Published Date: 2007-10-19 23:50:00
Subject: PRO/MBDS> Dengue - Cambodia (06)
Archive Number: 20071019.3413
DENGUE - CAMBODIA (06)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 18 Oct 2007
Source: Reuters [edited]
Dawn has not yet broken but already more than 1000 sick children
queue outside a hospital in Phnom Penh in a desperate wait to get
treatment for dengue, a mosquito-borne disease taking a heavy toll on
Dengue -- which causes fever, headaches and agonising muscle and
joint pains -- has killed 389 people in Cambodia this year ,
nearly all of them children, in what is believed to be one of the
worst outbreaks in years.
Outside the hospital, waiting children lie on reed mats on the
ground, their arms hooked up to saline drips hanging from the trees.
Dengue has infected more than 38 000 people in Cambodia so far this
year , government figures show. "Every day, every 10 minutes, a
child is arriving in shock, without a pulse, and with no blood
pressure," said Beat Richner, a Swiss doctor and founder of 4
donor-funded hospitals in the war-scarred Southeast Asian nation.
In all, his clinics can treat 900 infants, but it is not enough.
"More will die as the dengue continues to spread," he said.
There is no vaccine for dengue but even if a treatment existed, the
Health Ministry, which has an annual budget of USD 3 for each of
Cambodia's 13 million people, would struggle to afford it.
Instead, the Health Ministry focuses its efforts on prevention,
telling people in towns and villages to use mosquito nets, keep an
eye on their children, burn rubbish and not allow pools of stagnant
water, where the insects breed, to collect.
"We can change lots of things, but changing people's behaviour is
hardest of all," said Ngan Chantha, head of the ministry's
anti-dengue programme. "We tell them what to do, but as soon as we go
away, they revert to their old habits."
Many people disagree, saying it is impossible to keep an eye on
children when so many mothers and fathers have to work to provide for
their families in what remains one of the poorest countries in Asia.
"I am poor and can't afford a private clinic. Where should I go now?"
a 43-year-old [woman] shouted at the policemen keeping order at the
hospital gates as she covered her 7-month-old granddaughter with a
wet cloth to keep her cool. The child's mother is working in one of
the many garment factories around Phnom Penh, leaving parental duties
Even though dengue has always been a rainy season threat in the
tropical Southeast Asian nation, Richner said this year 
appeared to be the worst yet despite government and World Health
Organisation (WHO) campaigns.
He blamed the domestic and international authorities, which are
responding to higher-than-normal levels of dengue across the region,
for being slow to act even when it became clear in May that 2007 was
going to be a bad year. "That is very sad. It's a huge suffering for
the children," he said.
The WHO, United Nations Development Programme, Asian Development
Bank, and International Red Cross have all [contributed] to help
provide pesticides to kill mosquito larvae.
Richner's Kantha Bopha hospitals, which offer advanced medical
facilities to Cambodians for free, need USD 7 million a year to keep
themselves afloat, but the size of the dengue outbreak is already
causing them to eat into next year's  budget.
Furthermore, raising cash is becoming harder because of Western
preoccupation with diseases like bird flu, he said. "Bird flu is a
threat to the Western world, so they pour money and commitment into
that," he said. "But dengue? There's no threat to the United States
or Europe so nobody's interested."
[Byline: Ek Madra]
[In the last PRO/MBDS posting on dengue in Cambodia dated 30 Aug
2007, there had been reports of 34 542 confirmed cases with 365
deaths. According to the newswire above there are now reports of
"more than 38 000 cases" and 389 deaths attributable to dengue this
year (2007). This represents a significant increase since the last report.
Unfortunately, the newswire report presented above has taken a
sensationalist approach to the situation in Cambodia at the expense
of the government and the international agencies assisting the
country in disease control efforts and appears to be a strategy to
appeal to international private donors to support a local
non-governmental organization (NGO).
At present there is no commercially available vaccine to prevent
dengue virus infection. Hence, the only possible control measures
related to reducing the contacts between the vectors (_Aedes_ spp.
mosquitoes) and the human population. Main strategies for doing so
involve vector reduction strategies -- aimed at decreasing the
population of the vectors. This is done through mosquito
breeding-site elimination programs (reductions in standing water such
as in tires, vases, open plastic containers, etc.) This is also done
through the use of insecticidal approaches -- use of larvicides and
use of adult mosquito cidal agents. The other strategy is to
encourage the use of insect repellents, and to use impregnated bed
nets to reduce contact during the night (although the _Aedes_ spp.
tend to do their peak feeding during sun up and sun down periods of
the day... periods when people are not in their beds and would not be
using a bed net).
Hospitals do not prevent infections with dengue virus (the morbidity
due to infection) other than to provide educational messages on how
to prevent infection with the virus. They do provide supportive
treatment for the complications that result from dengue virus
infections, and can help to reduce the mortality associated with
dengue virus infections.
For a map of Cambodia, see
for a map of Cambodia showing locations of other outbreaks in the
region, see the HealthMap/ProMED-mail map at
<http://healthmap.org/promed?v=12.7,104.9,5>. - Mod.MPP]