Lutte contre la dengue : Interview du Dr Malanna Fortuné Bigma, Chargé de recherches au CARESP-Togo

---

Extract from the article: La dengue, une maladie virale dont le traitement est symptomatique. Souvent confondue au paludisme bien que le patient peut souffrir des deux maladies à la fois, la dengue est mortelle, et le Burkina est dans une période cruciale de la maladie. Dr Ma

---

« Caution: when you have a fever associated with headaches and retro-orbital pain, go for a consultation quickly, it could be dengue ».

Dengue fever is a viral disease that can only be treated symptomatically. Often confused with malaria, although the patient can suffer from both diseases at the same time, dengue is fatal, and some countries like Burkina are in a crucial period of the disease. In this interview, Dr Malanna Fortuné Bigma, D.E.S in Public Health and Research Manager at the African Center for Research in Epidemiology and Public Health (CARESP-Togo), gives advice on how to prevent the disease.

Santé-Education: What is dengue fever?

Dr Malanna Fortuné Bigma: Dengue fever is an infectious disease caused by a virus transmitted to humans by mosquitoes, which usually bite during the day. It is therefore a vector-borne disease.

What causes this disease?

Dengue fever is caused by a virus comprising 4 serotypes: DENV-1, DENV-2, DENV-3 and DENV-4, all of which are independent. But DENV-1, DENV-2 and DENV-3 are the three serotypes of the dengue virus circulating in Togo. This means you can get dengue at least 4 times.

Are there several types of dengue?

We prefer to talk in terms of clinical forms. After infestation, there are several clinical presentations: There are asymptomatic forms (with no signs), where dengue is discovered by chance after a serological test.Pauci-symptomatic forms (with few signs) characterized by an isolated fever of short duration, with or without headache or joint/muscle pain. Symptomatic forms are generally infrequent. But the most frequent forms are asymptomatic and pauci-symptomatic in around 50-90% of cases.

Is there a particular period when this disease is most prevalent?Yes, particularly during the rainy season, with a peak in the number of cases in October and November. But the fact remains that the disease can be contracted at any time of the year.

Some people confuse malaria with dengue fever. What is the difference?

The first thing to do is to go to a health center for a consultation as soon as you feel unwell.  Depending on the signs you present, the health worker will do what is necessary to diagnose what you have.But be careful, you can have both diseases at the same time.Malaria is a parasitic disease, and there is an effective cure.Dengue fever, on the other hand, is a viral disease and its treatment is symptomatic.

What are the symptoms of dengue fever?After infection, the disease evolves in 3 phases: first, a febrile phase: fever (39-40°C) with generalized pain (headache, retro-orbital pain, joint muscle pain), rash, mild hemorrhagic signs, nausea and vomiting.  This is followed by what is known as the critical phase, from day 4-5, when a drop in fever is observed. In the majority of cases, patients will recover and progress towards convalescence; but others will progress towards severe forms with organ damage (renal, hepatic, neurological, pulmonary, haemorrhagic...), most often fatal.

Finally, the convalescence phase: during this phase, the general condition improves, appetite returns, vital signs normalize and generalized itching appears.

How can this disease be treated?

There is no cure, but there is symptomatic treatment. Symptomatic treatment is enough to save the patient, which is why early consultation is essential to detect and prevent complications.

How long does treatment for dengue fever last?

This will depend on the duration of symptoms; on average 4 to 5 days if the patient is seen at the start of the illness.However, it's the convalescence period that is long and characterized by fatigue.

Is it fatal? It is usually benign, if treated early and appropriately. For unknown reasons, however, some people develop serious, life-threatening complications.

In some children, for reasons that remain unclear, the clinical picture of dengue fever can evolve into two serious forms: dengue hemorrhagic fever, and dengue fever with shock syndromes, which is fatal. The haemorrhagic form of the disease, which accounts for around 1% of dengue cases worldwide, is extremely severe: fever persists and multiple haemorrhages, notably gastrointestinal, cutaneous and cerebral, often occur. In children under 15, however, hypovolemic shock can set in (chills, clammy skin and an imperceptible pulse signalling circular failure), leading to abdominal pain and, without perfusion, death.

What is the epidemiological situation of the disease in Togo?

 In Togo, the Ministry of Health has announced health investigations following several cases of dengue fever.These cases have been reported in a scattered manner, with five cases in the maritime region in the south, one in the Plateaux region, and two in the Savanes region in the far north. Investigations are underway to identify any cases in the community, with a view to early treatment.

 How to prevent dengue fever?

 Prevention involves cleaning up the living and working environment.Individual prevention involves avoiding the bites of the mosquito that carries dengue fever:using repellent creams/sprays every 4 hours and wearing long clothing, installing anti-mosquito screens on doors and windows and using anti-mosquito twists during the day (living rooms and verandas), sleeping under a mosquito net impregnated with long-acting insecticide, killing adult mosquitoes by spraying bedrooms, under beds and in wardrobes with insecticides.

Mosquito larvae control with the help of the community; this is vector control, which consists of limiting the mosquito population by eliminating mosquito breeding grounds such as containers of all kinds exposed to rain and sun (cans, bottles, tires, pots...), as they constitute warm, stagnant water reserves conducive to the development of mosquito larvae. Pour out flowerpot saucers, cover drinking-water storage containers, cover garbage cans and keep rubbish dumps away from people.We also need to sanitize the home and peri-domestic environment, adopt intra- and extra-domestic spraying and isolate patients in the viremic phase under mosquito nets and/or with the use of repellent cream (to prevent mosquitoes from becoming infected).

 Avoid self-medication and anti-inflammatory drugs, and go to a health center as soon as the first signs appear. Don't forget to inform and communicate with those around you.

Interview by Abel OZIH