Some thoughts on dengue outbreak

The epidemic of dengue fever can overburden the healthcare system in the countries that have been affected by it, including Bangladesh. A joint research study conducted by 18 institutions of eight countries in the region shows that periods of elevated temperatures give rise to the dengue epidemic. This is why it mostly emerges during the hot and dry seasons.

Although the candidate vaccine for dengue was registered in 2016, it has not yet been adopted widely. At the same time, dengue-specific antiviral drugs are not available either. Therefore, the primary preventive measure to control the epidemic will have to address the cause that is spreading the virus, i.e. to limit, better to eliminate, breeding of the vector of the virus, the Aedes mosquito.

The breeding ground for the Aedes mosquito can be a wide range of things. Even a puddle of water at a corner of the house can serve as a breeding ground for the Aedes mosquito—the vector of the virus causing the disease. Therefore, utmost care must be given to ensure that there is no such environment that could allow mosquitoes to breed inside the house. All doors and windows must be shut at least 30-45 minutes before sunset as well as after sunrise. Use of mosquito nets while sleeping is highly recommended, especially for children.

Along with emergency medication, and fluid-based supplements to prevent fatal conditions such as dengue hemorrhagic fever, papaya-based products have been shown to improve the conditions of the patients. A number of scientific research studies have shown that papaya-based products either inhibit the dengue virus replication in the patients or improve their platelet count. In fact, papaya leaf extract has been shown to improve platelet count in dengue patients as well as in the animal model of dengue virus infection. Unripe papaya-based extract induces certain cytokines (a type of protein) involved in the production of platelets in human blood.

Fresh papaya leaf or small pieces of unripe papaya flesh (without the peel) can be blended in any fruit juice-maker. Freshly boiled and cooled water (or mineral water) can be added to blend the leaf or the papaya flesh. This will allow various bioactive components such as papain, a well-known carboxypeptidase enzyme, and vitamins and minerals such as calcium and zinc to be easily available for absorption after consumption. Each of these components has been proven to be beneficial in dengue-infected patients.

While health professionals, scientists and policymakers are trying to reduce the impact of the dengue epidemic in various ways, it would do well to also direct their efforts to promote the beneficial role of papaya-based products in fighting dengue. Since no adverse effects of unripe papaya-based products in dengue patients have been reported so far, it might be useful to add these products at least as a dietary supplement for dengue patients.

It is important to note that unripe papaya or papaya leaf based extract might have some adverse effects for pregnant women. Therefore, caution should be taken when it comes to pregnant women taking unripe papaya as a dietary supplement. Those who are allergic to papaya should also exercise caution.

In 2015, a comprehensive guideline was published in the British Medical Journal for the use of papaya leaf extracts. In case the presence of dengue NS1 antigen is detected, papaya leaf extract can be used in addition to the usual dengue management process suggested by a health professional. In fact, papaya leaf extract could be taken at any stage of the disease; however, it is best to be taken from the very first day of the fever. Papaya leaf extracts could be taken as syrup (three times a day before meals)—15-30ml for an adult and 5-10ml for a child (12 years old and less)—until one has fully recovered from the illness. These specific amounts refer to the pure juice that is extracted by blending or squeezing the papaya leaves. The precise amount of the pure juice that is prescribed based on the body weight of the patient is safe for consumption, as there are no severe forms of side effects reported after consumption of the stated amount. It is advised not to stop the treatment halfway.

To remove the bitterness, the extract can be mixed in honey or one can have sips of cold water right after consumption of the extract. It is also advisable to use freshly prepared extract each time it is consumed as freezing it might reduce the medicinal effects of the extract.

Until an effective vaccine is introduced to prevent the spread of the disease, precautionary measures to minimise Aedes mosquito breeding are extremely important. Furthermore, given that there is no specific drug to treat the disease, the medicinal benefits of papaya-based juice from leaf extract, to treat the patients who have already been infected with the virus, should be publicised to raise awareness. Different media outlets, television channels and newspapers can play a major role in raising awareness of this easy, simple method—it is one of the best options available right now—to treat dengue and related diseases.

Mohammad Tariqur Rahman, PhD, is a professor in the Faculty of Dentistry, University Malaya, Malaysia.

Email: m.tariqur.rahman@gmail.com

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