Dengue hemorrhagic fever (DHF), commonly known as dengue fever (DF), is the disease most commonly affecting children. According to Ministry of Health data, nearly 16 thousand cases of dengue fever occurred in Indonesia in the last two months of 2022, followed by a sharp increase in the same period in 2023. Cases tend to rise during the rainy season.
Dr. Eggi Arguni, a consultant pediatrician at Dr. Sardjito Hospital, diagnostic team leader at the World Mosquito Program (WMP) Yogyakarta, and a lecturer at the UGM Faculty of Medicine, Public Health, and Nursing (FK-KMK UGM), mentioned that the Aedes aegypti population, which is the vector (intermediate host) of dengue infection, tends to increase during the rainy season.
During this time, mosquito eggs are more likely to hatch. Additionally, there are more breeding sites due to water accumulation in plastic cups, old cans, discarded tires, clogged gutters, and other areas—the public needs to monitor the potential increase in virus transmission to humans during this season.
“There are four stereotypes of the dengue virus, namely DENV-1, DENV-2, DENV-3, and DENV-4. In theory, if during the second infection (secondary infection) we are infected with a different serotype of the dengue virus from the first infection, there is a possibility that the clinical manifestations will be more severe, such as plasma leakage, shock, or even death,” she explained on Thursday (Apr. 4) at UGM.
A report related to DF as of Mar. 1, 2024, showed cases in 213 districts/cities in Indonesia with 124 deaths. Dr. Arguni mentioned that the number of people infected could be greater than the reported cases.
This is because many people are asymptomatic or have been exposed to the virus but show no symptoms. Usually, they only experience mild fever and opt to take antipyretic drugs without realizing they have dengue fever.
Parents should be at the forefront of preventive efforts to ensure that children with dengue virus are promptly treated and do not worsen. Recognizing the symptoms in children is one way to do this.
“In symptomatic children, we should suspect dengue virus, especially when a sudden high fever is continuous or persistent. When they are given antipyretic drugs, the fever usually does not go below 38 degrees Celsius. Other symptoms include nausea, vomiting, weakness, skin hemorrhages, and the child appearing lethargic,” Dr. Arguni stated.
According to her, adults should also be aware of the difference in response to symptoms between themselves and children. While adults may complain of joint and muscle pain, children do not because they may be unable to communicate their pain.
Signs such as increased fussiness, loss of appetite and thirst, and vomiting can indicate that the patient is not well and should be taken to the nearest health center.
“In more severe dengue infection scenarios, when the platelet count is low, children may experience nosebleeds or bleeding gums when brushing their teeth,” she added.
Dr. Arguni also mentioned that dengue infection generally has three phases: the fever phase, the critical phase, and the recovery phase.
Towards the end of the fever phase or entering the critical phase, several warning signs should be monitored, such as abdominal pain, nausea, repeated vomiting, weakness, or signs of bleeding. The child should be taken to a doctor immediately if these danger signs are present.
“Dengue patients deemed to be in good condition by health workers do not need to be hospitalized, but they must still take their child to the hospital or health center every day (during the critical phase) for examination by a doctor and blood tests. Hematocrit and platelet levels will be monitored daily until the critical phase is over,” she explained.
For parents treating their children at home, Dr. Arguni suggested they provide the safest antipyretic medication, paracetamol. Avoid other medicines like nonsteroidal anti-inflammatory drugs (NSAIDs) as they can affect platelet function, increasing the risk of severe bleeding.
Parents should also ensure the child gets enough fluids, allow the child to rest, and avoid going out. Lastly, they should be vigilant for warning signs in children, such as abdominal pain, vomiting, and skin hemorrhages.
Parents’ role in protecting children from dengue virus infections during the rainy season cannot be overstated. In addition to eliminating mosquito breeding grounds outside and inside the house and cleaning the environment to remove Aedes aegypti breeding sites, parents can also take preventive measures against mosquito bites.
For example, they may dress children in covered, bright-colored clothing or use repellents. When a child is infected with dengue, recognize the symptoms and seek medical attention promptly at the nearest healthcare facility.
Author: Dita
Photo: flickr.com/Achmad Pachlevy