A BPO worker in his early 30s had fever for days but decided to ignore it and attended to his work and usual things. But around the seventh day of fever, he had stomachache and nausea, prompting him to seek medication at a private hospital in Makati. He was not readily admitted as the hospital said emergency cases are its priority.
The young man, together with his wife and his mother, decided to stay awhile at the hospital. By lunchtime, the BPO worker had severe stomachache was aggravated, which qualified him as emergency case for hospital admission. The following day, he seemed to be disoriented, he was awake but couldn’t recognize the people around him and merely stared at them. After convulsion and vomiting heavily, and his platelet count abruptly declined, he was gone that same day. It was only then that the culprit—dengue—was confirmed.
A young housewife was frantic as she was telling her aunt that his husband was diagnosed with dengue. It was around lunchtime and she said the attending doctor told them to come by 5pm. If his platelet count continues to decline by that time, then he would be admitted. Fortunately for him, a high-chlorophyll liquid supplement mixed in his drinking water, saved him. He was told to be dengue-free when he returned for checkup by the doctor.
Meanwhile, a journalist had a bout with flu that wouldn’t go away with over-the-counter medications, liquid diet and rest. For days, she would be experiencing high fever, body ache and pin-and-needle headache. Along with the fever, she was experiencing fatigue and depression. However, it was only on the fifth day that she decided to see a doctor. She wasn’t feverish at that time and she was feeling better. The doctor found tiny reddish spots on her legs. Along with all the symptoms she experienced, which she narrated to the doctor, she was diagnosed with dengue. She was sent home to rest more but was instructed to come to the hospital immediately should she experience bleeding from her nose or if she notice blood in her excreted matter. Fortunately, she was well after several days.
These are some stories of dengue victims which are closer to home. The journalist’s story is mine. The young wife whose husband had dengue was my niece. The young BPO worker was my son’s friend and colleague at work.
Lucky for those whose dengue bout is of the lesser strains like mine and my niece’s husband. But there is no mercy for those afflicted with virulent strains, which cause thrombocytopenia or a severe drop in platelets, hemorrhagic fever, organ failure, and massive bleeding. This is called dengue shock syndrome (DSS). This could be the case of the BPO worker. Coupled with late diagnosis, there was no way to save his life.
Dengue is a painful, debilitating mosquito-transmitted disease caused by any one of four different strains of the dengue virus. These viruses are related to the viruses that cause West Nile virus infection and yellow fever.
Dengue is transmitted by the bite of an Aedes aegypti mosquito infected with a dengue virus. The mosquito becomes infected when it bites a person with dengue virus in his blood. It can’t be spread directly from one person to another person.
There is no specific medicine to treat dengue. If you think you may have dengue, you should use paracetamol to control the fever. According to medical books, you should avoid medicines with aspirin or ibuprofen, which could worsen bleeding. You should also rest, drink plenty of fluids and seek medical advice. If you start to feel worse in the first 24 hours after your fever goes down, you should get to a hospital immediately to be checked for complications.
People with weakened immune systems, as well as those with a second or subsequent dengue infection, are believed to be at greater risk of developing dengue haemorrhagic fever.
Dengue is a common illness in over 100 countries. Every year 50 million to 500 million people are infected, and at least 500,000 of them need to be hospitalized for treatment. Dengue is highly endemic in the Philippines, where it had the highest incidence in the Western Pacific Region from 2013 to 2015.
Records from the Department of Health (DOH) shows that, as of April 2, 2016, a total of 33,748 suspected dengue cases were reported nationwide. Most of the cases were from Calabarzon, with 5,276 cases out of 33,748; Central Luzon, with 4, 384 cases; and Central Visayas with 3, 812 cases.
It is no wonder that Sanofi Pasteur’s dengue vaccine, Dengvaxia, the world’s first vaccine licensed for the prevention of dengue caused by all four serotypes in individuals between 9 and 45 years of old, has readily received marketing approval in the country along with other countries in Latin America and Asia.
In fact, the Philippines is the first country to implement dengue vaccination through the school-based immunization approach. As of April 17, 2016, a total of 148,431 (72 percent) pupils were vaccinated out of 206,673 pupils with parents’ consent according to the DOH.
On April 4, 2016, the DOH said it has started the administration of dengue vaccines to Grade 4 pupils aged 9 and above in Central Luzon, Calabarzon and Metro Manila. The next two doses will be given to the same students.
The first dose of the vaccine will be given from April to June 2016, followed by the second dose on October to December 2016, and the last dose on April to June 2017.
The research and development of this groundbreaking vaccine have been 20 years in the making. The vaccine has proven effective at protecting two-thirds of individuals (66 percent) aged nine years and older against dengue. It provides even greater protection against severe dengue (93 percent) and can prevent 80 percent of hospitalizations due to dengue [1], which account for the lion’s share of the economic burden in dengue-endemic countries.
