Dodging the dengue fever bullet

Special Report

Phuket consistently has among the highest number of dengue sufferers in the country, and the disease has killed one 24-year-old woman in Patong and hospitalized hundreds of others on the island already this year.

The Phuket Gazette‘s Chutharat Plerin reports.

PHUKET: Boonmee Paengud, 12, had been suffering from a fever for six days, and it wasn’t getting any better. His body temperature continued to soar. He suffered from severe headaches and had been vomiting.

“I feel better today,” he said weakly from his bed at Vachira Phuket Hospital on Monday. “But it was very bad. It wasn’t like other fevers I’ve had before.”

Watching her son’s condition deteriorate over the preceding week left his mother, Sutima Chimpitak, 35, feeling helpless.

“He started burning up and vomiting on Tuesday night [June 24]. I gave him some medicine, but the fever was very bad,” she said.

Then the fever took hold.

“His temperature went very high and he kept vomiting. His entire body turned red from the fever. I took him to the hospital on Saturday [June 28] and the doctors there took a blood sample to test,” Ms Sutima said.

Doctors told her to return on Monday, when they confirmed her fears – Boonmee had dengue.

“I took him to hospital because there’s nothing I could do to help reduce the fever, but when they told me he had dengue, I knew there was nothing anyone could do to cure him,” she said.

Ms Sutima already knew there was no cure because her 10-year-old daughter Boonyarat was hospitalized for the disease in December.

Thankfully, Boonyarat survived and by Tuesday Boonmee was starting to recover.

“He is talking more and that makes me so much happier,” Ms Sutima said with a happy sigh of relief.

“The doctors said that Boonmee would have to spend at least one more night in hospital, but if he recovered well enough, he could even go home tomorrow [Wednesday].”

PROTECTION

Ms Sutima knows about the dangers of dengue and how the disease is spread by the Aedes aegypti mosquito.

“I did my best to protect my children from mosquitoes. I keep my house clean, have electronic mosquito repellents throughout the house, and I make sure there are no pools of water around, but still both of my children caught the disease,” she explained.

“All I can suggest is that parents do their best, but if their children get a fever that just gets worse and worse – get them to a hospital before it is too late.”

SHOT IN THE ARM

There may be hope. French company Sanofi Pasteur is developing a vaccine that may be available as soon as late next year.

The vaccine is effective against all four dengue virus serotypes, said Eric Mansion, Managing Director of Sanofi Pasteur’s Thailand-Myanmar-Laos division.

The first of two pivotal Phase III efficacy studies of the vaccine showed a 56 per cent decrease of dengue cases in 31,000 volunteers throughout Southeast Asia.

“The Phase III clinical study was conducted in Asia amongst children aged 2 to 14 years from dengue endemic areas of Indonesia, Malaysia, the Philippines, Thailand and Vietnam,” Mr Mansion explained.

“For the first time in a Phase III study, the vaccine demonstrated protection against dengue in Asian children.”

In Thailand, the study was conducted in Ratcha Buri and Kamphaeng Phet provinces.

“The vaccine is a live attenuated vaccine, intended to be administered by subcutaneous injection over three doses given six months apart,” Mr Mansion explained.

“Initial safety data are consistent with the good safety profile observed in previous studies…

“Available data on long term follow-up show there is no increased risk of severe dengue in vaccinated people.”

DEPLOYMENT

However, even if the vaccine clears the last stages of the Phase III study, it needs market authorization from each country before it can be deployed.

After that, it will be up to health authorities to carry out effective large-scale vaccination campaigns, Mr Mansion noted.

“Dengue vaccination programs will face important challenges such as creating and implementing effective vaccination policies, as well as access and financing mechanisms for people most in need. It is urgent that the public health community work together to start preparing for vaccination programs,” he said.

“Also, infrastructures will have to be in place in order to effectively vaccinate the desired population.”
Regardless, Mr Mansion pointed out that Sanofi Pasteur’s goal is to make dengue the next vaccine-preventable disease and to support the World Health Organization (WHO) ambition to reduce dengue mortality by 50 per cent and morbidity by 25 per cent by 2020.

THE HOT ZONE

The WHO currently estimates there may be 50 to 100 million dengue infections worldwide every year; the CDC puts the annual number of infections globally at as many as 400 million.

“An estimated 500,000 people with severe dengue require hospitalization each year, a large proportion of whom are children. About 2.5 per cent of those affected die,” reports WHO.

Thailand is among the worst afflicted, and Phuket consistently has among the highest number of dengue sufferers in the country, Dr Krit Sakulpat, deputy chief of the Phuket Provincial Health Office (PPHO), told the Gazette.

Phuket last year suffered its worst dengue outbreak in two decades, with 2,249 people on the island infected. Two people died in the outbreak, including a 6-year-old girl from Myanmar.

So far this year, 220 people in Phuket have been diagnosed with the disease.

“One of the victims, a woman in Patong, died,” said Dr Krit. “And she was only 24 years old.”

Dr Krit explained that PPHO staff gather what data they can in order to better target areas for anti-dengue campaigns.

“The top five most dangerous areas in Phuket for contracting dengue, according to our patients’ records, are Rawai, Patong, Pa Khlok, Thepkrasattri and Srisoonthorn, in that order,” he said.

In line with global statistics, most people in Phuket who contract dengue are aged 15 to 24, with 107.8 people per 100,000 catching the disease, explained Dr Krit.

“The second most dangerous age range is 10-14 years old, with 82.19 per 100,000 contracting dengue,” he said.

Dengue does not discriminate, Dr Krit noted: “These numbers include Thais and foreigners.”

— Chutharat Plerin