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DENGUE FEVER: A SERIOUS PROBLEM IN THE PHILIPPINES

Introduction

A virus is a very small pathogenic antigen that requires a host cell to replicate

to cause harm. The virus can attach itself to several kinds of living host such as plants,

animals, bacteria and archaea. Although there is some exception, virus is very specific

when it comes to appending a host. Animal virus only affects animals, same goes with

archaea, bacteria and plant viruses. One specific virus that is endemic to countries

near the equator is the dengue virus. DENV or dengue virus, is prevalent in the

Philippines and causes outbreaks throughout the country. The dengue virus, is a

mosquito-borne single strand RNA virus that comes from the genus Flavivirus (Back

& Lundkvist). The purpose of this paper is to identify the causes of the endemic

dengue virus such as geographical location, economic condition and more

importantly method of transmissionandprevention.

Philippines is a country located in Southeast Asia with a population estimated

to about 100,098,000 people (Bersales). The general climate of the Philippines is

mainly tropical and the vast majority of the islands is covered by dense rainforest. The

country is a perfect breeding ground for the dengue virus carriers, which is mainly

female mosquitoes of the Aedes aegypti species. Because of the particular climate,

heavy rains and floods creates an artificial water container such as tires, jars and cans

during wet season where these particular types of mosquitoes primarily breed (Back

& Lundkvist). Dengue fever is the most important mosquito-borne viral disease in

the world. Dengue is a viral disease transmitted primarily by female mosquitoes

from the species Aedes aegypti. It is considered as the most common arbovirus

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DENGUE FEVER: A SERIOUS PROBLEM IN THE PHILIPPINES

(arthropod-borne virus) infection globally, with transmission occurring in at least

128 countries and almost 4 billion people at risk. The number of dengue cases

reported annually to the World Health Organization (WHO) has increased

significantly from an average of less than a thousand cases globally in the 1950s to

more than 3 million cases in 2015. However, there has been a substantial under-

reporting of dengue within the health systems and to WHO, which greatly

underestimate the apparent global incidence rate estimated at about 50–100 million

symptomatic cases per year. The transmission of dengue viruses is influenced by

population growth, urbanization, inadequate public health infrastructure, poor solid

waste management, environmental risk factors and inconsistent preventive

practices, among others. Dengue virus (DENV) has four different serotypes and thus

a person can be infected more than once. Moreover, dengue can evolve into a more

complex form of a disease known as dengue hemorrhagic fever (DHF) or dengue

shock syndrome, first recognized in the 1950s during dengue epidemics in the

Philippines and Thailand, which can be fatal. In the Philippines, epidemic dengue is

considered one of its eight pervasive infectious diseases. From 2008 to 2012, the

country's Department of Health (DOH) reported 585,324 dengue cases, with a case

fatality rate (CFR) of 0.55% or 3195 deaths and ranks fourth in the number of

dengue cases among the 10 Association of Southeast Asian Nations (ASEAN).

These might become the very reason why dengue cases happened. Lack of

cleanliness, proper hygiene and weak immune system are some of the causes why

dengue can be easily widespread.

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Dengue Fever Dengue (pronounced as DENG-gey) is a virus whose name “is

derived from the Swahili ki denga pepo, which means ‘seizure caused by an evil

spirit,’” according to Lisa A. Beltz, an assistant professor in the Department of Biology

at Kent State University and author of Emerging Infectious Diseases. It typically

occurs in tropical and subtropical environments. The warm, moist air is ideal for the

mosquitos that carry the virus. According to cdc.gov, a government website for

Centers for Disease Control and Prevention, there are four serotypes, or closely

related viruses (dengue one, two, three, and four), which causes greater risks. It is

possible that someone can get infected with all four serotypes. Because they are

different, getting infected with one will not build up a body’s immunity to the others

(cdc.gov). Being infected with one or more of the serotypes of the virus can lead to the

development of one of three diseases: dengue fever, dengue hemorrhagic fever, or

dengue shock syndrome. Dengue fever is a very painful disease that has no cure but

can be treated and go away within two weeks. The other two diseases caused by this

virus are also incurable but can be life-threatening, with a mortality rate of 30%

