|Year : 2017 | Volume
| Issue : 1 | Page : 3-8
Journey of dengue in Rajasthan in the last 15 years (2001-2015) with special reference to 2015
Monika Rathore, Amita Kashyap, Priyanka Kapoor
Department of Community Medicine, SMS Medical College, Jaipur, Rajasthan, India
|Date of Web Publication||18-Jan-2017|
Dr. Priyanka Kapoor
Department of Community Medicine, SMS Medical College, Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
Introduction: Dengue is an underestimated and under-reported disease. We have analyzed the last 15 years data of dengue reported in Rajasthan with special reference to the year 2015 to assess the trends.
Materials and Methods: This observational, descriptive study was conducted during January 2016-August 2016. Secondary data were collected from Integrated Disease Surveillance Programme (IDSP) Cell, Directorate, Medical and Health, Jaipur, the website of National Vector Borne Disease Control Programme, Census 2011. Reports of P form and L form and line listing of dengue cases of 2015 were collected.
Results: Rajasthan had 1452 laboratory-confirmed cases in 2001 and 1850 in 2006 after a gap of 6 years. The next surge came only after 3 years gap. Recently, there was a fourfold increase (>4000 cases/year) during 2013 and 2015. There were substantial dengue deaths till 2009, but thereafter, it never crossed the figure of 10. Surprisingly five districts, i.e., Bhilwara, Chittorgarh, Jhalawar, Pali, and Sirohi, did not report a single case of dengue during 2015. There was fourfold increase in dengue cases but paradoxically fourfold decrease in malaria cases in the last 5 years.
Conclusion: Dengue was the new emerging disease with 1452 confirmed cases in Rajasthan in 2001. Thereafter, there was a constant high load of dengue; however, case-fatality rate is below one after 2010. Recently, there was a fourfold increase (>4000 cases/year) during 2013 and 2015. Zero reporting of dengue in a few districts indicates the need for improvement in IDSP reporting in these districts.
Keywords: Death, dengue cases, Rajasthan, trends
|How to cite this article:|
Rathore M, Kashyap A, Kapoor P. Journey of dengue in Rajasthan in the last 15 years (2001-2015) with special reference to 2015. Indian J Health Sci Biomed Res 2017;10:3-8
|How to cite this URL:|
Rathore M, Kashyap A, Kapoor P. Journey of dengue in Rajasthan in the last 15 years (2001-2015) with special reference to 2015. Indian J Health Sci Biomed Res [serial online] 2017 [cited 2019 Jul 17];10:3-8. Available from: http://www.ijournalhs.org/text.asp?2017/10/1/3/198572
| Introduction|| |
Dengue is a self-resolving infection that can lead to life-threatening condition., Even single outbreak of dengue is considered a "potential public health emergency of international concern" by the World Health Assembly. The burden of dengue is underestimated as majority cases are subclinical or mild although these subclinical cases are also important source for disease transmission.
Currently, two-fifth of the world's population is at dengue risk. There are 50-100 million cases globally, out of them five lac require hospitalization and 2.5% die every year., India has witnessed its first outbreak in Delhi in 1996, followed by constant surge of cases in hot and humid season every year. In very short time, it became endemic in 16 states: Andhra Pradesh, Goa, Gujarat, Haryana, Karnataka, Kerala, Madhya Pradesh, Maharashtra, Punjab, Rajasthan, Tamil Nadu, Uttar Pradesh, West Bengal, Chandigarh, Delhi, and Pondicherry., Thereafter, almost all major cities of India were hard hit by dengue. Rajasthan has experienced many dengue outbreaks in the past, i.e., Ajmer (1969), Beawar (1976), and Jalore (1985). There were many fold increase in dengue cases in the year 2015. Paradoxically, malaria cases reduced remarkably during the last 5 years although both are mosquito-borne. We have analyzed the last 15 years data of dengue reported in Rajasthan with special reference to the year 2015 to assess the trends.
| Materials and Methods|| |
This observational, descriptive study was conducted by the Department of Community Medicine, SMS Medical College, Jaipur, during January 2016-August 2016. Secondary data regarding number of dengue cases and deaths of the year 2001-2015 were collected from state Integrated Disease Surveillance Programme (IDSP) Cell, Directorate, Medical and Health, Jaipur. Weekly reports of P form and L form from all districts of Rajasthan and line listing of dengue cases of the year 2015 were collected and analyzed. Data were also obtained from the website of National Vector Borne Disease Control Programme. Census 2011 is used for population base. All data obtained were entered into Microsoft Excel software and analyzed. Count data were presented in the form of proportions. Line diagram was used to depict time trends. Spot map was used for geographical distribution. Difference in proportions was analyzed using Chi-square test. The level of significance was kept 95% for all statistical analyses.
| Results|| |
Emergence of dengue
There was a sudden unexpected reporting of large number of fever cases, with decreased platelets, bleeding tendency, and shock in the year 2001. On investigation, dengue was diagnosed and was labeled a new emerging disease of India. Rajasthan had 1452 laboratory-confirmed cases in 2001. Then again there were 1850 cases in 2006 after a gap of 6 years. The next surge came only after 3 years gap. Thereafter, there was a constant high load of dengue in Rajasthan. Recently, there was a fourfold increase (>4000 cases/year) during 2013 and 2015 [Figure 1].
