Dr. Sher Bahadur Pun, infectious diseases expert at Sukraraj Hospital Specialized in Tropical and Infectious Diseases (STIDH, for Sukraraj Tropical and Infectious Disease Hospital) from Kathmandu, says he felt “helpless” when a tsunami of patients suffering from high fever, headaches and body aches suddenly descended on the hospital’s outpatient department in 2022.
Normally, 70 to 100 patients arrive daily. But when the dengue epidemic began, this figure rose to around 1,000 patients per day.
With the hospital’s available human and other material resources, it was almost impossible to handle an influx that amounted to almost ten times the capacity of the health facility. With indoor spaces saturated, doctors and nurses began providing outpatient services outside the hospital, Dr. Pun recalls. Working hours stretched until late in the evening.
The hospital’s inpatient department was also short of capacity. The intensive care beds were all occupied and the general ward patients were placed on mats on the floor.
“With indoor spaces saturated, doctors and nurses began providing outpatient services outside the hospital. »
– Dr Sher Bahadur Pun, infectious diseases expert at Sukraraj Specialized Tropical and Infectious Diseases Hospital (STIDH) in Kathmandu
The city’s private hospitals fared little better. Dr. Bishad Dahal, now a third-year internal medicine resident at the Kathmandu Medical School, had just started his internship in 2022 when dengue swept through the Kathmandu Valley. He remembers going to the hospital at 5 a.m. to take care of patients admitted for dengue fever, finishing his rounds at 9 a.m., then going to the outpatient department to take care of other suspected cases of dengue fever until 5:00 p.m. Then his rounds with admitted patients would resume. Until the winter season started and case numbers dropped, his workday ended between 9 p.m. and 10 p.m., he said.
For health workers in Nepal, difficult memories of the 2022 outbreak are brought back every monsoon: the country has experienced large-scale dengue outbreaks during the rainy season every year since.
Dengue fever in Nepal: when did it start? what is the situation at present?
The first case of dengue infection in Nepal was reported in 2004. A Japanese traveler had come to Nepal for vacation and was believed to have “imported” the mosquito-borne virus after contracting it in India .
Two years later, in 2006, 32 cases were reported in Chitwan district, in what was described as the country’s first indigenous outbreak.
For some years, dengue fever in Nepal was reported exclusively in the low-altitude Terai region, which shares a border with India.
According to reports released by the Nepal Epidemiology and Disease Control Division (EDCD, for Epidemiology and Disease Control Division), Nepal faced its very first major outbreak in 2010, with 917 cases and 5 deaths.
The next big wave of dengue cases occurred in 2013. By then, the infection had spread to 25 different districts in Nepal. The Aedes aegypti mosquito, which transmits the virus, is more common in tropical and subtropical climates, but as temperature norms have evolved, dengue has started to be reported even in the hilly and mountainous regions of the Himalayan country.
Until 2022, major outbreaks occurred every two to three years. But since 2022, the country has faced a rapid, seasonal annual increase in dengue cases – a growing concern for the health system.
Credit: Pragya Timsina
Every year, a new challenge
In a recent editorial published in the Kathmandu PostDr. Pun wrote that “the virus has become more complex and dangerous” over the years. But it is also difficult to predict the evolution of the virus.
Although the rate of transmission has greatly accelerated in recent years, this has not directly translated into higher mortality rates from year to year.
In 2022, when a total of 54,784 cases had been reported, the number of patients requiring admission to intensive care and hospital was very high. And the highest number of deaths to date – 88 deaths – was reported that same year.
In recent months, Nepal has been hit by some of the most devastating and widespread floods and landslides in its history.
This year, when dengue infections began to increase, hospitals also began preparing, anticipating more severe forms of dengue, because reinfection with a different serotype is usually more dangerous than the first.
But epidemiologists and clinicians have been surprised to find that even as the number of cases increases, the proportion of people with serious infection is falling. Dr. Sher Bahadur Pun called this year’s dengue wave “walking dengue” as the majority of patients appear to recover without needing hospitalization.
However, as of October 28, 12 verified deaths due to dengue had already been recorded, and the increase this year is only expected to fade in December.
Misfortune never happens alone
While researchers – and the World Health Organization – have indicated a link to climate change, dengue is not an isolated challenge.
In recent months, Nepal has been hit by some of the most devastating and widespread floods and landslides in its history. And this is due to massive rainfall. Once the rain stopped and affected communities began to recover and rebuild, the disease took over.
Ujjwal Timilsina, a 17-year-old student who was living in Kathmandu to pursue his higher education, first had a very high fever, reaching 39.4°C. His high temperature was accompanied by severe headaches and pain behind his eyes.
Then, one after the other, all of his roommates showed similar symptoms. Ujjwal had had dengue fever a year before, so he quickly recognized its symptoms. He took paracetamol and decided to wait.
But after two days, he was admitted to the hospital with uncontrollable vomiting, difficulty breathing and nosebleeds. Many people in his locality – which had been affected by flooding over the previous month – had similar symptoms.
Although dengue can take unexpected turns, the general trend is predictable. The monsoon season lasts from June to August, and soon after, dengue cases begin to increase. This is probably linked to the fact that the mosquito vectors breed in waterlogged ditches and ponds.
The spread of infection has also been more pronounced in urban areas and major cities like Kathmandu, Biratnagar, Chitwan and Pokhara, than in rural areas of the country.
The battle against the virus
But the virus is not the only one to evolve. Each year, Nepal becomes better equipped to prepare for the wave’s imminent arrival. Dr Gokarna Dahal, Section Head at the Vector-Borne Disease Control Section of the EDCD, told VaccinesWork : “Learning from past mistakes, this year we prepared well and in a more timely manner than before. »
A massive ‘mosquito find and destroy’ program has been undertaken in many local government areas. Health facilities were well prepared, stockpiling medicines and rapid diagnostic kits, and staff receiving additional training in the run-up to the monsoon.
The main goal is to prevent people from becoming infected. But in case they get sick, this time, the government is well prepared to deal with the epidemic, says Dr. Dahal.
