Dengue and Chikungunya are totally preventable diseases

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Dengue, Chikungunya as well as Malaria and Filaria are mosquito-borne diseases and are totally preventable. Here are some salient points to remember about their prevention.

• Malaria is transmitted via the bite of a female Anopheles spp mosquito, which occurs mainly between dusk and dawn. It may rarely spread as a congenitally-acquired disease or via blood transfusion, sharing of contaminated needles and organ transplantation.
• The Dengue mosquito (Aedes aegypti) bites in the day time.
• The Aedes Dengue mosquito has up to 3 meals in a day, while the malaria mosquito has 1 meal in three days. Malaria may infect only one person in the family; on the other hand, dengue mosquito will infect more than one member in the family in the same day.
• Malaria fever often presents with chills and rigors. If fever presents with joint and muscle pains, suspect Chikungunya.
• The Dengue mosquitoes may also breed inside houses in fresh collected water; hence, insecticide spraying, in response to dengue outbreaks, is not highly effective. Water should not be allowed to collect inside the house for more than a week. Mosquito cycle takes 7-12 days to complete and if any water collected utensils is scrubbed cleaned properly once in a week, there are no chances of mosquito breeding.
• Collection of water in and around the house can occur in flower pots, uncovered water tanks on the terrace, bird drinking pots, broken tires, broken glasses, water coolers or any container where water can stay for 7 days.
• Education of the public about discarding tires and other containers that accumulate standing water has shown promise in reducing breeding sites.
• Using mosquito nets/repellents in the night may not prevent dengue the mosquito bites during day time. Wearing full sleeves shirt and trousers can prevent the mosquito from biting the body during the day.
• Both malaria and dengue mosquito do not produce noise. Therefore, mosquitoes which produce noise do not cause diseases.
• There are no vaccines for malaria and dengue.
• Comprehensive community and governmental control strategy, including the seeding of water vessels with copepods that feed on mosquito larvae, is successful in eliminating A. aegypti and dengue transmission.

Differentiating Chikungunya from dengue

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Chikungunya and dengue are both acute febrile illnesses characterized by fever, myalgia and lethargy. Some patients may also have maculopapular rash, nausea, vomiting, and headache.

Distinguishing features of chikungunya include potentially debilitating bilateral polyarthralgia and, in some cases, arthritis.

Although these signs and symptoms may assist in differentiating dengue and chikungunya, clinicians should include both illnesses in their differential diagnosis of patients with acute febrile illness.

Dengue should be ruled out in patients with acute febrile illness and suspected of having dengue or Chikungunya.

Evaluate patients for the warning signs of severe dengue such as persistent vomiting, severe abdominal pain, tachycardia, restlessness, hypotension, narrow pulse pressure. If present, patients should be hospitalized for close monitoring and management.

Such patients should also be evaluated for other serious conditions, such as malaria, leptospirosis, and other bacterial infections.

Why an early diagnosis of dengue is essential

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Dengue should be diagnosed early as the patient has maximum viremia during early phase with more infectivity.
The test to be done is NS1 antigen and not IgM. NS1 is positive in less than 5 days and the IgM becomes positive after 5 days.
IgG and IgM kits are provided free by the government of India but not the NS1 kits, which need to be procured by the states themselves. IMA feels that the priority of the government should be NS1 kits and not IgM kits.
Also all cases of severe dengue with rapid test positive for NS1 or IgM should be notified as dengue cases. Currently the government requires ELISA test as the criteria.…

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