|Year : 2017 | Volume
| Issue : 4 | Page : 375-376
Epidemiological and demographic characteristics of dengue at a tertiary care centre in Gujarat
Paritosh K Kar1, S Haq2, Ashish Gupta3
1 Foundation on Tropical Diseases and Health Research Development, Midnapore, India
2 ICMR-National Institute of Malaria Research, New Delhi, India
3 ICMR-National Institute of Malaria Research, Field Unit, Haridwar, India
|Date of Web Publication||19-Feb-2018|
Paritosh K Kar
Chairman & Founder Trustee Foundation on Tropical Diseases & Health Research Development Midnapore-721 124, West Bengal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kar PK, Haq S, Gupta A. Epidemiological and demographic characteristics of dengue at a tertiary care centre in Gujarat. J Vector Borne Dis 2017;54:375-6
|How to cite this URL:|
Kar PK, Haq S, Gupta A. Epidemiological and demographic characteristics of dengue at a tertiary care centre in Gujarat. J Vector Borne Dis [serial online] 2017 [cited 2018 May 21];54:375-6. Available from: http://www.jvbd.org/text.asp?2017/54/4/375/225846
The work on epidemiological and demographic characteristics of dengue at a tertiary care centre in Saurashtra region by Mistry et al during the year 2013, is timely and useful from the surveillance point of view and appears very much relevant for dengue containment programmes. The epidemiological records by the National Vector Borne Disease Control Programme (NVBDCP), India for dengue cases and deaths in Gujarat was a matter of great concern in comparison to other states of India. The authors reported that the total number of hospitalbased suspected cases attending tertiary care OPD with dengue viral (DENV) infection during January 1 to December 31, 2013 was 4366, but as per NVBDCP record, the total number of suspected dengue cases and deaths in the state of Gujarat in 2013 was 6272 and 15, respectively (spread over different parts of the state including other seven Saurashtra districts, i.e. Kutch, Surendranagar, Jamnagar, Bhavnagar, Porbandar, Amreli, and Junagarh), and this was not incorporated while reconciling the work.
Also, the reported district-wise percentages of suspected dengue cases were very much inconsistent with national level data (as reported by NVBDCP 2016).Besides, in Fig. 2, the percentage of dengue cases shown was 43.5% which was different from 61.8% mentioned in the text which is very much confusing. Percentage-wise, there was high discrepancy in reported cases of dengue from the Sentinel Surveillance Hospital (SSH) OPDs, for example, Rajkot district reported 2563 cases while other seven Saurashtra districts showed 1803 cases with respect to the total cases of 6272 reported by NVBDCP. It indicates that the rest dengue cases (only 1906) were spread over to the remaining districts of Gujarat which includes 24 SSH OPDs, out of total 32. The authors may disclose such inconsistencies of epidemiological data from the surveillance point of view. The results revealed that no patient was admitted with dengue haemorrhagic fever (DHF) or shock syndrome (DSS) either in Rajkot SSH or other seven Saurashtra hospitals, although suspected dengue patients in Saurashtra districts constituted 69.61% (4366/6272) of national average; but NVBDCP’s record showed 15 such patients died from the dengue virus infection in districts of Gujarat. The authors may describe such surveillance incongruities, when they mention about developing capacity building in primary health centres (PHCs) level in the study area.
In the article, Mistry et al mentioned reducing density of vector breeding sites in selected foci of dengue positive cases in residential areas, i.e. both in urban (76.2%) and rural (23.8%) settings of the Saurashtra districts,but it has not been undertaken in selected epidemic sites with reports of any nearby critically ill patients, i.e. DHS or DSS, attended OPD(s), nor shown in the text, as it is one of the primary and principal measures of point-of-care hospital-based capacity building. The authors may refer such integrated approach to achieve study objectives. Since the primary vector of dengue in India is Aedes aegypti, an entomological and demographic investigation of larval density in and around the endemic foci of study sites of Saurashtra districts was essential to explore correlating demographic characteristics for containment purposes. Further, the recent epidemiological data on dengue, revealed the existence of repeated transmission cycles in greater way and culminated an out-burst of vector densities with the presence of primary vector Ae. aegypti in the area. Since, Gujarat is an ideal state for autochthonous dengue cases, originating from the irregular settlements outside the urban perimeters with a recent record of viral lineages characteristics of the circulation of strains, poor sanitation with higher infestation levels, accidental transport of working class people in numerous construction project sites, easy dispersion distances of mosquitoes vis-à-vis their contacts to human-being for co-circulating dengue lineages (15–800 m), overwarming and cold waves with cryptic maintenance of viral strains (transovarian transmission–TOT) for >3–4 months favour studies related to dengue virus(DENV) genetic diversity in the area.
Besides, other factors seem to be specific to the territory implying geographical situation and the eco-biological and “local context”, i.e. climate endemic mosquito species, demography and population flow in genetic evolution of dengue viruses. In such situation, the study protocol need to be envisaged to make an in-depth entomological follow-up of site-specific vector control measures with an assessment of DENV sero types 1–5 in DSH/DSS patients, in a point-of-care mode, to establish correlation of multiple virulent sero type circulation, to avoid further outbreak and to facilitate establishing containment measures as per WHO Guidelines, as therapeutic regimens and vaccines are yet to be introduced in South-East Asian and Western Pacific countries including India as the authors intended to undertake in the areas mentioned.
In usual practice, the surveillance in an area requires proactive monitoring. The occurrence of initial low levels of transmission during post-transmission (November–February) and during dry seasons (March–June) would be helpful in identifying early cryptic circulation of new sero types and mapping where infected patients are circulating preferably at the lag phase of the outbreak. Such guidelines, as recommended by WHO, are being implemented in India by the NVBDCP, Ministry of Health & Family Welfare, Govt. of India, for containing dengue epidemic.
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