(Beltz). Dengue fever has a multitude of symptoms that may be mistaken for another

virality is the most prevalent arboviral disease of humans, with 3.6 billion people

living in areas at risk of transmission and an estimated 390 million dengue virus

(DENV) infections and 96 million dengue cases annually. Dengue is endemic to the

tropical belt of Asia, Latin America, and the Pacific, circulates across Africa, and has

recently caused local outbreaks in the United States and parts of EuropeDengue has

expanded globally since the 1960s, driven by population growth, urbanization,

increased travel, and insufficient vector control programs. Despite increased

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funding and advances in dengue research, dengue epidemics are intensifying in

frequency, magnitude and geographic reach.4 The burden of dengue globally is

estimated at 15.8 disability-adjusted life years per 100,000 individuals, with major

economic, social, and political impact. Public health systems are strained by the

relentless spread of DENV and other arboviruses, such as chikungunya and Zika

(ZIKV) viruses, and discouraged by decades of failed vector control programs and

lack of interventions.

However, never before has the level of resources and commitment from

diverse researchers and stakeholders been as great, focused on increasing the basic

knowledge, potential treatments and vaccines, and new vector control strategies,

with the ultimate goal of conquering dengue. Here, we address existing tools and

current needs for dengue diagnostics and surveillance in low- and middle-income

countries (LMICs) and how these will be impacted by the introduction of dengue

vaccines. We review current knowledge and research gaps in

immunology/epidemiology in the context of natural infection and vaccines, as well

as in dengue pathogenesis and new approaches to vector control. Many of these

insights call into question existing paradigms in the dengue field and raise many

new and exciting questions.

Related Literature and Studies

According to Hasan S., et al. (2016), dengue is an acute viral illness caused by

RNA virus of the family Flaviviridae and spread by Aedes mosquitoes. Presenting

features may range from asymptomatic fever to dreaded complications such as

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hemorrhagic fever and shock. A cute-onset high fever, muscle and joint pain,

myalgia, cutaneous rash, hemorrhagic episodes, and circulatory shock are the

commonly seen symptoms. Oral manifestations are rare in dengue infection;

however, some cases may have oral features as the only presenting manifestation.

Early and accurate diagnosis is critical to reduce mortality. Although dengue virus

infections are usually self-limiting, dengue infection has come up as a public health

challenge in the tropical and subtropical nations. This article provides a detailed

overview on dengue virus infections, varied clinical manifestations, diagnosis,

differential diagnosis, and prevention and treatment.

According to the study of Agrupis K, A., et al., (2019), dengue is an important

public health problem in the Philippines. We sought to describe the trends in

dengue research in the country. We searched four databases and identified

published studies on dengue research in the Philippines during the past 60 years.

We reviewed 135 eligible studies, of which 33% were descriptive epidemiologic

studies or case series, 16% were entomologic or vector control studies, 12% were

studies on dengue virology and serologic response, 10% were socio-behavioral and

economics studies, 8% were clinical trials, 7% were on burden of disease, 7% were

investigations on markers of disease severity, 5% were on dengue diagnostics, and

2% were modeling studies. During the last decade, dengue research in the

Philippines has increased and evolved from simple descriptive studies to those with

more complex and diverse designs. We identified several key topics where more

research would be useful.

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Current Status of Dengue Cases in the Philippines as of 2019

According to the latest report of the DOH Epidemiology Bureau, there were

3,610 dengue cases reported from June 16 to 22. This number brings the cases

recorded, from all over the country since January 1 to June 22, to a cumulative

total of 98,179, with 428 deaths.The reported cases for June 16 to 22 alone is

eight percent (8%) higher compared to the same period last year (3,330 cases).

Since January, the highest number of cases came from Western Visayas (11,285),

CaLaBaRZon (10,313), Central Visayas (8,773), SOCCSKSARGEN (8,297), and

Southern Mindanao (8,289). Meanwhile, the DOH clarified that the alleged

outbreak in the Ilocos province were confined to specific barangays only and not

the whole province. The DOH Center for Health Development Office in Region 1,

Northern Luzon, reported a total of 353 dengue cases from Ilocos Norte from

January 1 to June 29, this is 47.7% higher than the number of cases reported for

the same period in 2018. Most of the cases came from Laoag City (94), Badoc (43),

Batac City (29), Pagudpud (21), and Dingras (20). There were no deaths reported.

