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Dengue – the whats, whys and hows.

Dengue - the whats, whys and hows.

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 Dengue seemed to have taken a back seat in the news the last year but it is fast becoming  a household concern, yet again. With  9,669* dengue patients being reported in Sri Lanka so far in 2021, it is safe to say that dengue ‘is back’ (not like it ever went away though). So we at oDoc are breaking it down for you. We go into detail about the causes, treatment and prevention of dengue, so keep reading!

What is dengue and how is it caused?

Dengue is a mosquito-borne disease. Dengue viruses spread among people through the bite of an infected Aedes species mosquito. These are the same types of mosquitoes that spread Zika and chikungunya viruses. These mosquitoes breed and lay eggs in still water (in buckets and pots in your garden which has collected water). These eggs can even survive up to 1 year and can withstand dry conditions till they are in water again.

Is dengue contagious?

Dengue is not contagious so you cannot catch the virus via contact with an infected person. However, an infected mother can pass the virus to her fetus during pregnancy or around the time of birth. In the case of infected breastfeeding mothers, it is encouraged that they continue breastfeeding their infant due to the benefits of breastfeeding. So far, there has only been 1 case of the virus passing to the infant via breast milk.

 

 

Dengue seemed to have taken a back seat in the news the last year but it is fast becoming  a household concern, yet again. With  9,669* dengue patients being reported in Sri Lanka so far in 2021, it is safe to say that dengue ‘is back’ (not like it ever went away though). So we at oDoc are breaking it down for you. We go into detail about the causes, treatment and prevention of dengue, so keep reading!

What is dengue and how is it caused?

Dengue is a mosquito-borne disease. Dengue viruses spread among people through the bite of an infected Aedes species mosquito. These are the same types of mosquitoes that spread Zika and chikungunya viruses. These mosquitoes breed and lay eggs in still water (in buckets and pots in your garden which has collected water). These eggs can even survive up to 1 year and can withstand dry conditions till they are in water again.

Is dengue contagious?

Dengue is not contagious so you cannot catch the virus via contact with an infected person. However, an infected mother can pass the virus to her fetus during pregnancy or around the time of birth. In the case of infected breastfeeding mothers, it is encouraged that they continue breastfeeding their infant due to the benefits of breastfeeding. So far, there has only been 1 case of the virus passing to the infant via breast milk.

 

What are the symptoms of dengue?

It is said that 1 out of 4 people who are infected with the dengue virus will get sick and can show mild to severe symptoms.  Mild symptoms include high fever along with a combination of aches and pain in muscles and joints, rashes and nausea. Symptoms last about 2–7 days. Most people will recover after about a week. Severe cases of dengue usually require hospitalisation. Symptoms and warning signs include:
  • Belly pain, tenderness
  • Vomiting (at least 3 times in 24 hours)
  • Bleeding from the nose or gums
  • Vomiting blood, or blood in the stool
  • Feeling tired, restless, or irritable

What are the symptoms of dengue?

It is said that 1 out of 4 people who are infected with the dengue virus will get sick and can show mild to severe symptoms.  Mild symptoms include high fever along with a combination of aches and pain in muscles and joints, rashes and nausea. Symptoms last about 2–7 days. Most people will recover after about a week. Severe cases of dengue usually require hospitalisation. Symptoms and warning signs include:
  • Belly pain, tenderness
  • Vomiting (at least 3 times in 24 hours)
  • Bleeding from the nose or gums
  • Vomiting blood, or blood in the stool
  • Feeling tired, restless, or irritable

If you are showing any of these symptoms or warning signs, seek medical attention immediately. It is also important to note that these warning signs usually begin 24–48 hours after your fever has gone away.

What’s the treatment for dengue?

Unfortunately, there is still no specific treatment to cure dengue. However, it is vital that you rest as much as possible and keep yourself hydrated by taking a lot of fluids if you are diagnosed with dengue. You can also take paracetamol (do not take aspirin or ibuprofen) to help with the fever and body aches and pains. 

It is advised to seek medical advice rather than self-diagnosing and opting for self-treatment. 

What can you do to prevent dengue?

