What is dengue?

Dengue is an acute viral infection which is so severe that there are even chances of death. Dengue spreads through mosquitoes. it belongs to Flaviviridae family. The infected mosquito is called Aedes mosquito. There are 4 serotypes. The cause of this disease can be mild where the patient may actually have the disease but will not feel it or can be so severe that it can lead to death. Dengue shock syndrome is severe. Every year there are atleast 100 dnewly reported dengue cases and around 2.5 billion people live in areas which are prone to dengue. The disease is spreading at a very fast rate with more and more regions getting affected with dengue. In 2012, highest nimber of dengue cases had been reported. The first case of dengue was reported in Chinese medical encyclopedia from the Jin Dynasty (265420 AD) which they called water poison where as in India the first reported case of dengue was from Madras(now chennai) in the year 1780 and the first virologically proved epidemic of dengue fever (DF) occurred in Calcutta (now Kolkata) and Eastern Coast of India in 1963-1964.

Symptoms of Dengue fever

Typically, people infected with dengue virus are asymptomatic (80%) which means that a person is a carrier of the infection but experiences no symptoms or only have mild symptoms such as an uncomplicated fever. Around 6% can be so sevre that it can result in death. It is very dangerous when it comes to children as the initial stages of symptoms will be mild like cold and gastroenteritis but can result in severe complications in the later stage. Number of people affected by dengue

Surveys conducted
Dengue has been reported as the most fast growing disease caused by mosquitoes in the world with more than 380 million people becoming a victim each year. In this Asia accounts for 70 percent of the reported cases and India has the highest reported dengue casualties in the world with 34 percent. In India more than 30 million apparent and 100 million asymptomatic infections are reported every year.

A survey was conducted in 28 panchayats across Kottayam, Ernakulam, Idukki and Pathanamthitta by the Tropical Institute of Ecological Sciences (TIES) . It was found that in houses 61.25 percent of the mosquitoes caused dengue. This was very high. 901 houses out of 1,471 houses were dengue causing mosquitoes. breteaue index which is used the measure the activities of dengue causing mosquitoes was found to be 207.4 percent. A survey was conducted Pune in Maharashtra where it was found out that out of 50 dengue patients 28 were from rural areas and 22 were from urban areas. Earlier the dengue virus was more prevalent in urban areas but now it is moving towards the rural areas which have made the residents in rural areas panic. There are totally four serotypes of dengue virus out of which the DENV-2 is the most predominant in Pune. the size of this disease is spreading at a rapid phase. This survey was conducted in October 2012 and it is found that this was the highest reported dengue deaths ever. The second highest was in 2006 where 26 deaths were reported. In Maharashtra state, there were totally 1256 dengue cases till October 2012. More than 60 percent of dengue deaths and cases are reported from Northern Maharashtra like Nashik, Dhule and Jalgaon. This is because the water is polluted in these areas and rapid urbanization. There are a lot of construction activities taking place in these areas and the growth is not properly planned. The water is not stored in a proper way.

The reason why more cases of dengue in Maharashtra is being reported is because there is a team of around 11,000 members who go to every home in rural areas and collect information of how many people are affected by dengue and what are the preventive measures they have to take to avoid it. In 2008 the Maharashtra government took a step to eradicate dengue by setting up 16 sentinel centres for diagnosing the dengue patients. It is the first state to take such a step. The city of Pune has also reported five cases of deaths and 500 cases of dengue in a span of 3 months. This increase in dengue deaths is due to improper storage of water, improper drainage system, more construction work is being carried out, no proper disposal of garbage and that is why the garbage is piling up. The public is also not completely aware of this situation and inadequate mosquito management system have made it more complex. It is very important for the houselholds to keep their utensils clean as the mosquito, aedes aegypti which is the one that

spreads dengue breeds in fresh water. All the households should clean their tanks twice a week. Since there has been shortage of water due to urbanization at a rapid rate, people store water which increases the chances of mosquito breeding. National Institute of Virology is conducting a research to study how the disease is spreading and based on the findings from this data a national policy will be framed on how much the patients are spending financially to get rid of this disease and what actions the government should take. A survey conducted in October 2012 in Kolkata claimed that 25,000 people were affected from dengue in October alone. But the experts claimed that more around 30,000 people were affected from this disease. An awareness campaign was conducted in Kolkata to make people understand how severe the situation was.

Indias current situation

More than 50,000 people children are born with HIV. There are more than 1,000 new cases of tuberculosis everyday. More than half the children in our country are malnutrition children. 1. In rural areas the doctors to population ratio is lower by 6 times. 2. Rural beds to population ratio is lower by 15 times 3. The villagers spend more on medicines. The rural people spend almost double the amount when compared to the urban people for the same disease. 4. More than 70 percent of the medicines being supplied to the rural areas are not original. 5. Because of this high expenditure on medicines more than 20 million people fall into the BPL every year. The rural people sell their land or borrow money from others to fund their medical expenses. 6. More than 60 percent of the population do not have access to the right medicines. Most of them have to travel more than 20kms for medical treatment. There are many reasons why the health care in rural areas is blocked. Some of them are 1. Less profit for private sector. 2. Not much population.

3. Difficulty in supplying medicines due to bad roads. 4. Doctors are not willing to go to a remote area. 5. Incentives missing.

Existing Dengue Vaccine Efforts

Different attenuation mechanisms have been used to develop three of the leading candidates:

Chimerization with yellow fever 17D vaccine strain, developed by Sanofi Pasteur Combinations of defined mutations/deletions and chimeras, developed by NIH Chimerization with dengue 2 PDK53 virus, attenuated by cell culture passage, developed by Inviragen.

But there is a disadvantage with all the 3 candidates that is 1 inoculation will not protect you from all the other four serotypes.