A superb long article in the latest e-newsletter from MSF: Honduras: MSF tackles outbreak of dengue fever. Excerpt:
Due to an alarming increase in cases of dengue fever in Honduras this year, Médecins Sans Frontières (MSF) has launched an emergency intervention in Tegucigalpa, capital of the Central American country, where the majority of cases have been reported.
MSF is supporting local health services with a three-pronged approach focusing on medical care, vector control and community education. Such a dengue intervention is relatively new for MSF.
More than 80 children have already been treated in an emergency pediatric ward set up by MSF. Mobile teams are also working with the local health authorities to identify and eliminate sources of infection in 4,000 households in the Tegucigalpa area.
Dengue, endemic in Central America, is a viral disease transmitted by mosquitoes of the genus Aedes. Symptoms are similar to flu, with headaches, fever, nausea, abdominal pain and rashes on the skin. Its most severe form, hemorrhagic dengue, causes bleeding and can lead to irreversible shock and subsequent death.
In Honduras, cases of the common form of dengue have significantly increased in 2010 compared to the previous year, with more than 50,000 cases already reported. However, the most alarming feature of this outbreak is the prevalence of hemorrhagic dengue, with more than 1,500 cases reported and 160 deaths - a massive 1850 per cent increase on 2009.
“I had come across the previous kind of dengue,” said Herminia Moncada, whose son was recently admitted to hospital with the disease. “But this is different. This dengue kills.”
The Honduras Ministry of Health has been responding to the high number of cases of dengue by making more hospital beds available and setting up specialized units in health centres in outlying areas. Despite this, the main referral hospital has still been overwhelmed by the upsurge in patients. Until recently, children with dengue fever had all been transferred to the referral hospital, as the decentralized units were only receiving adult patients.
To ease the overcrowding, MSF has set up an emergency ward at the San Felipe Hospital on the outskirts of Tegucigalpa where children under 15 with symptoms of the disease can be cared for. Already, on its second day of activity, the 23-bed ward was working to full capacity.
In hospital, treatment for children includes hydration and rest. “With dengue, we are unable to identify beforehand the patients who will improve rapidly. There is no vaccine or specific medicine for the virus, so all we can do is to control the symptoms and treat the consequences while waiting for the body to stabilize,” said Dr Elisabeth Bragança, in charge of the MSF emergency ward.
Even if the treatment sounds simple, oral hydration involves certain complexities: serum needs to be administered carefully to avoid a fluid overdose, as dengue alters the permeability of blood vessels and there is a risk of fluids invading other parts of the body, causing complications such as pulmonary edemas. “An ongoing balance in the amount of fluids given needs to be maintained,” said Dr Bragança.
MSF health staff are also spending time teaching the children’s parents and care-givers how to administer the fluid regularly to their children. “In my opinion, the success of this medical intervention mostly relies on us collaborating with the parents,” said Dr Bragança.
Frequently, parents stay in the ward throughout the night, giving their children serum at set intervals and writing down the amounts so that they can tell the health staff later. Often the parents have no one to stand in for them and sometimes spend many days and nights without sleep. For this reason, emotional support for the parents is one element of the intervention.
