By Matt Reed
choam khsan district, Preah Vihear province – A five-man team from the National Malaria Center ferried into this former Khmer Rouge stronghold via military helicopter this week to deal with a dengue fever outbreak that has killed at least 11 people.
Armed with several backpack canisters, the staffers have spent the week spraying insecticide in three communes where at least 120 people have been diagnosed in the last month with a disease that had previously been considered rare in this rural district near the Thai border.
“There have been a few isolated cases [in Preah Vihear] before, but this is the first time on this large of a scale,” said Ann Canavan of the British NGO Health Unlimited in Tbang Meanchey, the provincial capital.
The outbreak is the latest to take place in a remote area in Cambodia this year. In May, officials reported large numbers of cases in rural areas in Pursat, Ratanakkiri and Siem Reap provinces.
Because the mosquito that carries the dengue virus lives its entire life within a small area, dengue fever is most common where population is dense. In previous rainy seasons, Phnom Penh and Battambang have been the traditional epicenters for outbreaks.
But this year, National Malaria Center officials have had to act like firemen, running off to outbreak areas as provincial officials sound the alarm, delivering medical supplies, bednets, insecticide, larvicide and educational materials. In some cases, they have trained doctors who did not have the proper experience and knowledge needed to treat dengue patients.
Dr Ngan Chantha, national dengue fever program manager at the National Malaria Center, said improved roads are behind the wider spread of dengue. Cars, motorcycles and planes are carrying infected people and dengue-carrying tiger mosquitoes into the remote areas.
The spread of the virus is also intensified by the fact that the dengue-carrying tiger mosquito will often bite several people several times each, increasing the likelihood of transmission.
In Preah Vihear’s Kulen district, 15 people have been diagnosed with dengue fever. In Tbang Meanchey district, at least 10 have come down with the disease, according to provincial health department vice-director Khoy Bun Phanly. There has been one death from dengue in Kulen, she said.
Officials mark the start of the outbreak in Choam Khsan as May 20, when one district resident traveled to Nam Yun village, Thailand for treatment and was diagnosed with dengue by doctors there. Soon after, another four residents were found to have dengue.
“Following that, the number of cases started to increase,” said Canavan.
The outbreak prompted the provincial health department to send three medical staff to the district health center in late May. Health Unlimited sent six health staff from Tbang Meanchey at the beginning of June.
On June 12, a three-year-old girl arrived at the center with a severe case of dengue. In such a case, the virus breaks down the walls of blood vessels, causing blood to leak throughout the body.
Doctors at the center realized she was in shock, but were unable to do anything to help. She died soon after.
Word of more deaths throughout the district has made its way to the health center, but the rains have made sections of the district inaccessible to the already busy health staff.
On Sunday, the National Malaria Center team brought much-needed IV fluids and packets of the anti-larvicide Abate.
With IV tubes dangling from their arms, dozens of children rested Sunday on tables, chairs and floor mats in every available room of the health center.
Next door, a ramshackle wooden building—usually used as a kitchen—housed 15 children sick with dengue. Mothers and grandmothers sat nearby, waving mosquitoes away with pieces of cardboard and consoling crying children.
Some patients have chosen to go to Thailand for treatment. It takes two hours and 15,000 riel by motorcycle taxi to get to the Dangkrek Mountain range that forms the northern part of the Thai-Cambodian border. It is another two hours of hiking, with the patient usually carried in a hammock.
Five weeks after the first reported case, dengue in Choam Khsan has begun to even-out, according to Health Unlimited medical assistant Van Hai. On Wednesday, there were dengue 40 patients at the center.
“We expect that by the end of July we will see the end of the outbreak,” said Canavan.
Fears of a dengue fever epidemic this year prompted health officials to distribute a massive amount of Abate in 13 provinces in April. A similar distribution will take place again in late July.
The distribution has been matched by an education campaign, which has informed people that the tiger mosquito usually bites only at sunrise and sunset and that dengue usually affects small children and foreigners who have not built up resistance to the disease.
Dengue generally peaks during the rainy season, especially in August, because of the enhanced breeding conditions provided by dampness.
