Climate change casts shadow over 20 years of dengue fever surge in Nepal

Dr. Shah Bahadur Pun, an infectious disease specialist at Sukraraj Tropical Infectious Diseases Hospital (STIDH) in Kathmandu, said he felt “helpless” when a tsunami of patients with high fevers, headaches and body aches suddenly flooded the hospital's outpatient department. ” he says he felt. In 2022.

In normal times, an influx of 70 to 100 patients per day was expected. but, dengue fever epidemic Once launched, that number jumped to about 1,000 cases per day.

Hospitals' available human and other physical resources were hardly able to cope with the nearly ten-fold increase in hospital capacity. As indoor spaces became crowded, doctors and nurses began providing outpatient care in vacant lots outside the hospital, Pan recalled. Work hours extended into the night.

The hospital's inpatient department was also at capacity. Intensive care beds were full, and patients in general wards were camping out on mats on the floor.

“Due to crowded indoor spaces, doctors and nurses have started providing outpatient care in open grounds outside the hospital.”

– Dr. Shah Bahadur Pun, infectious disease specialist at Sukraraj Tropical Infectious Diseases Hospital (STIDH), Kathmandu

The management of private hospitals in the city has improved slightly. Dr. Bishad Dahal, currently in his third year of internal medicine residency at Kathmandu Medical University, had just joined his residency in 2022 when dengue struck the Kathmandu Valley. He went to the hospital at 5 a.m. to take care of admitted dengue patients, finished his rounds at 9 a.m., then went to the outpatient department to take care of other suspected dengue patients before 17 p.m. I remember working till then. Next, inpatient rounds will resume. He said his working hours ended between 9pm and 10pm until the winter season started and the number of cases started to decline.

For Nepal's health workers, painful memories of the 2022 outbreak are recalled every monsoon. Since then, the country has seen large-scale dengue outbreaks every year during the rainy season.

Dengue fever in Nepal: when did it start and how is it progressing?

The first case of dengue infection in Nepal was reported in 2004. The Japanese tourist was in Nepal on holiday and is believed to have “imported” the mosquito-borne virus after becoming infected in India.

Two years later, in 2006, 32 cases were reported in Chitwan district, which was considered the country's first indigenous outbreak.

In subsequent years, dengue fever outbreaks were recorded in Nepal. Terai area limitedIt is located in a lowland area and shares a border with India.

According to a report released by Nepal's Department of Epidemiology and Disease Control (EDCD), Nepal faced its first-ever pandemic in 2010, resulting in 917 infections and five deaths.

The next significant spike in dengue cases was in 2013. By this time, the infection had spread to 25 different districts in Nepal. of Aedes aegypti Virus-carrying mosquitoes are more common in tropical and subtropical climates, but as temperature norms change; Dengue fever has begun to be reported Also from the foothills and mountain ranges of the Himalayas.

Until 2022, major outbreaks occurred every two to three years. However, starting in 2022, the country has faced an annual and seasonal spike in dengue cases, raising concerns about the health system.

Every year, a new challenge

in recent editorials Over the years, “viruses have become more complex and dangerous,” Dr. Pan wrote in the Kathmandu Post. However, it is also difficult to predict the course of the virus.

Although the pace of infection has generally accelerated in recent years, this has not directly translated into a year-on-year increase in mortality rates.

Back in 2022, a total of 54,784 cases were reported, with a significant number of patients requiring ICU or hospitalization. That year, 88 deaths were reported, the highest death toll ever.

In recent months, Nepal has suffered some of the most devastating and widespread flooding and landslides in its history.

This year, as dengue infections began to rise, hospitals also began preparing in anticipation of more severe dengue cases. Reinfection with a different serotype is usually more dangerous than the first.

But epidemiologists and clinicians alike are surprised to find that, even as the number of cases increases, the proportion of people with severe infections is decreasing. Dr. Shah Bahadur Pan called this year's dengue wave “walking dengue” as the majority of patients appear to recover without requiring hospitalization.

However, as of October 28th, 12 deaths due to dengue fever confirmed Already tallied, this year's surge was expected to end only in December.

When the rain stops, the sadness of dengue fever also goes away.

Researchers and the World Health Organization Connection with climate changedengue fever is not an independent problem.

Nepal has been the hardest hit in recent months. Catastrophic and widespread flooding and landslides In its history. The cause was heavy rain. Once the rains stopped and affected communities began to recover and rebuild, the disease spread.

Ujjwal Timilshina, a 17-year-old student in Kathmandu pursuing higher education, initially had a very high fever of 39.4 degrees Celsius. His temperature soared, accompanied by a severe headache and pain behind his eyes.

After that, all the people living together began to experience similar symptoms one after another. Timirshina had contracted dengue fever a year ago and noticed her symptoms immediately. He decided to take paracetamol and wait it out.

However, two days later, he was hospitalized with intractable vomiting, difficulty breathing, and nosebleeds. Many people in his hometown were affected by last month's events. flood – You have had similar symptoms.

Although dengue fever can develop in unpredictable ways, the general pattern is predictable. The monsoon season lasts from June to August, and dengue cases begin to spike shortly thereafter. This is probably related to the fact that vector mosquitoes breed in flooded ditches and pools.

Additionally, the spread of infection has been more pronounced in urban areas and major cities such as Kathmandu, Biratnagar, Chitwan, and Pokhara than in rural areas of the country.

fight against viruses

But it's not just viruses that are evolving. Every year, Nepal becomes better prepared for the upcoming surge. Dr. Gokarna Dahal, Section Chief, Vector-Borne Disease Control Section, EDCD, said: How vaccines workLearning from past mistakes, I have prepared more timely and well this year than in the past. ”

Extensive “mosquito search and control” programs are being carried out in many local government areas. Healthcare facilities are well prepared, stockpiling medicines and rapid diagnostic kits, and staff receiving additional training during the pre-monsoon period.

The main purpose is to prevent people from getting infected. But in case they get sick, Dr. Dahal says the government is better equipped to deal with the outbreak this time.