Taking a holistic approach to dengue-Editorial-The Hindu-11-01-2020


The advent of a new tetravalent vaccine against the dengue virus has thrown new light into the evidence-based management of dengue.

About Dengue:

Dengue is essentially a tropical disease that occurs in the countries around the Equator.
Hot weather and high humidity aided by intermittent rainfalls favour the sustenance of Aedes aegypti and Aedes albopictus (a minor contributor)- the vectors transmitting the dengue virus.
Dengue is mostly an asymptomatic infection, and only a very few develop severe disease. Those very young or very old and those who have chronic ailment are at a greater risk of developing severe disease. The worldwide Dengue case fatality rate is as low as 0.3%.


The advent of a new tetravalent vaccine against the dengue virus has thrown new light into the evidence-based management of dengue.
The studies and trials have indicated that this vaccine confers about 80% protection to children vaccinated between 4 and 16 years of age without any major side effects.

Other factors:

Urbanisation, poor town planning, and improper sanitation are the major risk factors for the multiplication of the vector mosquitoes. The rapid and unplanned urbanization in India has only amplified the challenges for the public health system
Aedes eggs can remain dormant for more than a year and will hatch once they come in contact with water.

Shortage of skilled manpower:

Source reduction activities like preventing water stagnation and using chemical larvicides and adulticides are often recommended. These chemicals need to be applied in periodic cycles to kill the larvae that remain even after the first spray.
However given the scale of operations required and the shortage of skilled workers available for such measures, the above options are rarely used.
Many posts in government departments remain vacant despite there being a dire public health need. The National Vector Borne Disease Control Program notes that the deficiency of manpower has led to a lack of active surveillance in India which has severely impeded India’s actions against Dengue.


Dengue cases are often under-reported due to political reasons, fearing political backlash by the voters in subsequent elections.

The state also considers under-reporting of cases to avoid spreading panic among the common people.

Lack of Co-ordination:

There is a lack of coordination between the local bodies and health departments in the delivery of public health measures. This has resulted in piecemeal efforts from the stakeholders thus depriving the community the benefit that would arise from synergy.
The lack of proportionate targets and resources to the different levels of public health system has resulted in overburdening of the grass root levels.

Alternative medicine drugs:

Despite the guidelines for the management of dengue cases by the World Health Organisation (WHO) and the Indian government, the usage of complementary medicines like Nilavembu kudineer (a Siddha medicine) and papaya leaf extract are rampant among the people.

For any medicine, safety is more important than efficacy. Every modern medicine drug has come out after rigorous safety and efficacy studies for around 10 years, with an informed declaration of the side effects. There has been a lack of such studies with respect to the above alternative drugs.
The studies on which alternative drugs are being promoted are based on very primitive forms of research like case reports, in-vitro studies, and animal studies.

A meta-analysis of various studies has shown that there is no credible evidence for the use of papaya extract in dengue fever. However, some pharmaceutical companies are still marketing papaya extract pills. There are case reports which point out to many side effects due to the usage of these medicines.

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