August 2013, Champasak, Lao PDR: Dengue patients being treated at the Champasak hospital in southern Lao PDR. The country is struggling with its worst dengue outbreak in history. In August, public health facilities were stretched to their capacity. Credit: WHO/Dr. Luo
Almost 50,000 people have been affected by an outbreak of dengue fever in the Lao People├óÔé¼Ôäós Democratic Republic. The UN Central Emergency Response Fund has released more than $750,000 to fund prevention and treatment.
Dao* writhes in pain as his worried family waits for doctors in an overcrowded hospital in Vientiane, the capital of Lao PDR. Dao is suffering from dengue, a tropical disease which is spread by the bite of the Aedes aegypti mosquito.
Dao is one of nearly 50,000 people in Lao PDR who have been infected during this year├óÔé¼Ôäós unprecedented dengue epidemic. The outbreak is the worst of its kind in the country├óÔé¼Ôäós history, with cases reported in all 17 provinces. Alarmingly, around 70 per cent of the 92 deaths reported this year have been children under the age of 15.
The number of cases this year is four times higher than in 2010 and 11 times higher than last year. The reasons for this are unclear, though health officials suspect that irregular rainfall may be partly responsible. In a normal year, heavy rains from August to October help wash away larva and flush out breeding areas, reducing the number of mosquitoes. These rains have yet to arrive this year.
Nationwide awareness campaigns underway
The early symptoms of dengue fever are headache, vomiting and fever, which can easily be confused with those of flu or gastroenteritis. This makes it difficult to recognize in the first few days, hampering the chances of early treatment. Severe dengue is a leading cause of death among children, but early detection and access to proper medical care can help prevent complications.
There is no vaccine or specific drug treatment for dengue fever. The Government and the World Health Organization (WHO) (link: http://www.who.int/countries/lao/en/) are running a series of awareness campaigns including a weekly water clean-up campaign that aims to mobilize people to clear stagnant pools of water, primary breeding grounds for mosquitoes.
├óÔé¼┼ôThis is not easy. We need the whole community to take action: every family, every household,├óÔé¼┬Ø says Dr. Dapeng Luo, who is leading WHO├óÔé¼Ôäós Emerging Disease Surveillance and Response Unit. ├óÔé¼┼ôWe need everyone to commit to this project because the only long-term solution to this problem is our collective support against dengue."
The economic toll
Although cases are now on the decline, they still remain above the WHO epidemic alert level, an indicator of the continued severity of the outbreak. According to WHO projections, without immediate and effective action, Lao PDR could have anywhere between 61,000 and 120,000 dengue cases this year, with between 100 and 500 deaths.
The outbreak also has another dimension.
├óÔé¼┼ôTreatment for dengue costs the patient US$500. The average income in Lao PDR, however, ranges from $100 to $200 per month. Sick families become poor families,├óÔé¼┬Ø Dr. Luo says. In Dao├óÔé¼Ôäós case, his sickness meant his entire family spent their days in the hospital instead of at work, resulting in a further drop in income.
In late August, the UN Central Emergency Response Fund released more than $750,000 to support WHO├óÔé¼Ôäós response. These funds are being used to bolster clinical capacity through the deployment of hundreds of medical and nursing students to support overwhelmed clinics and hospitals and through the purchase of life-saving medical equipment.
Funds are also helping communities to proactively clear sites where mosquitoes breed. In all, the allocation is expected to benefit more than 4.7 million people in the 11 worst-affected provinces.
Back in the hospital in Vientiane, Dao├óÔé¼Ôäós uphill struggle against his costly and deadly adversary continues. With an uncertain future ahead, his family hopes that others learn from these campaigns and are able to avoid what they are going through.
*Not his real name