KARACHI, 25 August 2008 (IRIN) - Last week when Ghazi Khan, 19, was brought to the government Jinnah Postgraduate Medical Centre (JPMC) complaining of high fever, aches and nausea, his older brother Mohammad Zaman feared he would die.

"He showed classic symptoms of dengue fever," he told IRIN. Khan works as a gardener in a plant nursery in the southern port city of Karachi, and, according to his brother, usually works well after sunset.

Dengue, also known as "breakbone fever" is caused by a virus vectored by the aedes aegypti and albopictus mosquito. Human transmission occurs when a mosquito feeds on an infected person's blood and bites a healthy person.

According to news reports, the number of dengue patients in Karachi this year has risen to 287 - of which four have died. Last year, some 22 deaths were reported in Sindh Province. This is the fourth consecutive year dengue has spread in Karachi, the provincial capital of Sindh. According to experts, all four serotypes of dengue are present in the metropolis.

S.M. Munir, professor of medicine at JPMC, says there was no reason to sound the alarm bells since the number of patients this year compared to last year has been lower. However, there was no reason to be complacent, Munir said.

"There has been less rain, less water standing and less heat, so the mosquitoes have not found a conducive atmosphere to breed," he said. "The numbers may increase as this is just the start of the season."

Ramadan risk

There is another factor. The holy month of Ramadan, observed by Muslims as a month of fasting, is approaching. During Ramadan, people often get together before sunrise and at sunset, to break their fast or have their last meal before starting to fast. "The chances of infection spreading are more because of this," said Syed Abdul Mujeeb, who supervises JPMC's blood bank.

"Ramadan will provide an opportunity for the spread of the disease if we do not take measures now," Mujeeb said.

He said the increased number of people going to mosques during Ramadan at sunset and sunrise increased the risk of dengue fever as the aedes mosquito bites most often at these times. "Because many will use the mosque pond for ablutions and those fasting will also be drinking more water, the message that water needs to be covered, has to be repeated often," he said.

Back at the hospital…

Back at the hospital, a worried Muhammad Zaman, Ghazi Khan's brother, asked, "Is his life in danger?" He said he had heard of patients dying of bleeding. This is described by doctors as dengue hemorrhagic fever (DHF), which is often fatal.

"When they brought him here, his platelet count had gone down to 26,000," said Perveen Akhtar, head nurse in Ward 7 where Ghazi Khan was admitted. "But after supportive therapy that included injecting fluids intravenously to prevent dehydration, and a lot of rest, his platelet count increased to 70,000 and his fever has also gone down," said Akhtar. She had seen quite a few cases of DHF last year, and the year before that, and agreed it was quite disquieting.

Khan and two other patients suspected of suffering the viral disease stay inside a medicated mosquito repellant bed net as a precaution to prevent others patients from catching the virus.

Optimism

But Munir, who has worked at the hospital for the past 30 years, is optimistic. "Dengue is a self-limiting disease. In 80 percent of cases people do not develop any symptoms. Even for those who develop haemorrhagic fever, it is curable if people come for treatment at an early stage and don't wait till they are on their death bed," he said.

"Dengue is not synonymous with death," said Mujeeb, who is part of the dengue task force established by the hospital. "If the platelet count is monitored and the patient transfused in very dire cases, then there is little to worry about."

Children are more susceptible to the disease, but more fatalities occur among adults "because of pre-existing problems, especially if a person is suffering from other chronic or debilitating diseases," said Mujeeb.

He also said those infected with one serotype of the virus are at a greater risk of DHF if they suffer a second infection with a different serotype.

Climate is a major factor for the dengue epidemic, said Mujeeb. The mosquito breeds in still, clean water and a humid climate. Karachi offers it the perfect conditions to propagate, he said.

He believed a strong surveillance system and an aggressive anti-mosquito campaign could keep the country free of the disease. For this, Mujeeb said, empty plots and unoccupied houses - which remain unkempt and where weeds are allowed to grow - can provide an ideal breeding ground for the mosquito, even those that carry malaria.

"This is a largely man-made crisis," he said. He was referring to stagnant water due to poor drainage, water in flowerpots and earthenware jars, even water that collects in toilet bowls.

Overcrowding

But more than that, it is rural-urban migration that has led to the spread of dengue, with people living in over-crowded homes, making it easy for the mosquito to bite an infected person and transmit the virus to a healthy one, say specialists.

Shoaib Mir, executive director of JPMC, said the city authorities were active with their fumigation campaigns, which had helped nip the disease in the bud.

The JPMC has a contingency plan if the disease spreads. "Apart from four general wards that can accommodate dengue patients, we have 250 medicated mosquito nets and a ward exclusively for dengue patients if there is an outbreak," said Mir.

And for the first time, the government has invested in a mega platelets machine (cell separator) for patients at Karachi's Civil Hospital, raising hopes that dengue deaths this year will be limited.

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