Rural Provinces Report Dengue Outbreaks

Dengue fever outbreaks in Pursat and Ratanakkiri provinces have afflicted more than 30 people in each of those regions since the beginning of May, surprising health officials who did not expect the disease to strike in rural areas.

In Pursat, 36 people were diagnosed with dengue fever between May 1 and May 18, according to statistics from the Ministry of Health’s National Malaria Center. There have been 69 dengue cases and 11 deaths in that province since the beginning of the year.

In Ratanakkiri, there have been 124 recorded cases and four deaths since Jan 1. In April, there were 59 dengue cases, and from May 1 to May 18, there were 33 cases.

“Before, we never had an outbreak in these provinces,” said Dr Doung Socheat, director of the National Malaria Center. “Never in Ratanakkiri. In Pursat, just a few cases.”

The problem in Ratanakkiri has been aggravated by a lack of trained doctors, said Ngan Chan­tha, national dengue fever program manager at the National Malaria Center. People are going to private practitioners and are being charged as much as $200 for treatment, depending on how life-threatening the case is, he said.

In a severe case of dengue, the virus breaks down the walls of blood vessels, causing blood to leak throughout the body, causing shock and requiring immediate blood transfusions.

One doctor has been sent from Phnom Penh to Ratanakkiri to train health staff there on how to diagnose and treat the disease.

A team from the National Malaria Center is in Pursat, distributing IV fluids and medicine, and training health workers.

Insecticide has been sprayed in outbreak areas in Pursat, as well as in Svay Leu district in Siem Reap province, which has also suffered a small outbreak, according to Dr Chang Moh Seng, den­gue officer for the World Health Organization. There will be spraying in Banteay Mean­chey prov­ince next week, he said.

Results from blood samples taken from Khna Kroa village in Svay Leu district earlier this month found three confirmed dengue cases, Jonathan Croft, an official with Medecins sans Fron­tieres, said.

One child from the district recently died from dengue, said Dr Stefan Hoyer, WHO medical officer for malaria control.

National Malaria Center figures show 48 dengue cases in April and 47 cases for the first 18 days of May in Siem Reap pro­v­ince.

Since mosquitoes that carry dengue live their entire lives within a small area, dengue is most common where the population is dense. But so far this year, said Doung Socheat, there has not been a problem in Phnom Penh and Kandal province—considered to be high-risk areas.

But the disease is showing up in rural villages.

“Dengue fever has moved into the forest,” Hoyer said. “This year, we have had very little cases in urban centers. We have no idea why” it has made its way to rural villages, but “the mosquito is there.”

Hoyer said the recent outbreaks are relatively small. He warned that 80 percent of dengue cases for the year will occur in July and August.

The disease generally peaks during the rainy season, especially in August, because of the enhanced breeding conditions provided by the dampness.

“This is not as big of a problem compared to 1998,” Ngan Chan­tha said. “But compared to last year, it looks bad.”

Fears that the 1995 and 1998 dengue fever epidemics that struck thousands of Cambodians will recur this rainy season promp­ted health officials to begin a massive distribution of a chemical that kills mosquito larvae last month.

There are four strains of den­gue, and a bout with one strain results in permanent immunity from that strain and a temporary cross-immunity to the other three strains.

But this wears off after several years, helping to explain why epidemics have been occurring in Cambodia in three-year intervals since 1992.

The insecticide distribution has been matched by an education campaign, which has informed people that the dengue mosquito usually bites just after sunrise and just before sunset and usually affects small children and foreigners.

In all of Cambodia, 690 people have had dengue and 27 people have died from the disease since Jan 1, according to the National Malaria Center.


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