Rising Dengue Threat in Pune: Prevention and Treatment Measures
The most effective way to prevent dengue fever in high-incidence areas like Pune, India is through comprehensive mosquito control measures including elimination of breeding sites, use of insect repellents containing DEET, and wearing protective clothing, combined with prompt medical attention at the first sign of symptoms. 1
Understanding the Dengue Situation in Pune
Recent studies show an alarming increase in dengue prevalence in Pune, with seroprevalence rising from 62.9% in 2009 to 88.4% in 2019 2. This significant increase indicates intensified transmission of the dengue virus in the region, with DENV-3 emerging as the dominant serotype.
Several factors contribute to this rising incidence:
- Urbanization and increased population density 3
- Climate and environmental conditions favorable for mosquito breeding
- Inadequate vector control measures
- Limited public awareness about prevention
Prevention Strategies
Vector Control Measures
- Source reduction: Eliminate mosquito breeding sites by regularly emptying and cleaning containers that hold water (flower pots, buckets, tires) 4
- Community-wide cleanup campaigns: Focus on removing stagnant water sources
- Ultra low-volume insecticide spraying: Implement regular fogging with non-residual insecticides in high-risk areas 4
Personal Protection
- Use insect repellents containing DEET: Apply sparingly to exposed skin or clothing 4
- Wear protective clothing: Cover most of the body, especially during dawn and dusk when Aedes mosquitoes are most active 4
- Install screens: Ensure living and sleeping areas have proper window and door screens 4
- Use mosquito nets: Particularly important when sleeping during daytime 4
- Apply permethrin to clothing: This provides additional protection against mosquitoes 4
Environmental Management
- Early warning systems: Implement surveillance systems to detect outbreaks early 1
- Enhanced vector surveillance: Monitor mosquito populations in high-risk areas 1
- Urban planning considerations: Improve drainage systems and waste management
Recognizing Dengue Symptoms
Early recognition is crucial for effective management. Key symptoms include:
- Fever with headache
- Retro-orbital (behind the eye) pain
- Muscle and joint pains (hence the name "breakbone fever")
- Rash
- Nausea and vomiting
- Leukopenia (low white blood cell count)
Warning Signs Requiring Immediate Medical Attention
- Severe abdominal pain
- Persistent vomiting
- Rapid breathing
- Bleeding gums or nose
- Blood in vomit or stool
- Extreme fatigue or restlessness
Diagnosis and Treatment
Diagnostic Approach
- Laboratory testing: Dengue can be diagnosed through RT-PCR, NS1 antigen detection during acute phase, or IgM/IgG antibody detection 1
- Common laboratory findings: Thrombocytopenia (low platelet count), leukopenia, elevated hematocrit, and elevated liver enzymes 1
Treatment Guidelines
Fluid management: The cornerstone of dengue treatment is proper hydration
- For mild cases: Oral rehydration with increased fluid intake
- For severe cases: Initial resuscitation with crystalloid fluid bolus of 20 ml/kg, which may need to be repeated 2-3 times in profound shock 1
Pain and fever management: Use acetaminophen (paracetamol) 650-1000 mg every 4-6 hours (maximum 4g/day) 1
- Avoid aspirin and NSAIDs due to increased risk of bleeding 1
Monitoring: Regular assessment of vital signs, platelet count, and hematocrit levels
- Monitor vital signs every 15-30 minutes during rapid fluid administration 1
Hospital discharge criteria: Patients can be discharged when they have no fever for 48 hours without antipyretics, improving clinical status, increasing platelet count, stable hematocrit, no respiratory distress, and good urine output 1
Special Considerations
Children
- Require closer monitoring and are more susceptible to fluid overload
- Initial fluid bolus of 20 mL/kg recommended for children with dengue shock syndrome 1
Pregnant Women
- At higher risk of complications and require more intensive surveillance 1
Elderly
- More vulnerable to severe dengue due to comorbidities
- May require more aggressive management 1
Community Action Plan for Pune
- Public awareness campaigns: Educate residents about dengue prevention, symptoms, and when to seek medical care
- Regular community cleanup drives: Focus on eliminating breeding sites
- Coordination with local health authorities: Ensure prompt reporting of cases
- School-based education programs: Teach children about prevention measures
- Workplace initiatives: Implement prevention measures in offices and industrial areas
By implementing these comprehensive prevention and treatment measures, Pune can effectively combat the rising incidence of dengue and reduce associated morbidity and mortality.