(Govt. of Philippines, 10 Jul 2019)

With 106,630 dengue cases reported through the Philippines Integrated

Disease Surveillance and Response (PIDSR) system from 1 January to 29 June

2019, including 456 deaths, the current dengue incidence is 85% higher than in

2018, in spite of a delayed rainy season. Whereas the Case Fatality Rate (CFR) of
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0.43% as of 29 June 2019 is lower than in the same time period in 2018 (0.55%),

this is still significantly higher than the regional average of 0.22% in the Western

Pacific. The Philippines Department of Health (DoH) declared a National Dengue

Alert on 15 July 2019, urging regional DoH offices to step up dengue surveillance,

case management and outbreak response in primary health facilities and

hospitals, as well as through community and school-based health education

campaigns, clean-up drives, surveillance activities, case investigations, vector

control, and logistics support for dengue control. The National Disaster Risk

Reduction Management Council (NDRRMC), raised the code blue alert, activating

the national Health Cluster, led by DOH. (WHO, 16 Jul 2019)

Between 1 January to 6 July, 115,986 dengue cases including 456 deaths

were reported through the DOH routine surveillance system, with a CFR of 0.42%.

With a median age of 12 years, the most affected age group among dengue cases is

5-9 years (30%). Similarly, the most affected age group among dengue deaths is

5-9 years (40%). The majority of dengue cases are male (55%), whereas the

majority of dengue deaths are female (53%). CFR is highest in regions V (1%),

BARMM (1%), VI (0.6%), and VII (0.7%), whereas incidence is highest in regions

IX, CARAGA, VI, XII, X, and II. (WHO, 25 Jul 2019)

The Department of Health (DOH) declared a national dengue epidemic to

enable the local government units to use their Quick Response Fund to address

the epidemic situation. Based on the DOH Dengue Surveillance Report, there are

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146,062 cases recorded from January to July 20 this year, 98% higher than the

same period in 2018. There were 622 deaths. (Govt. of Philippines, 6 Aug 2019)

The Department of Health XI is scaling up efforts to inform the public on

the gravity of the dengue epidemic that has so far caused 4,345 cases and 21

deaths in Davao Region from January to Aug. 5 this year. The DOH Dengue

Surveillance Report identified Regions 4A with 16,515 cases; MIMAROPA with

4,254 cases; Bicol with 3,470 cases; Western Visayas with 23,330 cases; Eastern

Visayas with 7,199; Zamboanga Peninsula with 12,317 cases; and Northern

Mindanao with 11,455 cases. The morbidity rate has reached 10,502 cases

nationwide which is 71% higher than last year’s figures. In Davao Region, the

greatest number of cases is in Davao City (2,168). Other provinces also have high

number of cases: Compostela Valley with 788; Davao Oriental with 641; Davao del

Norte with 562; Davao del Sur with 151; and Davao Occidental with 35. ( Govt. of

Philippines, 12 Aug 2019)

During 1 January to 27 July, there are 167,607 dengue cases reported,

including 720 deaths. The number of cases reported is 97% higher than in 2018,

in spite of a delayed rainy season. Case Fatality Rate (CFR) as of 27 July is 0.43%,

which is lower than in the same time period in 2018 (0.54%), but still

significantly higher than the regional average of 0.22% in the Western Pacific. The

most affected age group among dengue cases is 5-9 years (23%), with a median

age of 12 years. Similarly, the most affected age group among dengue deaths is 5-

9 years (42%). The majority of dengue cases are male (52%), whereas the

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majority of dengue deaths are female (54%). CFR is highest in regions XI (.58%),

BARMM (.87%), and V (0.57%), whereas incidence is highest in regions VI, IV-A,

XIII, IX, X. (WHO, 13 Aug 2019)

As dengue cases continue to rise in Eastern Visayas, the Department of

Health's blue alert in Region 8 remains in effect. Based on the data released by

DOH-8, a total of 16,526 dengue cases with 50 deaths were reported from January

1 to August 23, 2019. The majority of the cases are from the province of Leyte

with 4,262 cases and 13 deaths. Ages ranged from one-month old to 88 years old.