Vaccines are vital in preventing infectious diseases
Living in a time of unprecedented medical interventions, it is difficult to fully appreciate the contribution vaccines have made to human health. In fact, the widespread adoption of vaccines was one of the greatest public-health innovations of the 20th century. Deadly and highly-infectious diseases, like small pox, whooping cough, polio and measles, have either been eradicated completely or are under control, thanks to the development and administration of vaccines.
Vaccines played a key role in the 20th century in protecting people from communicable diseases and preventing major epidemics. The hepatitis B virus (HBV) vaccine and the polio vaccine, to name just two, highlight how successful vaccines can be when they are implemented as part of a holistic approach to disease eradication.
Hepatitis B is one of the world’s most common and serious infectious diseases and the Hepatitis B virus (HBV) causes more than 1 million deaths every year.[2] Successful Hepatitis B vaccination strategies in 177 countries have led to a dramatic decrease in HBV transmission.[3] Randomized controlled trials of the Hepatitis B vaccine-administered at birth found that immunized infants born to mothers infected with Hepatitis B were 3.5 times less likely to become infected with the virus.[4] The health community expects that, thanks to universal vaccine programs, a reduction in the incidence and prevalence of chronic Hepatitis, cirrhosis and hepatocellular carcinoma will be achieved in the coming decades.[5]
The near eradication of polio, a crippling disease spread through fecal matter, is another vaccine success story and one of the major medical breakthroughs of the 20th century. In 1980, the disease paralyzed more than 50,000 children worldwide.[6],[7] Since 1988, polio vaccines have reached nearly 80 percent of children around the world, 7 thanks to collaboration among over 200 countries and 20 million volunteers backed by an international investment of more than $9 billion. This effort has successfully decreased the global incidence of polio by 99 percent and in 2013 only 416 cases of polio were reported.[8]
The way forward for dengue management
Dengue, like HBV and polio, poses a major public-health threat, but can be tackled with the introduction of universal vaccine programs as part of an integrated approach to combating the spread of the disease.
According to the World Health Organization (WHO), the implementation of the dengue vaccine is a vital part of achieving its goal of reducing dengue mortality by at least 50 percent and dengue morbidity by at least 25 percent by 2020.[9]
Dengue is present in over 100 countries and threatens over half of the world’s population.[9] Asia is the most heavily impacted region, representing approximately 70 percent of the global health burden of dengue, or about 67 million infections annually.[10] The direct and indirect costs of dengue are estimated at nearly $1 billion per year for Southeast Asia alone.[11] Disease-impact modelling predicts that if 20percent of the population aged nine years and older is vaccinated in dengue-endemic countries which could lead to a 50percent reduction in the dengue burden in these countries, within five years.[12],[13]
Complex diseases like dengue require an integrated approach to prevention. Considering the current costly public health burden caused by dengue in Asia, as well as the proven public-health benefits brought about by the implementation of vaccine programs, Asian countries should consider how best to introduce the vaccine in conjunction with other preventive measures, including vector control and public education.[14] Post-introduction, ongoing monitoring, supervision and evaluation of the vaccine’s public-health impact are equally critical to its success.
Another important milestone in vaccine history: flipping the model of vaccine introduction
Despite progress in global-immunization initiatives, vaccine-preventable diseases remain a major cause of morbidity and mortality.[15] Dysfunctional healthcare systems, geographical distance from health centers and socioeconomic factors all play a role.[16] In order to have the greatest impact, innovative vaccines need to be made available to populations at greatest risk first. When people in at-risk areas are vaccinated and protected as a priority, everyone’s disease burden and risk of infection are reduced.
Despite this, traditionally, new vaccines have been introduced into high-income countries first and have been subsequently made available in low and middle-income countries, where the disease burden is often the highest.[15] With Dengvaxia, Sanofi Pasteur has flipped the traditional model on its head by introducing the vaccine first in countries with populations that are at high risk of contracting dengue to ensure that populations in these dengue-endemic countries get priority access to the vaccine. This approach aligns with the WHO’s call to action to ensure universal access to life-saving vaccines.
The implementation of broad public immunization programs has a great chance of reducing the dengue burden globally. Successful vaccine program implementation requires policy-makers, national regulatory agencies, vaccine manufacturers, vaccinators and communities to work together to create and implement effective vaccination policies and increase access and financing mechanisms for at-risk populations. Sanofi Pasteur is committed to leading the way in the fight against dengue. Hopefully, like HBV, polio and many other highly communicable diseases, the reduction of global dengue incidence will soon be one more successful milestone in vaccine history.