  • Keep neighborhoods clean and free of still water 
  • Frequently clean garden, pots, vases and balconies
  • Wear clothes that cover the body and minimize exposure to mosquito bites
  • Always use mosquito repellents
  • Use mosquito nets
  • Installing net screens on doors and windows.

In these difficult times, it is vital we look after ourselves and our loved ones. If you or anyone you know is suffering from any of the above-mentioned symptoms you can speak to an on-demand doctor on oDoc from the comfort of your home.

Stay indoors. Stay safe.

*At day of writing (13th July 2021)

Sources

  1. Epidemiology Unit – Ministry of Health. (2021, July 13). Dengue update. Epidemiology Unit – Ministry of Health Sri Lanka. https://www.epid.gov.lk/web/index.php?option=com_content&view=article&id=171%3Adengue-update&catid=51%3Amessage-for-public&Itemid=487&lang=en
  2. Content source: Centers for Disease Control and Prevention. (2021, June 28). Dengue | CDC. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/dengue/index.html
  3. Dunkin, M. A. (2010, July 26). Dengue Fever. WebMD. https://www.webmd.com/a-to-z-guides/dengue-fever-reference
  4. WHO. (2019, July 8). Preventing Dengue in Sri Lanka. World Health Organization. https://www.who.int/srilanka/news/detail/08-07-2019-preventive-action-is-vital-to-curtail-dengue-outbreaks-in-sri-lanka

 

If you are showing any of these symptoms or warning signs, seek medical attention immediately. It is also important to note that these warning signs usually begin 24–48 hours after your fever has gone away.

What’s the treatment for dengue?

Unfortunately, there is still no specific treatment to cure dengue. However, it is vital that you rest as much as possible and keep yourself hydrated by taking a lot of fluids if you are diagnosed with dengue. You can also take paracetamol (do not take aspirin or ibuprofen) to help with the fever and body aches and pains. 

It is advised to seek medical advice rather than self-diagnosing and opting for self-treatment. 

What can you do to prevent dengue?

  • Keep neighborhoods clean and free of still water 
  • Frequently clean garden, pots, vases and balconies
  • Wear clothes that cover the body and minimize exposure to mosquito bites
  • Always use mosquito repellents
  • Use mosquito nets
  • Installing net screens on doors and windows.

In these difficult times, it is vital we look after ourselves and our loved ones. If you or anyone you know is suffering from any of the above-mentioned symptoms you can speak to an on-demand doctor on oDoc from the comfort of your home.

Stay indoors. Stay safe.

*At day of writing (13th July 2021)

Sources

  1. Epidemiology Unit – Ministry of Health. (2021, July 13). Dengue update. Epidemiology Unit – Ministry of Health Sri Lanka. https://www.epid.gov.lk/web/index.php?option=com_content&view=article&id=171%3Adengue-update&catid=51%3Amessage-for-public&Itemid=487&lang=en
  2. Content source: Centers for Disease Control and Prevention. (2021, June 28). Dengue | CDC. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/dengue/index.html
  3. Dunkin, M. A. (2010, July 26). Dengue Fever. WebMD. https://www.webmd.com/a-to-z-guides/dengue-fever-reference
  4. WHO. (2019, July 8). Preventing Dengue in Sri Lanka. World Health Organization. https://www.who.int/srilanka/news/detail/08-07-2019-preventive-action-is-vital-to-curtail-dengue-outbreaks-in-sri-lanka

 

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Breaking down the Delta Variant

Breaking down the Delta Variant

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It seems we hear of a news report of a newly discovered Delta COVID19 case in Sri Lanka almost on a daily basis. Resulting in the question, what is the delta variant and what does that mean for us?

For our more in-depth blog on variants, please click here

Short read: It is highly transmissible and has caused more hospitalisations than the Alpha variant in the UK (and India, though the data isn’t as neatly available), especially in young people and the unvaccinated. It is found to be more resistant to the Pfizer and AstraZeneca vaccine responses especially after only one dose but continues to provide 80-90% protection after two doses against symptomatic disease. A widespread of this variant in Sri Lanka could overburden an already overwhelmed medical system. Until vaccines can be rolled out to the majority of the population, adhering to strict COVID19 protocols by businesses and individuals is our only avenue for protection. 

