Investigation: How Close Was Oman To A Dengue Epidemic?

02 Feb 2019
POSTED BY Y Magazine

It’s the mosquito-borne disease that can kill you, and for which there’s no cure and no vaccine. While health professionals work overtime to spray infected areas and spread word of the dangers, many Omanis are paying lip service to their efforts. Team Y reports on why we should take this scourge on the Sultanate more seriously, and the risks we face if we don’t.



trip to a park or a wadi can seem like a simple and harmless adventure but can actually turn out to be anything but.

At least that has been the case for one patient among 48 diagnosed with a disease hitherto unheard of in the Sultanate: dengue.

The patient (name withheld due to privacy concerns), as per his doctor from a government hospital in the Wilayat of Seeb, contracted it during a picnic at the wadi with his friends.

Over the course of a week he developed symptoms such as skin rash and severe fever, for which he admitted himself to the hospital.

His doctor knew it wasn’t worth taking any chances as the “symptoms were all present” and two cases had already been registered. So, he immediately ordered a dengue test, which turned positive for the viral disease.

The 32-year-old Omani man became the third case to be diagnosed with dengue in the span of a mere week, in November.

News gets around quickly in Oman: there were eight cases of the disease by the end of November, then 33 in December, and finally, 48 as of January 13 – and it has caused a degree of panic among some, if not all, the country’s residents.

The prime area of infection remains in areas around Seeb, Al Hail, and Mabelah. However, it is believed that the areas surrounding Azaiba, Al Khuwair, Ghala, and Bausher are also at risk.

Dengue, a mosquito-borne viral disease is one that can cause flu-like symptoms that can quickly progress into more complications that can become life-threatening if left untreated. The disease is spread by female mosquitoes – from the species Aedes aegypti – that can infect people throughout its lifespan.

A tropical disease, by all means; and from 2001 to 2013, Oman only reported 64 cases of dengue and with a mortality rate of 4.6 per cent – a stark contrast when you realise that the cases are more widespread this time around.


The prevalence of dengue around the world


Nearly 2.5 billion people around the globe live in areas where there is a risk of transmission of the disease of which there are 390 million infections and 25,000 deaths every year.

In an interview with Y, Dr. Salim al Ghafri, a doctor with the Ministry of Health (MoH) says: “The word dengue is one that causes people to go into a state of panic. At least that’s what I’ve seen in countries such as Singapore where I’d worked during an outbreak of dengue in 2005.

“But there’s a very concerning difference between the way the two countries handled the disease. In Oman, the government took very swift steps with little to no lapse in time to handle the situation and prevent an epidemic from breaking out.

“This, coupled with the fact that dengue cannot be spread from person to person, certainly reduced any chance of spreading the disease within the communities.

“But, even so, the symptoms of the disease can be a very sudden fever that can span for days: aching eyes, headaches, severe joint and muscle pain, rashes; and in very rare cases, bleeding from gums. People must come forward if they feel they’re experiencing one or more of these at any given moment.

“It’s a disease that has no viable vaccine yet even though there are a few controversial variations of the jab available in other markets. We urge people not to opt for them as some variations of the strain can cause more harm than good and they are meant for people who have already been infected with dengue once.

“Still, what has shocked me is how aloof some citizens are about this situation. They don’t appear to be worried and are not cooperating with the authorities who are conducting free drives to stop the mosquitoes during its breeding stages itself; by targeting houses, buildings, and public spots.”

This is more dangerous than the mosquito itself, says the doctor of 25 years’ experience. He believes that creating awareness about the dangers disease can alleviate part of the problem.


Oman’s answer to dengue


The Omani government has made clear its stance of extinguishing the problem from grassroots level – by disinfecting areas invaded by mosquitoes.

Mosquitoes are known to lay their eggs in pools of water with no flow. So, any stagnant water would be considered an ideal environment for these winged insects to breed.

To combat this, the Ministry of Health and the Muscat Municipality have joined forces to launch a campaign to spray the insecticide near affected houses, farms, shops and streets.

While the overall response to this has largely been positive with more than 8,500 facilities being “neutralised”, there have been cases of families refusing the free service; according to one team that visited Baushar.

