Bangladesh’s worst ever dengue epidemic is putting pressure on hospitals

IIn a small, dimly lit control room at the Directorate General of Health Services (DGHS) in Dhaka, data on Bangladesh’s dengue outbreak flashes across multiple computer screens. Government analysts here have been busy collecting and monitoring the impact of the disease across the country since the first cases were reported last April.

The total in 2023 reported cases of dengue fever reached 321,179, with 1,705 deaths recorded, a huge jump from the previous year when 62,000 people were known to have the virus, and 281 died. It was the highest number of annual deaths from the mosquito-borne disease ever recorded in Bangladesh.

Last year’s deaths were at least included 113 children. According to Save the Children, the majority of these deaths involved children under the age of ten, with 38 deaths among those under the age of five.

“Children make up about 30% of all dengue cases in Bangladesh and are particularly vulnerable to the virus due to an underdeveloped immune system,” said Dr. Shamim Jahan, director of Save the Children in Bangladesh. “People under the age of five are particularly at risk of developing serious symptoms, such as dehydration and shock.”

In recent months, a surge in cases has pushed Bangladesh’s healthcare system to its limits, with hospital corridors overflowing with patients and wards running out of beds.

“It is the deadliest outbreak of dengue the country has ever seen,” said Dr. Mohammad Shafiul Alam, a scientist at the ICDDR, B health research center in Dhaka.

The high death toll has continued into the new year. The outbreak had consequences from Wednesday 756 people so far this month, resulting in 10 deaths, compared to 424 cases and three deaths this time last year.

However, the official figures may not provide a true indication of the scale of the outbreak. “These reported figures are likely an underestimate of the actual burden,” says Alam. “Numerous healthcare institutions in Bangladesh operate outside the reporting framework. This underlines the likelihood that the actual figures could be many times higher.”

Have dengue cases increased dramatically worldwide, of which 70% occur in Asia. Globally, the World Health Organization (WHO) estimates that 3.9 billion people – or half the world’s population – are at risk of becoming infected. Half a million cases were reported in 2000, compared to 4.2 million in 2022: almost an eightfold increase.

The increasing frequency of extreme weather events is fueling the spread of the disease to new locations and prolonging dengue seasons in countries where the disease is already present.

In Bangladesh, unusually high rainfall, combined with warmer temperatures and high humidity, has resulted in an increase in the mosquito population across the country. “Climate change is the crucial link in the increase in numbers we are seeing,” says Alam.

In Mirpur, a district in northeastern Dhaka, Masuma Begum watches over her nine-month-old daughter Sohana, who has contracted dengue and is sleeping under a fan. “She no longer has the strength to get up and play,” says Begum. “It’s been over four weeks and she still hasn’t gotten better.”

Outside their home, an open drain and a weedy yard create a perfect breeding ground for mosquitoes.

“We can’t afford to hospitalize her, so I did everything I could to protect her at home,” said an exhausted Begum, who has not left her daughter’s side since she fell ill . “I have used insect repellent and mosquito spray to keep the leeches at bay – but they still manage to get in.”

Bangladesh has seen regular outbreaks of dengue over the past two decades. Yet the recent outbreak has been surprising: not only did the increase in cases start earlier than normal (usually cases begin during the monsoon from June to October), but the disease has also spread beyond its previous concentration in Dhaka and Chattogram (or Chittagong, as it is better known).

“In 2022, Dhaka city accounted for 63% of cases, while in 2023, 66% were reported outside Dhaka,” Alam said. “Now dengue is being reported from all 64 districts of the country.”

In answerDGHS has repurposed six hospitals in Dhaka assigned to Covid-19 patients to control the dengue epidemic, and increased the supply of intravenous saline and other medicines across the country.

For many urban poor in Bangladesh, the cost of contracting dengue has increased the burden on their households.

Sumon Miah, 28, has spent most of his recovery in recent weeks under a thin mosquito net. After contracting dengue, he was unable to work and was fired from his job at a construction site. “I couldn’t afford to take a day off but was too sick to go in,” says Miah. “After ten days they let me go.”

His wife Kolpona, a maid, had to stay home to care for him and their two-year-old son – but then she too lost her job.

“I don’t know how we’re going to make it,” Miah sighs. “We have no savings and the money we spent on medicine doesn’t leave enough to pay for groceries and rent.” The stress worsens Miah’s already poor health.

Miah probably contracted the virus at work. Pools of stagnant water often found at construction sites serve as prime breeding grounds for the mosquito genus Aedes, the main vector (or transmitter) of dengue in Bangladesh.

Last July, Dhaka’s municipal councils began fining building owners that allowed mosquitoes to multiply on their property. The Minister of the Interior warned about this construction work would be stopped when dengue larvae are found on a construction site for the third time.

The problems are likely to persist this year. Experts warn that much more needs to be done to control mosquitoes and prevent major outbreaks.

“Bangladesh has an adequate policy for treating dengue patients,” Alam said. “However, there is an urgent need to increase investments in strengthening healthcare infrastructure, especially at the sub-district level.

He added that no vaccine has yet proven effective against all four variants of the dengue virus, so controlling the spread of the virus was of utmost importance. “All four have been shot in Bangladesh at different times since 2000,” he said.

Referring to successful experiments with letting go Aedes aegypti mosquitoes infected with a bacterium that prevents their eggs from hatching, Alam said: “Implementing integrated vector management nationwide is critical, while innovative approaches are explored, such as releasing Wolbachia-infected Aedes mosquitoesshould also be considered.”

At the Jurain cemetery, Mohamad Ismam prays for a new grave. He mourns his aunt, who died of dengue. “She was heavily pregnant and could give birth at any time,” says Ismam.

“Her sudden death was a shock to our entire family. Before she contracted the virus, she was completely healthy.”

Ismam, who works in a small shop in old Dhaka, describes his disappointment at the lack of management of the situation. “It seems like everyone has been affected in some way,” he says. “I myself became infected a year ago. It never goes away and it only seems to get worse.”