Bangladesh’s hospitals and health facilities have struggled to cope with a spike in dengue cases this year. On October 14, the official data said the number of dengue cases in the country was 237,251, the highest since 2000. So far, 1,158 people have died of dengue fever in the country. Awaaz South Asia explains the reasons behind the unprecedented surge in the viral infection.

Current situation

Dengue is a viral infection which is transmitted through an infected mosquito bite and is common in tropical and sub-tropical climates.

This year, Bangladesh reported the first dengue cases in January. The Bangladesh government health records say dengue cases have been reported every month, with a noticeable spike since July. In September, 79,598 dengue cases were reported in the country, making it the deadliest month so far.

Medical entomologist and professor at Bangladesh-based Jahangirnagar University Kabirul Bashar told Awaaz South Asia that October had seen a slight decline in dengue cases as compared to September. As many as 33,845 cases were recorded in the first two weeks of October.

“The highest peak was in September but it is seeing a slight decline. This is the first time in Bangladesh’s history that we are witnessing such a huge number of dengue cases,” Bashar said.

Dengue was first recorded in the country (then East Pakistan) in 1964 and was termed “Dacca fever”. Bangladesh began recording it as dengue only in 2000.

Bashar said the numbers could be far higher than being reflected in hospital admissions as many people could be taking home treatment.

Director, National Institute of Preventive and Social Medicine, Meerjady Sabrina Flora said dengue was endemic to Bangladesh, with a seasonal increase.

Flora told Awaaz that dengue was currently occurring in an “extensive and extended manner”.

“Not only is the incidence high, but dengue has also extended to rural areas and almost every corner of Bangladesh. Therefore, the number of cases as well as deaths is high,” she said.

What caused the surge?

The Director, National Institute of Preventive and Social Medicine, which is Bangladesh’s apex institution in the field of public health, says the Aedes aegypti mosquito had found a favourable environment for breeding due to a change in the weather pattern this year.

“Many people are suffering from dengue for the second or third time, increasing the risk of fatality in them. Also, Aedes mosquitoes had spread outside Dhaka this year. The cause (of more mosquito breeding) was atypical rainfall due to climate change,” Flora said.

Meanwhile, Prof Bashar also cited other causes. “First, it is the impact of global climate change. Second, it is the failure in managing the Aedes mosquito. Public awareness is low in our country and people are not taking preventive measures,” he said.

“Had the government managed the breeding source properly, the numbers would have been at the threshold level. But we could not manage it properly.”

Bashar said with dengue cases being reported across the country, it had now become more difficult to manage the outbreak. “We don’t have enough facilities in the rural areas,” the entomologist said.

WHO says no specific treatment

In August, the World Health Organization (WHO) said dengue was endemic to Bangladesh with “recurrent outbreaks and is one of the major public health concerns in Bangladesh”.

“Since 2010, the cases of dengue appear to coincide with the rainy season from May to September and higher temperatures. Bangladesh’s climate conditions are becoming more favourable for the transmission of dengue and other vector-borne diseases, including malaria and chikungunya virus, due to excessive rainfall, waterlogging, flooding, rise in temperature and the unusual shifts in the country’s traditional seasons,” it said.

The WHO advises that vector control activities “should focus on all areas where there is a risk of human-vector contact such as the place of residence, workplaces, schools, and hospitals”.

“There is no specific treatment for dengue infection, but early detection and access to appropriate healthcare for case management can reduce mortality. Rapid detection of severe dengue cases and timely referrals to tertiary hospitals can reduce mortality,” the WHO said.

How has Bangladesh responded

According to Flora, the government has taken initiatives to control mosquito breeding through awareness campaigns and onsite supervision through drones.

“New insecticide is being tried to overcome insecticide resistance. Treatment capacity has been strengthened and a multi-sectoral approach, including community engagement, has been done,” she said.

Experts, however, are not convinced with the government response.

Independent consultant at the Bangladesh-based Institute of Epidemiology Disease Control and Research Mohammad Mushtuq Husain said Bangladesh needed to improve the primary and secondary health care setup in the country to fight diseases such as dengue.

“The primary and secondary care facilities are missing in main cities, so the tertiary care hospitals bear the load in times of case surge. My suggestion is that only the critical care patients should be admitted to the tertiary care hospitals. Patient treatment will be better at each level if we have primary and secondary health facilities in the cities,” Husain said.

He said though there were primary and secondary healthcare setups in the rural areas, there was a shortage not only of the staff, but also of the treatment and diagnostic facilities.

“We need to equip our health setup for the future so as to fight diseases such as dengue,” he said.

Higher cases in other countries

While Bangladesh has seen an unprecedented increase in dengue cases, experts point out that cases have been reported from other countries as well.

Former head of Epidemiology and Communicable Diseases Division, Indian Council of Medical Research, New Delhi, Lalit Kant told Awaaz that many countries had reported a surge in dengue cases.

Kant noted that unusual weather events such as heavy rainfall and floods created stagnant water, which in turn increased breeding grounds for mosquitoes and transmitted diseases such as malaria and dengue.

He said an increase in temperature also had a positive effect on the “development of mosquitoes, their survival, biting rates, duration of transmission season, increase in flight range and in the altitude they can fly”.

In August, Bangladesh officials said 55 people were killed and more than a million affected by torrential rains, which caused floods and landslides in southeast Bangladesh.

A policy brief prepared in August by several international institutes, including the UK-based Grantham Research Institute on Climate Change, said “several factors linked to climate change are increasing the country’s flood risk, including the increasing frequency of extreme precipitation events and more erratic rainfall”.

“An increased number of cases have been reported from India, Pakistan, Nepal, Sri Lanka and Bangladesh in recent times. So, it appears that the rise is due to climate change,” said Kant.

He said the need of the hour was to take steps at the country-specific level.

“Problems like dengue can be tackled at the country level and each country has a plan to control dengue. Problems are faced when the control measures are to be applied on a massive scale,” Kant said.

Bashar also said a long-term plan was needed to manage dengue, a vector-borne disease.

“We need to make a sustainable integrated mosquito management plan for five years to manage dengue. We should incorporate home-to-home breeding, source management and home-to-home awareness,” he said.