The DOH noted a clustering of cases in 95 municipalities and 585 barangays in

Eastern Visayas. (Govt. of Philippines, 30 Aug 2019)

Between 1 January and 17 August, 229,736 dengue cases including 958

deaths were reported through the DOH routine surveillance system, with a CFR of

0.42%. With a median age of 12 years, the most affected age group among dengue

cases is 5-9 years (23%). Similarly, the most affected age group among dengue

deaths is 5-9 years (40%). The majority of dengue cases are male (52%), whereas

the majority of dengue deaths are female (54%). Between 11 and 17 August,

13,327 cases and 40 deaths were reported, compared to 17,137 cases and 36

deaths in the preceding week, but still 40% higher than in 2018. (WHO, 2 Sep

2019)

Between 1 January and 31 August 2019, 271,480 dengue cases including

1,107 deaths were reported through the DOH routine surveillance system, with a

CFR of 0.41%. With a median age of 12 years, the most affected age group among

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dengue cases is 5-9 years (23%). Similarly, the most affected age group among

dengue deaths is 5-9 years (39%). The majority of dengue cases are male (52%),

whereas the majority of dengue deaths are female (53%). Between 25 and 31

August, 12,526 cases and 41 deaths were reported, compared to 13,192 cases and

38 deaths in the preceding week, but still 52% higher than in 2018. Similarly, the

weekly CFR of 0.33% in epidemiological week 35 is lower than in the same time

period in 2018 (0.40%). (WHO, 13 Sep 2019)

During week 36, 2019, a total of 13,059 dengue cases were reported

nationwide. As of 31 August 2019, the cumulative number of cases was 292,076

with 1,184 deaths. This is higher compared to 135,490 cases with 690 deaths

reported during the same period in 2018. (WHO, 26 Sep 2019)

Between 1 January and 21 September 2019, there were 322,693 dengue

cases including 1,272 deaths reported through the DOH routine surveillance

system, with a CFR of 0.39%. During week 38, 8,856 cases and 15 deaths were

reported, compared to 9,815 cases and 37 deaths in the preceding week, but still

25% higher than in 2018. Similarly, the weekly CFR of 0.17% in epidemiological

week 38 is lower than in the same time period in 2018 (0.45%). (WHO, 4 Oct

2019)

As of 24 October, approximately 350,000 dengue cases were recorded and

1,342 deaths, the current dengue epidemic is the largest in the last ten years, or

since the disease has been monitored in the Philippines. (OCHA, 24 Oct 2019)

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This year, most countries in Asia and South-East Asia are reporting a large

increase in the number of detected dengue cases. The Philippines is among the

highest of these, and have reported over 371,500 cases as of November 2019.

(ECHO, 25 Nov 2019)

371,717 cases were recorded between January to October 2019 compared to

180,072 for the same period last year (106 per cent increase). With 1,407 deaths

recorded compared to 927 for the same period last year (62 percent increase).

The case fatality rate (CFR) is 0.38 per cent, lower than 0.51 per cent in the same

period last year. There are 16 provinces which have declared state of calamity

due to dengue: Aklan, Albay, Cavite, Capiz, Catanduanes, Eastern Samar,

Guimaras, Iloilo, Leyte, Mountain Province, North Cotabato, Paranaque, South

Cotabato, Southern Leyte, Western Samar and Zamboanga Sibugay. (IFRC 26 Nov

2019)

Signs and symptoms of Dengue

Many people, especially children and teens, may experience no signs or

symptoms during a mild case of dengue fever. When symptoms do occur, they

usually begin four to seven days after you are bitten by an infected mosquito.

Dengue fever causes a high fever — 104 F degrees — and at least two of the

following symptoms:Headache, Muscle, bone and joint pain, Nausea, Vomiting, Pain

behind the eyes, Swollen glands and Rashes.

