Dengue is a mosquito-borne viral disease that has rapidly spread in all regions of WHO in recent years. Dengue virus is transmitted by female mosquitoes mainly of the species Aedes aegypti and, to lesser extent, Ae. Albopictus. Dengue is widespread throughout the tropics, with local variations in risk influenced by rainfall, temperature and unplanned rapid urbanization.
Severe dengue was first recognized in the 1950 during dengue epidemics in the Philippines and Thailand. Today, severe dengue affects most Asian and Latin American countries and has become a leading cause of hospitalization and death among children and adults in these regions.
Before 1970, only 9 countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries in the WHO regions of Africa, the Americas, South-East Asia and Western Pacific regions are the most seriously affected. Cases across the Americas, South-East Asia and Western Pacific exceeded 1,2 million in 2008 and over 3,34 million in 2016 (based on official data submitted by Member States). Recently the number of reported cases has continued to increase. In 2015, 2,35 million cases of dengue were reported in the Americans alone, of which 10.200 cases were diagnosed as severe dengue causing 1181 deaths.
Indonesia is reported as the second largest with dengue fever cases among 30 endemic countries. The number of cases of dengue fever is most prevalent in the provinces of East Java, West Java, and Central Java. Indonesia, with 25,75 million inhabitants and 17.500 islands spread across the equator, poses as the largest archipelago country in the world, comprising 3,1 million km2 of ocean (62% of the total area) with a coastline of 81.000 km and approximately 2 million km2 of land (38% of the total area). Its tropical climate and subsequent relative high humidity makes Indonesia favorable conditions for vector-borne disease transmission. The increasing trend of dengue infections over the current decades putting Indonesia as one of endemic area for dengue fever and tread both the people as well as travelers visiting the archipelago.
The Aedes aegypti mosquito is the primary vector of dengue. The virus is transmitted to humans through the bites of infected female mosquitoes. After virus incubation for 4-10 days, an infected mosquito is capable of transmitting the virus for the rest of its life.
Infected symptomatic or asymptomatic humans are the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes. Patients who are already infected with the dengue virus can transmit the infection (for 4-5 days; maximum 12) via Aedes mosquitoes after their first symptoms appear.
The Aedes aegypti mosquito lives in urban habitats and breeds mostly in man-made containers. Unlike other mosquitoes Ae. aegypti is a day-time feeder; its peak biting periods are early in the morning and in the evening before dusk. Female Ae. aegypti bites multiple people during each feeding period. Aedes eggs can remain dry for over a year in their breeding habitat and hatch when in contact with water.
Symptoms of Dengue
Dengue fever is a severe, flu-like illness that affects infants, young children and adults. These are a few kinds of dengue:
- Mild Dengue Fever
Dengue should be suspected when a high fever (40°C / 104°F) is accompanied by 2 of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands or rash. Symptoms usually last for 2-7 days, after an incubation period of 4-10 days after the bite from an infected mosquito.
- Dengue Hemorrhagic Fever
At first, symptoms of DHF may be mild, but they gradually worsen within a few days. As well as mild dengue symptoms, there may be signs of internal bleeding. A person with Dengue hemorrhagic fever may experience: bleeding from the mouth, gums or nose; clammy skin; damage to lymph and blood vessels; internal bleeding, which can lead to black vomit and feces or stools; a lower number of platelets in the blood; sensitive stomach; small blood spots under the skin; weak pulse.
- Dengue Shock Syndrome
DSS is a severe form of dengue. It can be fatal. Apart from symptoms of mild dengue fever, the person may experience: intense stomach pain; disorientation; sudden hypotension, or a fast drop in blood pressure; heavy bleeding; regular vomiting; blood vessels leaking fluid.
Without treatment, this can result in death.
Prevention and Control
At present, the main method to control or prevent the transmission of dengue virus is to combat vector mosquitoes through:
- Preventing mosquitoes from accessing egg-laying habitats by environmental management and modification;
- Disposing of solid waste properly and removing artificial man-made habitats;
- Covering, emptying and cleaning of domestic water storage containers on a weekly basis;
- Applying appropriate insecticides to water storage outdoor containers;
- Using of personal household protection measures, such as window screens, long-sleeved clothes, repellents, insecticide treated materials, coils, and vaporizers;
- Improving community participation and mobilization for sustained vector control;
- Applying insecticides as space spraying during outbreaks as one of emergency vector-control measures;
- Active monitoring and surveillance of vectors should be carried out to determine effectiveness of control interventions.
There is no specific treatment for dengue fever. The pharmacology therapy based on therapeutic effect such as antipyretics like paracetamol, prevent dehydration by giving lots of fluids and consuming foods that are a lot of nutrition and avoid using analgesics which can increase the risk of bleeding such as aspirin. Immunodulators can be administered in both prevention of disease and accelerate the healing process.
Immunodulators work by increasing the body’s immune system either by increasing the number of immune cells effectiveness effect in the body. Two of the ingredients that are proven as a natural immunodulatory ingredient are Echinacea and Black elderberry.
Echinacea or cone flower is a flowering plant from Asteraceae family. Echinacea purpurea is one of the most widely used species for immunodulator. Based on research by Manayi, et.al said that Echinacea purpurea has immunodulatory effects by increased activity of the body’s immune system such as neutrophils, macrophages, polymorphonuclear leukocytes (PMN) and Natural Killer cells (NK). Black elderberry extract has been researched to have immunodulatory activity by increasing cytokine production in the body. In the other hand, from several research, this extract has the ability as an antiviral by inhibition of viral replication.
PT. SIMEX PHARMACEUTICAL INDONESIA as one of the pharmaceutical companies in Indonesia presents IMUNVIT PLUS products as an immunodulatory supplement containing combination of Echinacea purpurea and Black elderberry extract. In addition to, IMUNVIT PLUS contain Zinc picolinate and selenium. The addition of these two mineral will increase the activity of the immunodulator so that is suitable to be used for prevention of disease.
There are two dosage form of IMUNVIT PLUS product: tablet and syrup with guava flavor for fit to children taste. IMUNVIT PLUS Syrup can be a solution for patients who have difficulty taking tablet dosage form.
- Haryanto B. 2018. Indonesia Dengue Fever: Status, Vulnerability, and Challenges. Current Topics in Tropical Emerging Diseases and Travel Medicine. dx.doi.org/10.5772/intechopen.82290
- Manayi A., Vazirian M., Seidnia S. 2015. Echinacea purpurea: Pharmacology, phytochemistry and analysis methods. Pharmacognosy Reviews. 2015; 9(17): 63-72
- The American Botanical Council. 2004. The ABC Clinical Guide to Elderberry. European Elder Berry Sambucus nigra: 1-4.
- Product Profile Imunvit Plus. 2018. Jakarta: PT. SIMEX PHARMACEUTICAL INDONESIA