Rajasthan has seen 37 deaths in 2001 and 26 in 2006. There were substantial dengue deaths till 2009, but thereafter, despite many fold increase in number of dengue cases in 2013 and 2015, it never crossed the figure of 10 [Figure 2]. Free dengue diagnostic kits and past experience for detecting and treating dengue helped treating doctors to reduce deaths.
Highest (2.40) case-fatality rate (CFR) was seen in 2004. It remained constantly low after 2010 and lowest (0.17) was seen in 2015 [Figure 3]. The decrease in CFR might be due to better healthcare facilities, health awareness, early case detection and treatment, and better planning and implementations.
Dengue versus malaria in Rajasthan in the last 5 years
There was fourfold increase in dengue cases but paradoxically fourfold decrease in malaria cases at the same time, i.e., when malaria is reducing, dengue is increasing, while both are mosquito-borne diseases, though of different types [Table 1]. We ought to analyze vector density indices and investigate vector control measures done in field. Artificial collection of water, for example, coolers and water pots for birds, has increased dengue many folds even in rural areas.
Data showed lesser dengue death/10 lakh in Rajasthan as compared to India (2011-2015) [Table 2].
|Table 2: Comparative analysis of dengue in India and Rajasthan (2011 - 2015) |
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Geographical distribution of cases (2015)
Only laboratory-confirmed dengue cases of 2015 were analyzed for this distribution. Majority of cases were confined to eastern part of Rajasthan, for example, Kota (1327), Jaipur (853), Baran (262), Ajmer (218), Bharatpur (200). Other moderately affected districts were Alwar, Bundi, Karauli, and Dausa. Northern Rajasthan had very few cases (<50), except district Sri Ganganagar (89). There were five districts with nil reporting, for example, Jalore, Sirohi, Pali, Pratapgarh, and Banswara [Figure 4].
CFR was highest in infants (4.35), followed by >65 years age group (3.77). Seventy percent cases reported were male (P = 0.000). CFR was almost equal in male (0.18) and female (0.16) [Table 3]. CFR is more in urban area (0.22) as compared to rural (0.09) [Table 4].
|Table 4: Distribution of dengue cases in urban versus rural areas (2015) |
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Reporting of dengue cases starts increasing from July onward and peaked in September and October [Figure 5]. It shows a clear seasonal trend. There was exponential increase (>63,000) in dengue cases in 2015. Ajmer, Kota, Udaipur, and Tonk bore the highest burden, followed by Jaipur, Rajsamand. Surprisingly, five districts, i.e., Bhilwara, Chittorgarh, Jhalawar, Pali, and Sirohi, did not report a single probable case of dengue in their "P" form during 2015 although laboratory-confirmed cases were reported from these districts, except Pali and Sirohi district [Table 5]. It further indicates that doctors avoid reporting probable cases of communicable diseases.
|Figure 5: Seasonal distribution of probable dengue cases in Rajasthan 2015|
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|Table 5: District-wise probable and laboratory-confirmed cases of dengue reported in 2015 |
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| Discussion|| |
Underestimation and under-reporting of dengue are due to its subclinical or mild presentation in most cases. It is routinely reported as "pyrexia of unknown origin," i.e., easy to label. It was also observed that doctors avoid writing presumptive diagnosis of dengue and other communicable diseases as it brings accountability of carrying out control measures in the area.
We observed that majority cases were young (19-25 years), similarly various studies of Delhi and Pakistan,, also observed maximum cases in 21-30 years. While Bandyopadhyay et al. and Karnataka study observed more cases in lower age group (11-30 and 14-30 years respectively) and Rathore et al. reported little older (31-40 years) age group. Majority (70%) were male in our study; consistent to Faisalabad, Pakistan (71%), and North Karnataka (58.2%). Our study observed that almost one-third cases were from rural areas also, similar (38%) to Faisalabad, Pakistan study. Although dengue was considered a disease of urban areas, availability of cooler and prevalent water pots for birds kept anywhere may be the reason for its spread in rural areas also. CFR was highest in infants (4.35), followed by >65 years age group (3.77) as these age groups are most vulnerable. Almost equal CFR was observed in male (0.18) and female (0.16). CFR was more in urban area (0.22) as compared to rural (0.09). CFR remained continuously low after 2010. It remained <1 after 2010. This might be due to better healthcare facilities, health awareness, early case detection and treatment, and better planning and implementations. The CFR of dengue in Rajasthan was constantly low (<1%) after 2010 although it remained above 1% during epidemics in India. In our study, dengue cases were reported mostly in September and October similar to the studies done previously., A study done in Kolkata in 2012 revealed that cases started reported even in August and remained till November. The reason of this peak in this season may be due to increased vector transmission in monsoons and postmonsoon season as this environment favors growth of mosquitos.
| Conclusion|| |
Dengue was the new emerging disease of India in 2001, with 1452 confirmed cases in Rajasthan. It took 6 years for the next outburst with 1850 cases in Rajasthan in 2006. Then, next surge came only after 3 years gap. Thereafter, there was a constant high load of dengue; however, CFR is below one after 2010. Recently, there was a fourfold increase (>4000 cases/year) during 2013 and 2015.
The paradox of rise of dengue when malaria is decreasing in recent years needs to analyze vector density indices and investigate vector control measures done in field.
Zero reporting of dengue in a few districts indicates the need for improvement in IDSP reporting in these districts.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]