Bangladesh battles record dengue deaths as disease pattern changes

Dhaka, Bangladesh: Every time Mosammat Mayna visits Mugda Hospital’s dengue ward, she is overcome with grief and fear.

The 23-year-old has been working as a cleaner in the hospital for roughly one month. Her sister Maria Ratna passed away from dengue last month while she was performing her cleaning duties there.

During the dengue outbreak this year, my sister toiled nonstop for months before contracting the illness. The hospital administration offered me her job after she passed away, Mayna told Al Jazeera.

Ratna’s passing devastated our family, but despite my extreme fear, I accepted the offer because I was unemployed.

With hospitals overflowing and the death toll rising, Bangladesh is experiencing its worst dengue outbreak in history. The mosquito-borne illness claimed 24 lives in the nation last Wednesday, the highest number in a single day.

A mosquito that bites an infected patient becomes a carrier and can spread dengue to others, even though the illness does not spread from person to person. Because of this, areas with a high dengue patient population, like the hospital where Mayna works, are riskier for those who are not yet infected.

Health professionals are concerned because dengue typically goes away in South Asia by the end of September after the yearly monsoon rains stop.

According to the government’s Directorate General of Health Service (DGHS), at least 1, 549 people—including 156 children between the ages of newborns and 15—have passed away from the disease in Bangladesh as of Monday.

Up until this year’s outbreak, the record deaths were roughly five times as many as the 281 fatalities from last year, which was the highest number ever recorded in Bangladesh. 1, 01, and 354 cases, the previous highest number in a single year, were reported in 2019.

Dr. Mohammed Niatuzzaman, director of Mugda Hospital, told Al Jazeera that he had never seen a dengue outbreak of this size and that patients were pouring in from all over the densely populated nation. “Seeing so many dengue patients in November is very unusual.”

outbreak of an “epidemic” size

Previously, dengue outbreaks were mostly restricted to densely populated urban areas like Dhaka, which has a population of over 23 million. According to experts, the disease has spread to all districts this year, including rural areas.

According to DGHS data, Dhaka reported fewer cases than the rest of the nation for the first time this year, accounting for 65 percent of all cases.

Sohaila Begum and her 11-year-old daughter, who has been suffering from a high fever for more than one week, traveled to Mugda Hospital from Patuakhali’s southern district. They are residing in the hospital’s hallways because there are no beds available.

She told Al Jazeera that her daughter’s condition had improved and that when her fever worsened, doctors at the district hospital advised us to take her right away to any reputable hospital in the cities.

We arrived in Dhaka but are currently strapped for cash. Everything in this place is very expensive. If we stay any longer, we’ll get into trouble.

This year’s outbreak is nothing less than an epidemic, according to Dr. ANM Nuruzzaman, a public health expert and former director of the DGHS.

The nation is experiencing political unrest prior to the next election, so the severity of dengue has sort of disappeared from the public and media’s radar, he said.

As the main opposition Bangladesh Nationalist Party (BNP) calls for the ouster of the current Awami League government and the appointment of a caretaker administration to ensure free and fair elections, Bangladesh is anticipated to hold its general election on January 7 despite political unrest and violence engulfing the nation.

As the disease’s pattern and severity have changed and gotten worse, dengue is a serious crisis. Long ago, the government ought to have declared it a public emergency, according to Nuruzzaman.

Government representatives assert that they have taken all necessary precautions to stop the spread of dengue and that it would not have changed much if it had been declared a public emergency or epidemic.

“At the beginning of August, special dengue wards were to be opened at all government hospitals across the nation.” According to Dr. Mohammad Robed Amin, director of noncommunicable disease at DGHS, the health ministry also set aside emergency funds to combat the outbreak.

Because of the size of our population and the near impossibility of providing healthcare and treatment for everyone, the healthcare system in our nation has serious flaws, he claimed.

For a number of reasons, Amin noted that this year’s cases and fatalities are “abnormally high.” The overwhelming prevalence of Den- 2 type dengue among the patients, he claimed, is the main cause.

There are four different types of dengue: Den-1, Den-2, Den-3, and Den-4. After infection, a person develops immunity to one type of dengue but not to others.

“Over the past few years, Den – 3 strains have predominated in Bangladesh, and people have developed immunity to them.” However, this year, more than 75% of patients received a Den-2 diagnosis, and nearly all of the fatal cases were brought on by this strain, according to Amin. He also noted that numerous studies have shown that years of Den-3 prevalence are worse than Den- 2 outbreaks.

The outbreak in rural areas is another factor contributing to the high fatalities, he claimed.

The disease has spread across the nation this year, and there aren’t many medical facilities in rural areas. In addition, the majority of people are unaware of how serious the illness is. It can be fatal if you don’t receive treatment right away. And many places have experienced that.

Why did the deaths set records?

Entomologists claim to have discovered the potential cause of this year’s record outbreak.

The pattern of dengue subsiding by September changed last year when the disease peaked in October and claimed 86 lives, according to Kabirul Bashar, professor of medical entomology at Jahangirnagar University in Bangladesh. That number was 22 the previous year, in 2021.

“Last year, we raised the alarm, claiming that the disease’s very course has changed.” According to Bashar, the lone scientific expert on the nation’s National Anti-Dengue Committee, dengue is no longer a disease linked to the monsoon and now lasts for an entire year.

According to the scientist, patterns in temperature, rainfall, and other natural phenomena are changing as a result of climate change.

Now, throughout October and the first few days of November, we experience rain that is almost monsoon-like. He said, referring to the kind of mosquito that transmits dengue, “It alters the breeding and lifecycle of the Aedes mosquito populations.”

Between June and September, when stagnant water makes the ideal habitat for the Aedes mosquito, which typically breeds in clean water and feeds during the day, dengue is most common in South and Southeast Asia.

However, Bashar, who has spent more than 20 years researching mosquitoes, made the ground-breaking discovery that they now reproduce even in murky sewers and salty seawater.

Therefore, you have unusually consistent rains during the off-season, which are ideal for breeding, and mosquitoes are widening their horizons for reproduction. He told Al Jazeera, “It’s a double whammy.”

Malathion and temephos, the two insecticides most frequently used in Bangladesh, were also found to be “useless” against Aedes mosquitoes.

According to Md. Golam Sharower, a professor at the National Institute of Preventive and Social Medicine, these two insecticides have evolved resistance and are no longer effective against mosquitoes.

These two insecticides, which do little to reduce the mosquito population, are still used by the majority of our city corporations across the nation.

Bashar stated that in order to stop the spread of dengue and ultimately eradicate the Aedes mosquito population, the government must implement a comprehensive five-year plan.

If such a plan is not put into action right away, the disease will only get worse over the coming years, he claimed.

Mayna has started to regret her decision to work as a cleaner at Dhaka’s Mugda Hospital after being overtaken by the unusually protracted dengue epidemic.

“I had assumed that dengue would go away once the rainy season was over, but patients are still arriving every day. She told Al Jazeera, “Forget the ward beds; there isn’t even room in the hospital hallways.”

Source: Aljazeera