Last week, the Epidemiology and Disease Control Division held a meeting with stakeholders—health workers, officials and representatives of local units in Sunsari district, to discuss the growing scourge of the dengue epidemic.

Officials discussed the risks, as well as possible causes of the spread of the virus, and reminded the agencies concerned of their responsibilities to control the spread of the deadly disease.

“Participants in the meeting patiently listened and agreed that the risk is serious and that their roles to control the spread of the virus are crucial,” an official of the Department of Health Services told the Post, asking not to be named as he is not authorised to speak to the media. “But neither has the caseload of dengue infection gone down in Sunsari nor have deaths. It seems that we have learned nothing, neither from our past mistakes and experiences nor from the recent classes.”

At the request of the Health Ministry, the World Health Organisation’s South-East Asia Region invited technical experts from its collaborative centre in Thailand. The expert team gave case management training to health workers in all seven provinces in Nepal. But cases of dengue infection have still been steadily rising.

At least seven people have died of dengue infection in Sunsari district in the past two months.

According to the BP Koirala Institute of Health Sciences, a 30-year-old male patient died of dengue haemorrhagic fever. The other six patients, who succumbed to the deadly disease, had underlying conditions—diabetes, hypertension, and renal failure.

Of around 4,500 confirmed cases of dengue reported so far since the start of this year, around 3,000 have been reported from Sunsari.

“Over 3,000 cases of dengue infection have been confirmed in our hospital alone,” said Dr Jagat Narayan Prasad, director at the hospital. “We have been overwhelmed with dengue patients.”

According to the hospital administration, beds in the hospital’s emergency ward, Covid ward, observation wards and several other departments are occupied by dengue patients. Dozens of patients with serious complications have been visiting hospitals for treatment every day.

The hospital has converted its 100-bed Covid ward into dengue ward. A separate dengue special clinic has been brought into operation after the hospital’s outpatient department was overwhelmed with dengue patients.

“Several doctors, nurses, paramedics and other hospital staff have also been infected with the dengue virus and this has affected service delivery,” said Prasad. “We have started a process of hiring 150 nursing staff in view of the growing dengue cases.”

In 2019, the disease gripped 68 districts; six people died, and more than 16,000 were hospitalised. Sunsari was the epicentre of the dengue outbreak and most of the deceased were from Dharan.

Last year, 88 people died and more than 54,000 were infected with the virus, which had spread to all 77 districts of the country. Hospitals in Kathmandu Valley were

overwhelmed with dengue patients and many complained that they were deprived of treatment. At the time, pharmacies had run out of paracetamol, the most widely used medicine to treat fever.

Experts say unless the lessons and experiences gained in the previous outbreaks are implemented, the disease will not stop spreading.

“Authorities must implement the decisions and suggestions of experts to break the chain of infection,” said Dr Sher Bahadur Pun, chief of the Clinical Research Unit at Sukraraj Tropical and Infectious Disease Hospital. “The ongoing spread of infection could be just a start of a larger epidemic.”

The post-monsoon time is considered the peak season for dengue transmissions, but the country has already witnessed outbreaks of the potentially deadly disease since the start of the year. Experts say the virus has become endemic with cases of dengue reported throughout the year.

They say the real number of infections could be several times higher, as the government’s case reporting system is not very effective and more than 80 percent of the cases are asymptomatic. Many people infected with the dengue virus show mild symptoms, which do not need any treatment or can be treated with paracetamol at home.

Entomologists said that a new dengue virus serotype might be responsible for the ongoing epidemic in Sunsari, as the district saw a massive outbreak in 2019.

“When a new serotype of the virus spread in areas that have already witnessed large-scale outbreaks from a different serotype, death and severity rate increases, and this is what is happening in Sunsari,” said Professor Murari Das, an entomologist at the BP Koirala Institute of Health Sciences. “We don’t even know the serotype of the virus currently spreading in various districts throughout the country.”

Last year, virus serotypes DENV-1, DENV-2, and DENV-3 were found responsible for the dengue epidemic in the country. There are four serotypes of dengue, numbered 1 through 4.

Dengue is a mosquito-borne disease transmitted by female Aedes aegypti and Aedes albopictus mosquitoes. The same vector also transmits chikungunya, yellow fever, and Zika, according to the World Health Organisation.

Dengue-transmitting mosquitoes breed in clean water and bite people in daylight. Uncovered water tanks and discarded objects such as plastic cups and bottles could be breeding grounds for dengue-carrying mosquitoes.

“Dengue ‘search and destroy’ should be a regular and widespread effort if we have to get rid of infection,” said Das. “Otherwise, infection will continue to spread.”

According to doctors, mild to high fever, severe muscle pain, rashes, severe headache and pain in the eyes are some symptoms of dengue. Doctors advise that those with these symptoms should seek immediate treatment. While there is no specific cure for the disease, early detection and access to proper medical care can lower fatalities.