Nepal has been battling an outbreak of dengue fever over the past two months, with the country reporting more than 17,500 infections and 21 related deaths.
The increase in the numbers of dengue cases comes as the COVID health crisis in the Himalayan country has begun to recede, with daily infections of the novel coronavirus dropping below 500.
Dengue cases have been recorded in 75 out of 77 districts across Nepal, according to the Ministry of Health.
However, experts say most infections go unreported and that authorities have been able to register only a small percentage of the total cases.
Sher Bahadur Pun, Head of Clinical Research Unit at Sukraraj Hospital for Tropical and Infectious Diseases (STIDH) in Kathmandu, said many patients do not visit healthcare centers to seek treatment because they consider the disease to be a seasonal viral infection and are aware of it. There is no specific treatment for dengue fever.
“In some of the affected areas, whole families have been infected. But only one or two family members have visited doctors, and only these cases have been recorded,” he told DW.
Rona Jha, director of the National Public Health Laboratory (NPHL), shares a similar view, noting a lack of adequate monitoring and testing capabilities.
“In the case of a dengue outbreak, many cases may not have been reported in the absence of established testing laboratories and due to the lack of systematic databases like the ones we had during the COVID-19 pandemic,” she said.
Avoiding mosquito bites is key
Dengue fever, which occurs mainly in tropical and subtropical regions, is often mild, but in some cases it can be fatal.
It is a mosquito-borne disease transmitted by female Aedes aegypti mosquitoes and Aedes albopictus mosquitoes. According to the World Health Organization, the same vector also transmits chikungunya, yellow fever, and Zika viruses.
Symptoms of dengue fever include mild to high fever, severe muscle pain, skin rash, severe headache, and eye pain.
Many dengue patients in Nepal are also reported to use over-the-counter (OTC) strong painkillers and antibiotics
This is not the first time Nepal has experienced dengue fever. The country experienced a major outbreak in 2019 as well with six people dying and more than 17,000 hospitalized.
Health experts have long called on the government to take effective measures to prevent the spread of the disease.
Jha said authorities need to launch a campaign to eliminate mosquito breeding sites and raise awareness of the precautions people should take.
Moreover, measures should be taken to avoid mosquito bites in schools, offices as well as at home.
“Dengue prevention and control depends on effective vector control measures. The best way to achieve this effect is by taking precautions by the people and the communities themselves.”
The outbreak can last weeks
The government has faced criticism for its handling of the outbreak so far.
Boone blamed the authorities for not paying enough attention to the warnings of public health experts and taking appropriate action at the right time.
“Although awareness campaigns and disinfection campaigns have now started, they will not be effective as mosquitoes infected with the dengue virus have already reached our homes,” he said.
Speaking at a public event on Tuesday, Gajan Thapa, a former health minister and a prominent leader of the ruling Nepali Congress, said all levels of government – federal, provincial and local – had failed to come up with a coordinated response to contain the spread of dengue fever.
In response to the criticism, Roshan Pokharel, secretary of the Ministry of Health, told DW that the government has launched public awareness campaigns as well as intensified efforts to destroy potential mosquito breeding sites.
But Bukharel admitted the lack of coordination between the authorities. He said the current outbreak could last another four to six weeks due to the rainy season.
Fighting drug shortages
A Health Ministry official, who asked not to be named, said the government is considering declaring an epidemic of dengue fever in the country, with the hope that this will improve coordination between various branches and levels of government.
In recent days, reports have emerged that health facilities are running short of medical examination kits as well as vital medicines such as paracetamol, which doctors recommend to lower fever and ease body aches.
Many patients are also reported to use strong pain relievers and antibiotics without a prescription.
Ramesh Koirala, a cardiologist, said using such drugs without consulting a doctor could lead to serious health problems – and sometimes death.
Edited by: Srinivas Mazumdaro