Like many hospitals all over the country, Phnom Penh's Kantha Bopha has had a dramatic increase in patients, resulting in a lack of space on July 3.
A tiny girl lies lifeless in the intensive care unit of Angkor Hospital for Children,
her six-year-old body breathing only with the aid of a machine. Her family is soon
escorted to a private room where a doctor must explain that dengue shock has caused
massive brain damage -nothing more can be done, and in a few moments their daughter's
life support will be shut off. As she took her last breaths on July 4 she became
the 174th victim of dengue fever in Cambodia this year. Today the death toll is at
182, and rising.
Hospitals countrywide continue to be swamped with dengue patients. Dr. Varun Kumar
has been working for months with Cambodian doctors in rural provinces, and he expects
the situation to worsen over the next few months. A peak in dengue infections generally
occurs in July and August and recedes around October, Kumar said.
But this year, the first cases were reported in January, and now an escalating outbreak
has led to the highest number of severe dengue infections ever reported by this time
in the year.
According to Dr. Ngan Chantha, deputy director of the National Malaria Center and
National Dengue Program Manager, there have been 14,986 cases of dengue, causing
182 deaths, so far this year. At the same time point in 2006, there were 4,308 cases
and 58 fatalities. For all of last year there were 16,649 cases and 158 deaths.
In May, the Angkor Hospital for Children in Siem Reap, where the population percentage
of dengue infections is the highest, treated 219 cases compared to 10 for the same
time period in 2006. In June, dengue numbers reached 723 cases, 678 more than last
year-a staggering 94 percent increase.
Cambodia's four Kantha Bopha children's hospitals reported 7,120 severe dengue cases
in June. The hospitals' director told the Post that 90 percent of child dengue patients
would die without hospitalization. Kantha Bopha medics now test some 600 blood samples
for dengue infection every day, the director said.
The 60-bed Kirivong Referral Hospital in Takeo province has already seen 315 dengue
cases in the past two months, according to Dr Robert Overtoom of the Swiss Red Cross.
Ang Roka Referral Hospital, also in Takeo, treated 100 new patients in the first
week of June and has converted their HIV/AIDS building into a ward for a overload
of dengue patients, Overtoom said.
"There is no specific treatment for dengue and effective vaccines can only be
expected in 5-10 years time," said Overtoom. "Intensive supportive and
nursing care is the most important aspect of management, so the nursing staff in
both hospitals work around the clock."
The dengue fever virus is spread by the female Aedes aegypti mosquito, commonly known
as the tiger mosquito because of its stripes. The tiger mosquito, also the main carrier
of yellow fever, feeds primarily in the day, and unlike malaria carrying mosquitoes,
prefers to breed in dirty water. It is more prevalent in urban areas where old containers,
water-filled garbage and old tires often litter the ground.
There are four serotypes, or strains, of the dengue virus. An infection with a particular
strain provides lifetime immunity. According to experts, this year the circulating
strain of dengue in Cambodia has changed from DEN-2 to DEN-3, leaving no one immune.
Overtoom said a second infection with a different strain of the virus often results
in a more severe and prolonged illness. He said the body attempts unsuccessfully
to fight the virus with antibodies from the previous infection.
This commonly results in more serious manifestations of the virus -dengue hemorrhagic
fever or dengue shock syndrome-which can prove fatal, particularly in children.