Text by Henrylito D. Tacio
Photos courtesy of DOST
If there’s a disease these days that needs no introduction, it’s coronavirus disease 2019 (COVID-19). In the past, it was dengue fever and its lethal form, dengue hemorrhagic fever (DHF).
Although there is now a vaccine available in the market against dengue, most Filipinos are afraid to use it. The reason: it was linked to the deaths of children. In fact, it is for this reason why most Filipinos are afraid of being vaccinated with the anti-COVID vaccine.
Dengue vaccine is a vaccine used to prevent dengue fever in humans. The development of dengue vaccines began in the 1920s but was hindered by the need to create immunity against all four dengue serotypes. In 2021, one version – sold under the brand name Dengvaxia – became commercially available.
But look no further. The Department of Science and Technology (DOST), through its Tuklas Lunas program, has developed a herbal capsule that may treat dengue. The clinical trial is expected to end soon.
The clinical trial, which costs nearly P12 million, is being implemented by Pharmalytics Corporation. The funding comes from DOST through the Philippine Council for Health Research and Development (PCHRD).
The randomized, double-blind, placebo-controlled study – which is being conducted in Cavite – aims to determine the efficacy and safety of an herbal capsule when taken orally by adults with dengue fever showing no warning signs.
Each fixed-dose capsule combines the ability of tawa-tawa (scientific name: Euphorbia hirta) and banaba (Lagerstroemia speciosa) to increase platelet count with the immune-boosting and anti-inflammatory properties of luya (Zingiber officinale).
Tawa-tawa was once used by students of the University of Santo Tomas Faculty of Pharmacy. They wanted to find out the effects of the tawa-tawa decoction on a dengue patient showing a symptom of thrombocytopenia (low platelet count due to excessive bleeding).
Results of the study showed that platelet count increased by 47%, depending on the drug used to induce thrombocytopenia. Bleeding time was reduced up to 62%, while blood clotting time decreased to 58% compared to the control group.
Banaba, also known as giant crape myrtle, is used to treat diabetes and kidney failure, as well as obesity and high fever. Luya, more popularly known as ginger, is high in gingerol, a substance with powerful anti-inflammatory and antioxidant properties.
“Once proven safe and effective, the herbal capsule will be the first definitive treatment for dengue,” the press statement said. “It could pave the way for use in cases showing warning signs and even in severe types.”
On the economic side, farmers can benefit from cultivating any of the three medicinal plants, the increased demand for which may come from local pharmaceutical companies that could manufacture the treatment for domestic and even overseas markets.
Dengue causes a wide spectrum of diseases. “This can range from subclinical disease (people may not know they are even infected) to severe flu-like symptoms in those infected,” explains the Geneva-based World Health Organization (WHO). “Although less common, some people develop severe dengue, which can be any number of complications associated with severe bleeding, organ impairment and/or plasma leakage.”
There are four distinct but closely related serotypes of the virus that cause dengue (DENV-1, DENV-2, DENV-3, and DENV-4). “Recovery from infection is believed to provide lifelong immunity against that serotype,” the WHO says. “However, cross-immunity to the other serotypes after recovery is only partial and temporary. Subsequent infections (secondary infection) by other serotypes increase the risk of developing severe dengue.
Like death and taxes, dengue exempts no one: fat or thin, ugly or beautiful, rich or poor, educated and illiterate. Children, who are exposed to open areas while playing, are more prone to dengue.
“Children are much more likely to get DHF than adults,” explains Dr. Allan Schapira, who used to be the person in charge of infectious diseases at the WHO regional office in Manila. “This is the reason why children are much more at risk of dying.”
Adults, however, are not spared. Franklin Penas (not his real name) was a lawyer based in Manila, but at one time, he went to Baguio for a vacation, and it was there that he contracted dengue. A few days after being bitten, he suffered a high fever, severe headache, and pain behind the eyes. There was also an outbreak of rashes in some parts of his body.
From Baguio, Franklin was brought to Manila. But it was already too late. He suffered a hemorrhage in the liver and died three weeks after being confined in one of the well-known hospitals in Makati City.
Even doctors die from dengue, too! There was a case of a lady physician whose daughter suffered from dengue. Unknowingly, a mosquito which bit her daughter had bitten the doctor. A few days after the daughter died, as a result of dengue, the doctor also showed manifestations of having dengue. She also died of the same disease.
