Doctors race to identify unusually deadly dengue strain in India

·4-min read
A dengue patient rests under a mosquito net at the dedicated ward of a government hospital in Prayagraj, Uttar Pradesh, India - Rajesh Kumar Singh/AP 
A dengue patient rests under a mosquito net at the dedicated ward of a government hospital in Prayagraj, Uttar Pradesh, India - Rajesh Kumar Singh/AP

Attempts to control a deadly outbreak of dengue fever in northern India that has killed more than 110 people are being hampered by a lack of understanding of which strain of the disease is dominant, doctors are warning.

There are four strains of dengue fever - known as “breakbone fever” as it can lead to severe joint pain and stiffness - with varying degrees of mortality.

The Indian Council of Medical Research (ICMR), the country's leading public health body, has said this outbreak is driven by the D2 strain, which is the most likely to lead to fatal haemorrhaging.

While up-to-date mortality data is unavailable for much of Uttar Pradesh and Bihar, the two hardest hit states, at least 88 children have died during this outbreak of dengue fever in the district of Firozabad in Uttar Pradesh alone.

India typically sees a surge in dengue fever cases during its annual monsoon season as the mosquito, which spreads the disease, are able to breed more easily in pools of standing water.

Doctors in northern India told The Telegraph a large-scale public study was needed to understand why this year's outbreak was causing severe complications in so many children. They suggested it could even be caused by a new strain of dengue fever.

“We need to conduct virological studies on a significant number of the children who have died, assuming we are not able to get more virus study data from investigations done in this outbreak. We don’t have a handle on what is happening,” said Dr Yogesh Jain, one of India’s leading rural healthcare experts.

“It is unusual to see so many dengue fever cases where there is an encephalitis complication [inflammation of the brain] but viruses do change their patterns and evolve,” added Dr Jain.

Uttar Pradesh’s health minister, Jai Pratap Singh, said the D2 variant was likely to be behind the outbreak: "This is a different strain as compared to the regular strain of dengue and there is a need to be careful."

The ICMR said a number of samples from three districts of Uttar Pradesh - Firozabad, Agra, and Mathura - had shown the current outbreak was being caused by the D2 strain.

There have been reports of mass hospitalisations of children right across India, although it is unclear whether these are down to dengue.

In the eastern Indian state of West Bengal, around 200 children have been hospitalised in the city of Jalpaiguri with similar flu-like symptoms, including fever, cough and shortness of breath, in four days.

In Firozabad, where 12,000 people have contracted dengue fever, footage emerged of parents arriving at hospitals with their lifeless children in their arms. Some claimed their children had died after being turned away from multiple hospitals that had already run out of beds.

A senior health official in Firozabad admitted that there were three to four children in one bed in the district’s overwhelmed hospitals. Hospitals in Uttar Pradesh are again trying to ramp up their bed capacity to deal with the influx of dengue fever patients, but they face a race against time.

Dr Sumit Ray, medical superintendent of Holy Family Hospital in Delhi, warned the outbreak would not subside until mid-October, several weeks after the end of the monsoon, and would likely spread to other states.

“In Delhi, we are already seeing a spike in dengue fever cases. I don’t think it is a new strain that we are seeing but it is one of the four usual strains, possibly D2, which we already know has a higher mortality rate,” said Dr Ray.

“It is going to get worse and I fear it will peak some more before we see cases come down because the rains will continue and it usually only peaks after the rains stop - unless the authorities in Uttar Pradesh take some strong public health measures.”

In the 1970s dengue fever was endemic in just nine countries, but a range of factors, including climate change and increasing urbanisation, means the disease has taken hold in more than 100 countries and infects around 100 million people every year.

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