Want more details? Read on!

The Delta variant (B.1617.2) was first sequenced in India post its recent COVID wave of March 2021. The variant was classified as a variant of concern by the WHO alongside the Alpha variant (B.1.1.7) first discovered in Britain, the Beta variant (South Africa) and the Gamme variant (Brazil). Variants of concern are those that are considered highly transmissible, highly infectious and/or deadly.

So what do we know about this newest variant on the block?

Image source: Dr. Eric Topol

How transmissible is it?

WHO’s Dr Mike Ryan described the Delta variant as “faster, fitter and will pick off the more vulnerable more efficiently than the previous variants”. The variant is the fastest spreading one in the UK and has prompted medical professionals to estimate that it is around 60-70% more transmissible than the Alpha variant. 

Tracked data shows that COVID cases have grown 75% week over week in May in the UK (mostly amongst young people and the unvaccinated). 

Why is more transmissible more dangerous?

To quote Zeynep Tufecki on a New York Times op-ed:

“Increased transmissibility is an exponential threat. If a virus that could previously infect three people on average can now infect four, it looks like a small increase. Yet if you start with just two infected people in both scenarios, just 10 iterations later, the former will have caused about 40,000 cases while the latter will be more than 524,000, a nearly 13-fold difference.”

What are its symptoms?

Even in the early throes of the Indian third wave, reports of different COVID19 symptoms began to circulate amongst social media. 

Updated COVID19 symptoms as per the CDC now include:

  • Fatigue
  • Muscle or body aches
  • Headache
  • Sore throat
  • Congestion or runny nose
  • Diarrhoea
  • Nausea and vomiting

How does it affect hospitalisations and the death rate?

A Public Health Scotland study found that the risk of hospital admissions was almost doubled with Delta vs. Alpha. 

Amongst those vaccinated with Pfizer or AstraZeneca, the Public Health England study reported that those with one dose of vaccine were 75% less likely to be hospitalised and those with both doses are 94% less likely to be hospitalised when compared to the unvaccinated population.

How does it respond to vaccines? 

A report published by Public Health England indicated that the variant is moderately resistant to vaccines, especially just the first dose. A single dose of AZ or Pfizer reduced a person’s risk of developing symptomatic illness by 30% (vs. 50% for the Alpha variant). A second dose of AZ increased protection to 60% (compared to 66% for Alpha). Two doses of Pfizer were 88% protective against the variant (compared to 93% against Alpha). 

No studies are available about the Sputnik or Sinopharm response to the new variant.

How can we stay safe?

Whilst richer countries look to rapid deployment of vaccines to counteract the rising Delta cases, Sri Lanka – with limited access to vaccines – must rely on the tried and tested COVID19 safety precautions:

  • Limiting physical gatherings (especially, AC & indoors)
  • Masking indoors & outdoors (over nose & mouth, when around those that are not of the same household)
  • Washing hands with soap
  • Sanitising high touch surfaces

As the third wave has taken us to the brink of medical capacity, any spread of the Delta variant in Sri Lanka could have serious ramifications to public health, but also to the overburdened medical system.

We encourage all Sri Lankans to get vaccinated, to stay home and follow COVID19 protocols to the utmost of your abilities. 

If you are experiencing any COVID19 symptoms or would like to speak with a doctor about your general health, download the oDoc app here

If the uptick of cases and variants are causing your mental health to suffer, speak to a psychologist on the oDoc app safely from your home.

Sources

  1. Stowe, J. et al. Effectiveness of COVID-19 vaccines against hospital admission with the Delta (B.1.617.2) variant., Preprint at https://go.nature.com/3gnqwxr (2021)
  2. Sheik, Z et al. SARS-CoV-2 Delta VOC in Scotland: demographics, risk of hospital admission, and vaccine effectiveness., The Lancet: 397: 2461-262 (2021)
  3. WHO says delta is the fastest and fittest Covid variant and will ‘pick off’ most vulnerable, CNBC (2021)
  4. UK reports 6,238 daily Covid cases amid fears over Delta variant infectiousness, The Guardian (2021)
  5. Tufecki, Z., Covid’s Deadliest Phase May Be Here Soon, The New York Times (2021)
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Understanding the dynamics – breastfeeding, pregnancy and COVID vaccines

Understanding the dynamics - breastfeeding, pregnancy and COVID vaccines

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As Sri Lanka rolls out its vaccination program, the questions have shifted from “Which vaccine should I get?” to “Should pregnant and breastfeeding women get vaccinated?” 

