RESURGENCE OF DENGUE IN THE PHIIPPINES
Submitted by:
Rolian Angelo R. Cagadas
Submitted to:
INTRODUCTION
Dengue fever is a mosquito-borne disease caused by dengue virus, prevalent
in tropical and subtropical areas. It is frequently asymptomatic; if symptoms appear they typically begin 3
to 14 days after infection. These may include a high fever, headache, vomiting, muscle and joint pains, and
a characteristic skin itching and skin rash. Recovery generally takes two to seven days. In a small proportion
of cases, the disease develops into severe dengue (previously known as dengue hemorrhagic fever or
dengue shock syndrome) with bleeding, low levels of blood platelets, blood plasma leakage,
and dangerously low blood pressure.Dengue virus has four confirmed serotypes; infection with one type
usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent
infection with a different type increases the risk of severe complications.The symptoms of dengue
resemble many other diseases including malaria, influenza, and Zika. Blood tests are available to confirm
the diagnosis including detecting viral RNA, or antibodies to the virus.There is no specific treatment for
dengue fever. In mild cases, treatment is focused on treating pain symptoms. Severe cases of dengue
require hospitalisation; treatment of acute dengue is supportive and includes giving fluid either by mouth
or intravenously.
The earliest descriptions of a dengue outbreak date from 1779; its viral cause and spread were
understood by the early 20th century. Already endemic in more than one hundred countries, dengue is
spreading from tropical and subtropical regions to the Iberian Peninsula and the southern states of the US,
partly attributed to climate change. It is classified as a neglected tropical disease. During 2023, more than
5 million infections were reported, with more than 5,000 dengue-related deaths.As most cases are
asymptomatic or mild, the actual numbers of dengue cases and deaths are under-reported.
In the Philippines, dengue is a major public health problem and is endemic in all regions of the
country. The country's outbreaks are largely seasonal, with most episodes occurring during the wet season
(June–February).The Philippines has made dengue a notifiable disease since 1958, has all four DENV
serotypes circulating and ranks among the countries with the highest number of dengue episodes in
southeast Asia. On average, 170,503 symptomatic DENV infections and 750 deaths were officially reported
to the Philippines Department of Health (DoH) annually from 2010 to 2014, i.e., an incidence of about 178
symptomatic dengue episodes per 100,000 population and a reported case fatality rate of approximately
0.44% (Philippines DoH, unpublished communication, September 2015).A recent review of the
epidemiology of dengue in the Philippines showed that the incidence rate of dengue was highest among
children of 5–14 years of age, with over 80% of dengue-related deaths occurring among individuals of less
than 20 years of age.
The societal disruption brought by the coronavirus disease 2019 (COVID-19) pandemic indirectly
affected the dynamics of various infectious diseases. Dengue fever, considered a major public health
problem in tropical countries such as the Philippines, is one of the diseases found to be significantly
affected. The decline in the incidence of dengue from March 2020 was strongly associated with public
health and social measures implemented by governments to limit the spread of COVID-19. These include
limitations of social gatherings, cancellation of face-to-face classes, increased work-from-home setups, and
community lockdowns. However, the recent lifting of lockdown restrictions and the gradual increase in
human mobility resulted in a 191% increase in dengue cases in the Philippines.
Philippines against dengue
One of the Philippine government programs is the National Dengue Prevention and Control
Program. This aims to eliminate dengue infection by properly implementing an integrated vector control
approach and simultaneously reinforcing the diagnosis, management, and surveillance of dengue cases.
The 5S strategy, the 4 o’clock habit, and the dengue fast lane are the three main campaigns of the
Department of Health to prevent dengue. The 5S strategy encourages communities to search and destroy
breeding sites, employ self-protection measures, seek early consultation, support fogging in hotspot areas,
and sustain adequate hydration. The 4 o’clock habit specifically refers to a stop, look, and listen approach,
whereby one drops whatever is being done to search and destroy mosquito breeding sites. Dengue fast
lanes in hospitals are put in place to ensure that suspected dengue patients are given immediate and
proper medical intervention. The government also introduced the Dengvaxia vaccine through mass
immunization campaigns in April 2016 to protect children from hospitalization and severe dengue.
However, these efforts turned out to be futile as new findings revealed that the dengue vaccine could
result in a higher risk of severe dengue infection to recipients without prior dengue infection. The
Dengvaxia controversy spawned a significant decline in vaccine confidence in the country. Nevertheless,
the culmination of efforts against dengue infection has resulted in a significant decline in dengue cases in
the country; with cases dropping from 430282 in 2019 to 59675 in 2020 and mortalities dropping from
1612 in 2019 to 231 in 2020[5]. The Department of Health claims that current activities and initiatives
against dengue, such as updating the Dengue Manual of Operations, partnering with tertiary hospitals, and
releasing administrative issuance lowered dengue incidence and mortalities. However, this must be taken
with a grain of salt because the emergence of COVID-19 in 2020 also significantly contributed to the
observed decline in dengue cases.
LIMITATIONS IN DENGUE RESPONSE IN THE PHILIPPINES
Despite the progress reported by the Department of Health in terms of prevention and control of
dengue during the COVID-19 pandemic, there is an alarming rise in dengue cases in the country at the
moment. Its alarming resurgence uncovers the presence of various lapses and barriers to healthcare. While
the COVID-19 pandemic laid bare the systemic healthcare inequities faced by millions of Filipinos, it has
ironically concealed the omnipresent lapses in our dengue response. This is primarily due to the health and
sociopolitical policies put in place to mitigate the spread of the COVID-19 pandemic. However, the
improving pandemic response, the diminishing fears of COVID-19 infection, and our slow return to the old
normal are slowly uncovering the gaps in our dengue response, paving the way for its subsequent re-
emergence in the Philippines.
CONCLUSION
Mitigating the resurgence of dengue relies heavily on controlling the vector that transmits it. The
key to the decline of dengue morbidity and mortality can be achieved by properly implementing existing
strategies and incorporating various modifications necessary as the country transitions to a new normal.
These strategies include: Proper implementation of the enhanced 5S-Strategy against dengue to protect
the population from mosquito bites and prevent the spread of dengue; Increase public awareness and
education through health campaigns; Strengthening of current surveillance and reporting systems to track
outbreaks, monitor disease trends, evaluate progress in morbidity and mortality reduction goals, and
consequently guide decision-making for quicker responses and better resource allocation; Promotion of
vaccine confidence through a coordinated, transparent, evidence-based education, and behavioral
intervention campaign; Allocation of health resources to cheap and simple dengue diagnostics like nucleic
acid amplification test-loop mediated isothermal amplification assay; Supporting research and projects like
the Wolbachia Project within Bicol-Center for Health Development to control dengue spread; and
Increasing capacity building by training healthcare providers, ensuring adequacy of medical supplies, and
improving healthcare facilities’ capacity to diagnose and treat dengue promptly. While we are recovering
from the COVID-19 pandemic, we urge the government and relevant stakeholders to act hand in hand in
transitioning to a new normal, without sacrificing all the progress that has already been made concerning
dengue control and eradication.
