In Cambodia, cases of dengue decrease in Takeo hospital but efforts to control outbreak must continue

The shortage of blood for transfusions, needed in case of complications, is also a concern.
© Christopher Peskett / MSF Dengue is an infectious disease transmitted by mosquito bite and caused by four different types of viruses. Symptoms include muscle pains, high fever, nausea and intense joint pains. Dengue haemorrhagic fever is a more severe form. Bleeding and shock can occur and are potentially lethal if not treated, particularly in children. There is no specific medicine for the disease but early diagnostic and treatment can prevent complications and death. The World Health Organization estimates there may be around 50 million cases of infection worldwide each year The number of children admitted to the Takeo Provincial Hospital, in southeast Cambodia where MSF is helping fight an outbreak of dengue, has slightly decreased. Admissions have fallen from an average 200 patients per week to 125 this week. "We've seen an encouraging drop in the number of admissions but it is too early to say if these results are significant," said Philippe Berneau, MSF Head of Mission. "Health authorities at provincial level must step up their prevention campaigns; still too many children die because they are brought to the hospital too late." Seven children died in Takeo, mainly from dengue shock syndrome or dengue haemorrhagic fever, the most severe form of the disease. "The central health authorities have just produced information leaflets in Khmer language, but at provincial level the response has been slow and the leaflets still have not been distributed here," said Berneau. The shortage of blood for transfusions, needed in case of complications, is also a concern. "We have convinced families to give blood but it remains difficult to get enough," explained Philippe Berneau. "There should be campaigns to raise awareness of the importance of donating blood." Since the onset of the outbreak, MSF has worked closely with the ministry of health, sending additional doctors and nurses and providing medical supplies such as syringes, rehydration kits and infusions. MSF has recruited a doctor with intensive experience in dengue to help the hospital provide a 24-hour supervision of patients. "The staff felt uneasy about keeping children with complications and would refer them to Phnom Penh hospital, but finding transport was often a problem," said Berneau. Today, more children can be treated immediately in Takeo hospital. MSF teams have assessed four other districts of the province - Bati, Kirivong, Ang Roka and Prey Kabas - and found a stable situation. Dengue is endemic in Cambodia but the hospital was taken by surprise in June when the outbreak hit the country much earlier than in previous years. Official figures for Cambodia reveal a much more severe epidemic than normally, with a total of nearly 15,000 cases recorded by July 2007 against 16,600 cases for the whole of 2006. The outbreak also proved more lethal with a death toll of 182 by July 2007 against 158 for the whole of 2006.