The mosquito-borne disease, once largely confined to Dhaka, is spreading across the country as increased rainfall and heat cause cases to increase fivefold in a year, with young people being hit the hardest.
All through Fabeha Monir for WHO
In a small, dimly lit control room at the Directorate General of Health Services (DGHS) in Dhaka, data on Bangladesh’s dengue outbreak flashes across multiple computer screens. Government analysts here have been busy collecting and monitoring the impact of the disease across the country since cases were first reported last April.
In 2023, the total reported cases of dengue numbered 321,179, with 1,705 deaths recorded, a massive jump from the year before, when 62,000 people were known to have had the virus, and 281 died. It was the highest number of annual deaths caused by the mosquito-transmitted disease ever recorded in Bangladesh.
Last year’s deaths affected at least 113 young people. According to Save the Children, most of those deaths occurred among children under the age of 10, with 38 deaths among those under the age of five.
“Children account for around 30% of all dengue cases in Bangladesh and are vulnerable to the virus due to their underdeveloped immune system,” says Dr Shamim Jahan, national director of Save the Children in Bangladesh. “Children under five years old are at risk for serious symptoms, such as dehydration and shock. “
In months, emerging cases have pushed Bangladesh’s fitness formula to the limit, with hospital corridors saturated with patients and wards without beds.
“This is the deadliest dengue outbreak ever seen,” says Dr. Mohammad Shafiul Alam, a scientist at the ICDDR,B Health Research Centre in Dhaka.
The increased number of deaths continued into the new year. As of Wednesday, the outbreak had affected another 756 people so far this month, resulting in 10 deaths, compared to 424 cases and 3 deaths in the same period last year.
However, the official figures may not give a true indication of the scale of the outbreak. “These reported figures are likely an underestimation of the actual burden,” says Alam. “Numerous healthcare facilities in Bangladesh operate beyond the reporting framework. This underscores the likelihood that the actual figures could be several times higher.”
Dengue cases have been on the rise especially around the world, with 70% of them occurring in Asia. Globally, the World Health Organization (WHO) estimates that 3. 9 billion people (part of the world’s population) are at risk of infection. Half a million cases were reported in 2000, up from 4. 2 million in 2022, an eight-fold increase.
The increasing frequency of extreme weather events is driving the spread of the disease to new places and prolonging dengue seasons in countries where the disease is already present.
In Bangladesh, unusually heavy rainfall, combined with warmer temperatures and peak humidity, has led to an increase in the mosquito population across the country. “Climate substitution is the key link to the increase in numbers we’re seeing,” says Alam.
In Mirpur, a district northeast of Dhaka, Masuma Begum cares for her nine-month-old daughter Sohana, who has contracted dengue fever and sleeps under a ventilator. “He doesn’t have the strength to get up and play anymore,” Begum says. “It’s been over 4 weeks and he’s still getting better. “
Outside your home, an open drain and overgrown yard create an ideal breeding ground for mosquitoes.
“We can’t afford to admit her to hospital so I’ve been doing whatever I can to protect her at home,” says an exhausted Begum, who has not left her daughter’s side since she fell ill. “I’ve been using repellent and mosquito spray to keep the bloodsuckers at bay – but they still manage to get inside.”
Bangladesh has experienced frequent outbreaks of dengue fever over the past two decades. Still, the recent outbreak has been surprising: Not only has a build-up of cases begun beyond the usual (cases typically begin between the June to October monsoons), but the disease has also spread beyond its concentration in Dhaka and Chattogram (or Chittagong, as the term suggests).
“In 2022, the city of Dhaka accounted for 63% of cases, while in 2023, 66% were reported outside Dhaka,” says Alam. “Now dengue is being reported in all 64 districts of the country. “
In response, the DGHS has repurposed six hospitals in Dhaka allocated to Covid-19 patients to control the dengue outbreak and increased the supply of intravenous saline and other medicines across the country.
For many of Bangladesh’s urban poor, the cost of contracting dengue has added to the burdens on their households.
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Sumon Miah, 28, has spent most of the past few weeks recovering under a flimsy mosquito net. After contracting dengue, he was unable to work and was fired from his job at a facility. “I couldn’t take days off, but my health was too bad to go,” Miah says. “After 10 days, they let me go. “
His wife, Kolpona, a cleaner, had to work around the house to take care of him and their two-year-old son, but she too lost her job.
“I don’t know how we are going to cope,” sighs Miah. “We have no savings and with the money we’ve spent on medicine, there’s not enough left to cover groceries and rent.” The stress is worsening Miah’s already poor health.
Miah likely contracted the virus at work. The puddles of drinking water discovered in the structures are an ideal breeding ground for Aedes mosquitoes, the main vector (or transmitter) of dengue in Bangladesh.
Last July, Dhaka municipalities began fining owners of structures that allowed mosquitoes to proliferate on their premises. The local government minister warned that structure paintings would stop if dengue larvae were discovered for the third time at the site of a structure.
Most likely, the challenges will persist this year. Experts warn that more needs to be done against mosquitoes and giant outbreaks must be avoided.
“Bangladesh has good enough policies to treat dengue patients,” says Alam. “However, there is a pressing need to increase investment to strengthen fitness infrastructure, especially at the sub-district level.
He added that no vaccine has yet been shown to be effective against all four variants of the dengue virus, so it is imperative to how the virus spreads. “All four have been recorded in Bangladesh at other times since 2000. “he says.
Referring to reports of success in releasing inflamed Aedes aegypti mosquitoes with a bacterium that prevents their eggs from hatching, Alam says, “Implementing built-in vector control at the national level is crucial, while exploring cutting-edge approaches, such as the Wolbachia-inflamed Aedes mosquito. “mosquitoes. “
At the Jurain cemetery, Mohammad Ismam prays at a new grave. She mourns her aunt, who died of dengue. ” She was very pregnant and gave birth any day,” says Ismam.
“His sudden death came as a surprise to our entire family. Before she contracted the virus, she was perfectly healthy.
Ismam, who works in a small shop in the old Dhaka, laments the lack of management of the situation. “It turns out that everyone has been affected in one way or another,” he says. “I myself got fired up a year ago. It never goes away and only gets worse.