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Published on August 28, 2007

Public health authorities must strike a delicate balance between prevention of an epochal flu pandemic that has not happened and seasonal outbreaks of diseases like dengue fever which kill many every year. As Thailand and other countries in Southeast Asia have braced themselves against an "impending" bird flu epidemic that has yet to arrive, the region has, since the beginning of this year, been ravaged by a particularly lethal outbreak of dengue fever, the worst in almost a decade. Over 1,000 out of hundreds of thousands of people infected by the deadly virus borne by the Aedes aegypti mosquito have died so far this year.

According to the World Health Organisation, the number of cases in many countries, including Thailand, has already exceeded the total for 2006 and is expected to match the level of 1998 - the worst year on record, when 1,500 people died out of 350,000 infected. In Thailand, the number of people infected in the first seven months of this year was 32,082, of which 33 died, which has made dengue one of the deadliest contagious diseases this year. In the same period last year, 29 out of 24,490 people infected had died.

So far dengue outbreaks have been reported in 62 out of Thailand's 76 provinces. The Public Health Ministry has been doing a good job in deploying more than 1,500 teams of health officials and volunteers to monitor outbreaks and carry out measures to contain the spread of the disease, including fumigation and getting rid of breeding grounds.

What makes dengue particularly difficult to contain is the mosquito that carries the virus multiplies in clean water anywhere, outdoors as well as indoors. A spike in dengue incidences usually occurs during the rainy season as puddles, discarded plastic bags or tin cans become breeding grounds. In the household, uncovered water containers and vases also pose potential risk as larvae can turn into mosquitoes in a matter of days. The Health Ministry says about 80 per cent of people infected with dengue in this country are bitten by Aedes mosquitoes inside their own homes.

According to health authorities, people infected with milder forms of dengue may not realise they have the disease because of flu-like symptoms including fever and joint pain. In more severe cases, victims develop rashes, feel nauseous and have headaches. In the worst scenario, patients develop potentially fatal dengue haemorrhagic fever, which causes severe internal bleeding and circulatory failure. The disease is curable and most of those infected will recover if they are correctly diagnosed and undergo treatment in time. No vaccine has been found for any of the four dengue strains.

Although the Public Health Ministry is running an efficient network to monitor and control outbreaks, more needs to be done, particularly to educate the public about the menace of dengue and how to control the outbreaks.

Some health experts blame the rise in the number of dengue fever outbreaks to rapid urbanisation in Southeast Asia, which led to a proliferation of slums and shanty towns with no running water. Without running water, people have to store water in their household containers, which are either left uncovered or inadequately covered and therefore become breeding grounds for dengue-carrying mosquitoes.

The Health Ministry must redouble its effort to bring this dangerous and contagious disease under control by effective use of its available manpower and resources, much of which have been geared toward the prevention, monitoring and containment of higher-profile diseases such as bird flu. There is no reason why the ministry's manpower and resources should not be made more flexible so that each of the thousands of units within its network is able to be equipped and trained to handle all sorts of outbreaks of contagious diseases.

The ministry must also prioritise and strike a delicate balance between the need to stay on guard against a panic-inducing flu pandemic, which has the potential to kill millions worldwide but which happens only every once in a long while, and seasonal diseases like dengue fever and malaria which happen every year and can kill, over years, a considerable number of people whose lives could otherwise be saved for want of a good system in place to deal with them efficiently.