Dengue fever is characterized by high fever, severe headache, pain behind the eyes, and muscle and joint aches. Many people, including doctors, mistake dengue for influenza and flu-like diseases, so it often goes untreated until symptoms become severe and the patient goes into shock.
It happens when DHF strikes in. “There’s often a rash in dengue while there’s none in flu,” explained Dr. Allan Schapira, an epidemiologist who was then with the regional office of the World Health Organization (WHO) when interviewed by this author. “Fever caused by dengue tends to last almost a week, while that of flu disappears after three to five days.”
After a dengue patient goes into shock, it’s usually a matter of time before multi-organ failure occurs and death becomes inevitable. This terrifying scenario is characterized by high continuous fever (40-41 degrees) lasting up to seven days that may be accompanied by loss of appetite, nausea, vomiting, abdominal pain, and bleeding from the skin, nose, or gums.
In the worst cases, the patients’ condition may suddenly deteriorate after a few days of fever, and they may die within 24 hours. “Death often results from bleeding in the brain, intestines or other organs,” said Dr. Lulu Bravo, a professor of pediatric infectious and tropical diseases at the College of Medicine, University of the Philippines.
While waiting for the anti-dengue capsule to be available commercially, the best protection against dengue is still not to be bitten by the mosquito carrying the virus.
According to Dr. Willie T. Ong, there are several things you can do about that. “There’s no need to panic (when it comes to dengue) because we have 10 ways to beat dengue,” says the 2007 recipient of the Outstanding Filipino Physician award from the Department of Health.
- Clean up your backyard. Mosquitoes love to stay in the dark and damp areas. So if your garage is littered with boxes and assorted garbage, clean them up or throw them away. Don’t let them become mosquito havens. Schedule a weekend clean-up day.
- Empty containers with stagnant water. The dengue-carrying mosquitoes breed in stagnant water. This means that flower pots, garbage cans, aquariums, unused swimming pools, tires, and other piles are potential breeding grounds for mosquitoes. So after the rains fill them with water, throw the water away. Next time, keep these containers closed and upside down. Flower vases should also be replaced weekly.
- Check your surroundings for stagnant water. Some ornamental plant leaves have this “whorl” or cup-like shape that can hold water. Beautiful to behold but deadly in design. Turn them over and throw the water away. Upturned coconut shells are also notorious for holding water. Non-moving rivers, especially in squatter areas, are full of mosquito eggs.
- Close your doors and windows. Some people open their doors in the morning for a whiff of fresh air. They also believe that mosquitoes would leave the house and go into the sunlight. “But my advice is to keep your doors shut at all times,” he advises. If it’s too stuffy, then place a screen door that keeps the flies and mosquitoes outside.
- Spray insecticide regularly. To rid your house of mosquitoes, flies, and cockroaches, spray insecticides every few days. Make sure you spray those dark corners, crevices, and cabinets. You’ll be amazed at the number of pests you’ll find dead in the morning. Just make sure that household members are not exposed to the insecticide as they are not the target. Just spray selected rooms when people are not around.
- Wear pants, pajamas, long sleeves, and socks. Mosquitoes are attracted to your breath as you exhale, so they know how to reach you even in the dark. “I guess they love bare, plump skin, especially the kids who don’t shoo them away and let them suck as much blood as they want,” Dr. Ong believes.
- Apply insect repellants or use mosquito nets. If your kids are going hiking, camping, or off to school, you can apply insect repellants like Off-Lotion. Kids like to play outdoors and are prime targets of these mosquitoes. You can wipe it on selected areas of the clothing like collars, sleeves, and pants. Avoid applying lotion on the eyes, mouth, or hands.
- Kill those mosquitoes. When it comes to dengue, it’s either kill or be killed. Instruct everyone to kill as many mosquitoes and flies as they can. Once you’ve got them trapped in your bathroom, show no mercy. Mosquitoes belong to the forest, not in your home.
- Involve the whole community. The best way to defeat dengue is if the whole community is aware of the threat. Ask your community leaders to schedule a clean-up day. The danger is in those empty houses and lots, which are excellent breeding places for mosquitoes. Become a volunteer to monitor and clean up your surroundings.
- Spread the word: Dengue fever is here. You’ll never know where dengue will strike next, so better be prepared. Inform your neighborhood.