rd team will join forces already present in eastern indonesia

After having sent the 2nd team on-site last week, Fair Future will leave on August 31, 2021, in reinforcement to join the Base Camp of Rumah Kambera in Sumba East. A 3rd team made up of Kawan Ayu, Kawan Hasto and Kawan Alex. The mission is clearly defined in what we have been doing for months on the spot, namely: To fight as best as possible the devastation linked to the Covid-19 pandemic on the spot.

Common diseases we work on

Tuberculosis in Indonesia: A social disease affects the poorest communities, those living in difficult conditions. There are hundreds of thousands of new cases in Indonesia, such as HIV, which is not often mentioned here!

Tuberculosis

Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.

A social disease, tuberculosis affects more particularly the poorest groups of the population, in particular the homeless people in whom the incidence (approximately 200 / 100,000) far exceeds that of other groups.

In Indonesia, tuberculosis is the leading cause of death in the category of infectious diseases. However, when one considers the general causes of death, tuberculosis ranks 3rd after heart disease and acute respiratory disease at all ages. The number of tuberculosis cases found in 2019 was around 645,000 cases. This figure has increased from the tuberculosis data recorded in 2018, which was in the order of 566.00 cases.

Meanwhile, the number of recorded deaths from tuberculosis based on WHO 2019 data is 98,000 people. This includes 5,300 deaths of tuberculosis patients with HIV / AIDS.

Life-saving anti-tuberculosis drugs are still unaffordable and out of reach for children in high-burden countries like Indonesia.

In 2020, the 30 countries with a high TB burden accounted for 87% of new TB cases. Eight countries account for two-thirds of the total, led by India, followed by Indonesia, China, Philippines, Pakistan, Nigeria, Bangladesh, and South Africa.


More info: https://tbindonesia.or.id/pustaka-tbc/informasi/tentang-tbc/situasi-tbc-di-indonesia-2/

Dengue virus infection: DENV is a real major cause of acute febrile illness here. In the most affected regions, mortality is very high & affects the most vulnerable. Especially for those who do not have access to medical care.

Malaria and the vulnerable: Every year, malaria kills thousands of people in Indonesia, in all regions, even the richest. 70% of all deaths are children under five, and affect people and families who cannot access medical care.

Antimicrobial resistances. In here, this is a real health emergency, almost all drugs are available over the counter! This scourge turns simple wounds and easily treatable diseases into causes of death.

Antimicrobial resistance

Antimicrobial agents have played a vital role in reducing the burden of communicable diseases around the world. The WHO South-East Asia Region is no exception. On an Indonesian or "local" scale, antimicrobial drugs, including antibiotics, are very cheap, accessible, and very effective. It is with good reason that many have long considered them to be "miracle drugs".

The situation in Indonesia with this major health problem is absolutely catastrophic. Participating physicians prescribe antimicrobials on all counts, for infections for which any form of antimicrobial is unnecessary. Too large a proportion of sick patients simply no longer respond to the treatments they - sometimes very urgently - need.

The emergence of antimicrobial resistance (AMR) creates “superbugs” that make treatment of basic infections difficult (and in some cases impossible) and surgery risky. And while the emergence of resistance in microorganisms is an ongoing phenomenon, its amplification and spread are the results of one thing: human behavior.

The WHO South-East Asia Region is particularly affected. As the risk assessments conducted by WHO have shown, the Region is probably the most at-risk part of the world. Not only does AMR affect the health and well-being of people in Indonesia, it also has ramifications for public health and general well-being. This makes the problem of immense global importance.

 


More info: https://www.balimedicaljournal.org/index.php/bmj/article/viewFile/1386/pdf

Air pollution and health: Plastic that burns, everywhere! Air pollution is responsible for almost 50% of mortality here. Dioxins, furans, mercury, and polychlorinated biphenyls are highly toxic!

Malnutrition and famine: Malnutrition causes serious illnesses where we are! The phenomenon, creating a vicious cycle of starvation & disease. This is a major problem in which we deal with!

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