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Table of Contents
CORRESPONDENCE
Year : 2017  |  Volume : 54  |  Issue : 4  |  Page : 375-376

Epidemiological and demographic characteristics of dengue at a tertiary care centre in Gujarat


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 Publication19-Feb-2018

Correspondence Address:
Paritosh K Kar
Chairman & Founder Trustee Foundation on Tropical Diseases & Health Research Development Midnapore-721 124, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9062.225846

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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 Sep 24];54:375-6. Available from: http://www.jvbd.org/text.asp?2017/54/4/375/225846



Madam,

The work on epidemiological and demographic characteristics of dengue at a tertiary care centre in Saurashtra region by Mistry et al[1] 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[2]. 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)[2].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[1] 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[3], 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[4].

Besides, other factors seem to be specific to the territory implying geographical situation and the eco-biological and “local context”, i.e. climate[5] 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[6] 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[7], to avoid further outbreak and to facilitate establishing containment measures as per WHO Guidelines[8], as therapeutic regimens[9] and vaccines[10] 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[7], are being implemented in India by the NVBDCP[2], Ministry of Health & Family Welfare, Govt. of India, for containing dengue epidemic.



 
  References Top

1.
Mistry M, Goswami Y, Chudasama RK, Thakkar D. Epidemiological and demographic characteristics of dengue at a tertiary care centre in Saurashtra region during the year 2013. J Vector Borne Dis 2015; 52(4): 299-303.  Back to cited text no. 1
    
2.
Dengue cases and deaths in the country since 2010. Delhi: National Vector Borne Disease Control Programme (NVB-DCP), Ministry of Health & Family Welfare, Govt. of India 2016. Available from: www.nvbdcp.gov.in/den-cd.html (Accessed on March 15, 2017).  Back to cited text no. 2
    
3.
Dar L, Broor S, Sengupta S, Xess I, Seth P. The major outbreak of dengue hemorrhagic fever in Delhi, India. Emerg Infect Dis 1999; 51: 589-90.  Back to cited text no. 3
    
4.
Mondini A, de Moraes Bronzoni RV, Nunes SH, Chiaravalloti Neto F, Massad E, Alonso WJ, et al. Spatio-temporal tracking and phylodynamics of an urban dengue outbreak in São Paulo, Brazil. PLoS Negl Trop Dis 2009; 3(5): e448.  Back to cited text no. 4
    
5.
Kar PK, Ghosh SK. An analysis on model development for climactic factors influencing prediction of dengue incidences in urban cities. Indian J Med Res 2014; 137: 811-2.  Back to cited text no. 5
    
6.
Focks DA, Brenner RJ, Hayes J, Daniels E. Transmission thresholds for dengue in terms of Aedes aegypti pupae per person with discussion of their utility in source reduction efforts. Am J Trop Med Hyg 2000; 62(1): 11-8.  Back to cited text no. 6
    
7.
Aubry M, Dupont-Rouzeyrol M, O’Connor O, Roche C, Lastere S, et al. Epidemiology and genetic evolution of dengue viruses the French Pacific territories. BMC Proc 2011; 5 (Suppl 1): p. 45.  Back to cited text no. 7
    
8.
Prevention and control of dengue haemorrhagic fever: Comprehensive guidelines. WHO Regional Publication, SEARO No. 29. New Delhi: World Health Organization (SEARO) 2000; p. 134.  Back to cited text no. 8
    
9.
Sinha Sukesh Narayan, Kar Paritosh K, Perugu Shyam, Rama Krishna UV, Thakur CP. Adefovir dipivoxil—A possible regimen for the treatment of dengue virus (DENV) infection. Chemometr Intell Lab 2016; 155: 120-7.  Back to cited text no. 9
    
10.
Moren DM, Fauci AS. Dengue and haemorrhagic fever: A potential threat to public health in United States. J Am Med Assoc 2008; 299: 214-6.  Back to cited text no. 10
    




 

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