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Most people recover within a week or so. In some cases, symptoms worsen

and can become life-threatening. Blood vessels often become damaged and leaky.

And the number of clot-forming cells (platelets) in your bloodstream drops. This can

cause a severe form of dengue fever, called dengue hemorrhagic fever, severe

dengue or dengue shock syndrome.

Signs and symptoms of dengue hemorrhagic fever or severe dengue — a life-

threatening emergency — include:Severe abdominal pain, Persistent vomiting,

Bleeding from your gums or nose, Blood in your urine, stools or vomit, Bleeding

under the skin, which might look like bruising, Difficult or rapid breathing, Cold or

clammy skin (shock), Fatigue, and Irritability or restlessness.

Action to be Taken to Prevent Dengue

One dengue fever vaccine, Dengvaxia, is currently approved for use in those ages 9

to 45 who live in areas with a high incidence of dengue fever. The vaccine is given in

three doses over the course of 12 months. Dengvaxia prevents dengue infections

slightly more than half the time.The vaccine is approved only for older children

because younger vaccinated children appear to be at increased risk of severe

dengue fever and hospitalization two years after receiving the vaccine.

The World Health Organization stresses that the vaccine is not an effective tool, on

its own, to reduce dengue fever in areas where the illness is common. Controlling

the mosquito population and human exposure is still the most critical part of

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prevention efforts.So, if you're living or traveling in an area where dengue fever is

known to be, the best way to avoid dengue fever is to avoid being bitten by

mosquitoes that carry the disease.If you are living or traveling in tropical areas

where dengue fever is common, these tips may help reduce your risk of mosquito

bites:

 Stay in air-conditioned or well-screened housing. The mosquitoes that

carry the dengue viruses are most active from dawn to dusk, but they can also

bite at night.

 Wear protective clothing. When you go into mosquito-infested areas, wear

a long-sleeved shirt, long pants, socks and shoes.

 Use mosquito repellent. Permethrin can be applied to your clothing, shoes,

camping gear and bed netting. You can also buy clothing made with

permethrin already in it. For your skin, use a repellent containing at least a 10

percent concentration of DEET.

 Reduce mosquito habitat. The mosquitoes that carry the dengue virus

typically live in and around houses, breeding in standing water that can collect

in such things as used automobile tires. You can help lower mosquito

populations by eliminating habitats where they lay their eggs. At least once a

week, empty and clean containers that hold standing water, such as planting

containers, animal dishes and flower vases. Keep standing water containers

covered between cleanings.

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CONLUSION

Dengue fever is a dreadful disease, and is an emerging public health problem.

In recent years, an urgent need has been appreciated for a vaccine to prevent the

morbidity and mortality from this disease in a cost-effective way. In spite of many

challenges, vaccine development has made remarkable progress, and the current

dengue vaccine pipeline is advanced, diverse, and overall promising with hope to

bring relief worldwide. Cleanliness is the best thing that people might do to

prevent this kind of virus. Everyone must instill in their minds that “prevention is

better than cure”.

Reference:

 Agrupis, K. A., Ylade, M., Aldaba, J., Lopez, A. L., &Deen, J. (2019).

Trends in dengue research in the Philippines: A systematic

review. PLoS neglected tropical diseases, 13(4), e0007280.

https://doi.org/10.1371/journal.pntd.0007280

 Factsheet: Dengue and severe dengue. World Health

Organization.2014 March. Available from:

http://www.who.int/mediacentre /factsheets /fs117/en/

 Shamimul Hasan, Sami Faisal Jamdar, MuntherAlalowi, Sadun

Mohammad Al Ageel Al Beaiji. 2016. “Dengue virus: A global human

threat: Review of literature., J Int Soc Prev Community Dent. 2016 Jan-

Feb; 6(1): 1–6. doi: 10.4103/2231-0762.175416

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 United Nations Office for the Coordination of Humanitarian Affairs

(OCHA).

 https://www.cram.com/essay/The-Causes-Of-Endemic-Dengue-

Virus/FKDQ6MSZHBQQ

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