The answer in short: Yes, everyone should get vaccinated when offered the chance.

For a more detailed answer on how the vaccine affects pregnant and lactating women, read more below.

Breastfeeding and vaccinations 🤱🏾

Women who have recently given birth or are still breastfeeding should get the vaccine. 

Initially, the clinical trials for the COVID-19 vaccines currently in use did not include women who were breastfeeding. So, there was no clinical data on the safety of vaccines in lactating women, effects of the vaccine in breastmilk production and the consequences on the baby. However, now according to the WHO and new research, lactating women can receive a COVID-19 vaccine.

Recent reports have shown that breastfeeding women who have received COVID-19 vaccines have antibodies that pass on to the baby via breast milk, helping in protecting the baby. 

 A study conducted in Israel with thePfizer-BioNTech vaccine, with 84 breastfeeding women, showed that IgA antibody (the first line of defence when exposed to an infection) secretion was present as early as 2 weeks after vaccination in the breast milk. This was followed by a spike in IgG antibody (important for remembering the virus to prevent future infections) 1 week after the second dose in the breast milk. This suggests a potential protective effect against infection in the infant as these antibodies are passed on to them via the milk. No mother or infant experienced any serious adverse event during the study period.

More data is needed to understand what protection these antibodies provide to the baby. Even though the studies on breastfeeding and vaccinations are not advanced, the present data shows no indication of harm to the mother or child.

Pregnancy and vaccinations 🤰🏾

As with many other vaccines, the effects of the COVID-19 vaccines on pregnant women have not been studied extensively yet. However, health professionals assess the risks of COVID19 vs. the COVID vaccine when deciding whether pregnant women should receive the vaccine. 

Pregnant women with any of the following conditions are at a higher risk of contracting severe COVID than women who are not pregnant: 

  • have underlying health conditions (for example diabetes, high blood pressure or asthma)
  • are overweight
  • are aged 35 years or over

Preliminary findings in a study conducted in the US on the effects of mRNA vaccine in pregnant women did not show obvious safety signals among pregnant women who received mRNA Covid-19 vaccines compared to the control group.

It must be noted that injection-site pain was reported more frequently among pregnant women than among non-pregnant women, whereas other side effects such as headache, chills, and fever were reported less frequently. However, a more detailed and longitudinal study is needed to understand the full impact of vaccination on pregnant women. 

We already know pregnant women are at a higher risk of getting severe COVID and also at a higher risk of delivering a baby prematurely. So in a country like Sri Lanka, where the transmission rate is high, the benefits of getting the vaccine far outweigh the risks. 

Fertility and vaccinations 🌸

Women who are planning to get pregnant in the near future can absolutely take the vaccine. There is no evidence of COVID vaccines affecting fertility or the chances of getting pregnant. So get your vaccine when it becomes available to you. 

If you want more detailed information on getting vaccinated you can speak to one of our on-demand GPs at any time via the oDoc app. If you or your loved ones are showing any COVID symptoms please consult a doctor via oDoc immediately or use the oDoc COVID symptom checker to understand what you should do next.

Sources

  1. Perl, S. H., Uzan-Yulzari, A., Klainer, H., Asiskovich, L., Youngster, M., Rinott, E., & Youngster, I. (2021). SARS-CoV-2–Specific Antibodies in Breast Milk After COVID-19 Vaccination of Breastfeeding Women.
  2. Vaccination Considerations for People Pregnant or Breastfeeding. (2021, June 16). Centers for Disease Control and Prevention. 
  3. Public Health Scotland. (2021, June 18). Pregnancy, breastfeeding and the coronavirus vaccine. The Coronavirus (COVID-19) Vaccine. 
  4. WHO. (2021, June 4). Episode #41 – Vaccines, pregnancy, menstruation, lactation and fertility. World Health Organisation.
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