Four-year-old Srey Mom sits forlornly on an oversized bed in the National Pediatric Hospital, an intravenous drip protruding from her partially shaved head.
There is nowhere else to put it. The backs of the little girl’s hands are too bruised from the needles that have supplied her with fluids to nurse her back to life since she was admitted seven days ago with dengue hemorrhagic fever.
When her mother brought her to the hospital, Srey Mom was already in shock, with a high fever, weak pulse and clammy skin. But after a week of intensive treatment, including blood and plasma transfusions, doctors say she will soon be well enough to return to her home in Kompong Speu province.
Srey Mom is one of the lucky ones. According to figures just released by the World Health Organization and the National Malaria Center, 107 children nationwide have already died this year from the hemorrhaging caused by the mosquito-borne disease.
These fatalities are only the tip of the iceberg. The total number of confirmed dengue hemorrhagic cases in the first six months of the year has already topped 4,000. Since the onset of the rainy season in June, dengue hemorrhagic fever rates have soared to more than 30 times the seasonal average. The rate of transmission now stands at more than 15 times the epidemic warning threshold.
And with the traditional peak of the dengue season still two months away, health officials fear Cambodia may be facing its biggest epidemic ever.
Dr Kdan Yuvatha, chief of the National Pediatric Hospital’s technical office, agrees the outlook seems bleak.
“It’s getting worse,” he says, pointing to the 52 cases already admitted to the hospital’s dengue ward this week. Three of them have already died.
“We are afraid this year we are having a big epidemic. It will be worse than 1995,” he says, referring to the worst epidemic yet, when more than 10,000 children contracted the disease and 447 died.
“It’s already a major epidemic,” said Dr Yit Sunnara of Kantha Bopha children’s hospital, which treats about 80 percent of dengue hemorrhagic patients brought to Phnom Penh.
“We have seen the number of patients quadruple from May to June. We are even using our conference room as a ward for dengue patients.”
The dengue virus is spread by the Aedes Aegypti mosquito, also known as the tiger mosquito. In the wet conditions of the rainy season, the tiger mosquito flourishes, hatching its larvae in pools of standing water.
In adults, the virus usually develops into dengue simple, also known as “breakbone fever” because of the pain it causes. Dengue hemorrhagic fever, the more dangerous manifestation of the virus, is typically confined to children, who account for more than 95 percent of cases.
Because the tiger mosquito lives its entire life within a small area, the dengue virus is most common where population density is high. As a result, urban environments like Phnom Penh and Battambang have been the traditional epicenters for dengue outbreaks.
But medics studying the latest figures have noticed an alarming new development in the patterns of dengue transmission.
During the dry-season outbreak in January, the total number of reported cases outside Phnom Penh was only half that in the capital. But after January, as the number of cases in the capital began to fall, the transmission rate in the provinces continued on an upward trajectory. In June, the number of cases reported in the provinces was four times the number originating in Phnom Penh.
“In some provinces we are seeing dengue appear for the first time,” says Dr Stefan Hoyer, dengue program officer for the World Health Organization. “It’s becoming more and more rural.”
The example of Srey Mom is a case in point. Her home is a farm in a rural district of Kompong Speu, where, according to her mother, dengue was all but unknown until this year.
“My daughter had a high fever for three or four days,” Sok Chea recalls. “And then I remembered I had heard some of our neighbors’ children had got dengue, but it was only this year that it happened, not before.”
Health officials have several explanations for the spread of dengue into the provinces. Warmer weather resulting from the El Nino weather phenomenon is thought to have contributed to a rise in dengue levels by providing enhanced breeding conditions for the dengue-bearing tiger mosquito.
Several countries in the region have recently experienced abnormally high levels of dengue hemorrhagic fever, with 16,647 cases reported in Vietnam since the beginning of the year.
Dengue is also classed by the World Health Organization as one of a number of “emerging diseases,” whose range and virulence is increasing year by year.
In response to the new rural outbreak of dengue, the National Malaria Center and the World Health Organization have launched a nationwide program to eradicate the tiger mosquito, along the lines of January’s campaign in Phnom Penh. Insecticide spraying has already taken place in the most affected province, Kandal, with the next 15 most vulnerable provinces to follow.
A publicity campaign on television, radio and leaflets has begun to urge people to store water in regularly cleaned, covered containers and to use the pesticide Abate, which prevents the mosquito’s larvae from hatching in water. Malaria officials have already started to distribute the first of 25 tons of Abate to households across the country.
The campaign also provides practical advice on how to recognize dengue symptoms so that children can receive prompt treatment.
