Dengue

The past month has not been an easy one for Laos. One of its provinces, Luang Prabang, has been suffering through a chronic food shortage that began months ago and has resulted in over 15,000 people dealing with moderate to severe food insecurity. A recent flash flood in Borikhamxay caused the Nam Xan river to overflow, sweeping away livestock and destroying rice stores for the families there.  As the well-worn joke goes, it’s a bit like living in the Old Testament here. If the sky opened up today and rained frogs, I’m pretty sure my neighbours would just shrug and buy bigger umbrellas.

But we now have a budding epidemic to deal with that has dwarfed the natural disasters in terms of loss of life this year. Dengue is a vector-borne illness transmitted by mosquitoes, just as malaria is. Unlike malaria, there are no prophylactics to prevent or lessen the impact of the disease and no antivirals or other medicines to specifically treat dengue once a person gets the disease. Symptoms of the disease include a mild to high fever, muscle and joint pain and rash. Though no treatment will cure the disease, allowing the disease to continue without any form of medical response could cause it to worsen and lead to death in some cases.

Dengue is endemic to Laos and the country deals with the disease every year. But the numbers this year are off the charts for some unknown reason. The season for Dengue generally runs from April to November, with the number of cases to this point of the year usually around 1,500 people. Three years ago was seen as an abnormally high year with 3,500 people affected. By comparison, there have now been 15,000 people infected with Dengue so far this year. Fifty-four people have died so far from the disease, compared to 22 for the entire year in 2010. And things may only get worse from here.  Dengue traditionally tends to reach its peak only toward the end of the rainy season, in August and September, so the numbers seem destined to rise.

As there is no vaccine to prevent the disease, the only way to protect yourself is to keep from being bitten at dusk and dawn, the times when the Aedes mosquito is most active. Long-sleeved shirts and mosquito repellent are the order of the day. Even I’m becoming cautious in this respect. I lived in Cameroon for 18 months on a half-bottle of Muskol, but I’m spraying myself every day now if I expect to be out early or late.

As the numbers have risen, the Lao Government has been working in conjunction with the World Health Organization (WHO) to find a way to contain the problem and reverse the trends. Beyond raising awareness of the problem, they are also attempting to address its cause by staging community clean ups of the areas where the mosquitoes tend to breed. This means removing the pools of water that collect as the rains come and cleaning areas that tend to attract mosquitoes. Particularly vulnerable in this respect are the villages around the country, so the focus has been placed on the eleven provinces showing the highest rates of infection, with the hope that up to 6,000 volunteers can be mobilized to assist with the response there this month. As the numbers rise, it is anticipated that medical students will be added to hospital rosters to assist with case management. As might be expected, the costs associated with making these responses are soaring to match the rising rates of infection, with estimates now reaching into the millions of dollars.

To this point, I haven’t personally been affected by Dengue. Vientiane Province has been impacted by the disease, with over 1200 cases and one death reported, but to the best of my knowledge, none of my UN colleagues have been infected. One friend outside of the UN did contract the disease earlier in the year as did his neighbours, but all of them were able to recover without incident. He informed me of this as we sat around his patio table that was decorated with enough cans of Off mosquito repellent that each of the party goers could have taken one home as a souvenir. “Dengue seems to be really bad in this neighbourhood,” he said, as I checked the sun that was sinking below the horizon and reached for my own spray bottle.

As the central hub for UN operations in the country, the Resident Coordinator office that I head has been receiving regular updates from WHO, as this is one of the main UN agencies in the country. A recent appeal from them to assist with funding the response has left me at a loss, as the budget for the RC Office is not broad enough to pitch in for such extraordinary efforts, but we continue to explore the options for finding funding sources within and outside of the UN. In a country that is prone to large-scale natural disasters such as flooding and typhoons, the tiny mosquito may prove to have the most devastating impact on Laos in 2013.