It’s a service that is mostly staffed by around 1,200 health workers who are volunteering to work extra hours to facilitate it. This team includes doctors, nurses, health educators, health supervisors from the MoH, sprayers from the municipalities, field supervisors, and also members from the Shura and Municipal council representatives. They are all out in the field on weekends and on their own time as they begin at 8am and end at 2pm.

But their commendable efforts are being inhibited due to a lack of support by some residents.

One member spraying the smoke-like insecticide in the heart of Baushar is clearly frustrated.

He says: “You can see that there are ticks and crosses that we stick on every house depending on the status of the place. So, if you notice, there are a lot more crosses than ticks here in Baushar.

“Most of the times this is because there is no one in the houses or the places are left shut. But, every now and then we stumble upon someone who refuses to comply and asks us to leave the property.

“All of us have our identification cards and are in uniform and must present the ID at the request of the resident. But even then, we’ve come across some issues in gaining the trust of the some people.

“This is bad as someone who may comply with the law will still be at risk because their neighbour didn’t opt for spraying their house.”

An Omani nurse from the Royal Hospital, Mariyam al Zadjali, accompanying the team clarifies that the only way the country can prevent dengue from becoming an epidemic is if it “stands and works together”.

She tells us: “Every red tick sticker we put in a home is a matter of concern. There could be a source of water in the house that we should have neutralised or mosquitoes that would have been killed by the smoke.

“In the end, we do what we can. We fumigate around the house and hope that it gets the mosquitoes in the more visible parts of the house. Some people are even rude to us, asking us to stay away from their property and to spray around it.

“One of the reasons people say no to this mandatory service is because of the smell of the gas. It isn’t appealing at all – but it’s not meant to be that way. This smoke is meant to kill the insect and nothing else.

“This makes me wonder whether it’s the mosquitoes and the disease that’s the culprit or the people who act this way.”

Our outing with the team is largely positive as most buildings in the area have been mostly cooperative, with only a few businesses remaining shut over the weekend. Those that have been disinfected from the outside display few signs of treatment, and any stagnant water seen on the streets has been discarded immediately.

We also come across one shopkeeper, Mahesh, who rushes in from shopping in Ruwi with his family to open the doors of his grocery store to the team of sprayers. He is immediately praised by the team leaders.

But the shopkeeper reveals something shocking: “In 2014, my ageing mother was diagnosed with Zika in India and she lost her life due to complications that arose during treatment. It too is caused by these mosquitoes and since then we’ve been very careful.

“What happened to her changed our lives and today we’re going to take every step we can to not let that happen again.”

Mahesh’s concerns are warranted. A quick research shows us that the Zika virus is spread by the same breed of mosquitoes and is also life-threatening for some. This means that if the same mosquito were to carry this strain of the virus, we could be looking at a potentially deadlier outbreak.


Efforts curbed by unsupportive residents


While we cannot come across anyone who opposes the ministry’s moves of fumigation, one volunteer, Evangeline, steps in to explain how one family in Al Hail – the epicentre of the disease – refused to open their doors and also called the ROP saying they were being harassed.

She tells: “The ROP came to their house and explained the whole situation to them – taking our side in the matter – but they still wanted us off their property. But the neighbours were all supportive, and even though we tried to fumigate the areas around their house, we were being watched by them.”

This is exactly why we need to take this situation more seriously, says Dr. Salim. “Our healthcare system hasn’t had to deal with an epidemic of large proportions and even though we’re confident that we can, we don’t want to take a chance.

“Take for instance the chikungunya virus (also a disease carried by the aedes aegypti) that broke out in Kerala, India in 2012. It was handled very efficiently but that was because the healthcare system there is prepared to take such actions with very short notice. Even so, some 70-odd people died.


Can this outbreak be classified as an epidemic?


“This dengue outbreak is no epidemic by any means, but it still has the potential to become one – and possibly something more if these mosquitoes are carrying different strains of viruses such as zika and chikungunya.

“The greatest concern about dengue is that there’s no cure for it. So, if you think that there’s a chance you have it, you must head to the doctor immediately. There, a blood test will be conducted to check for the virus in your blood and an additional antibody test will be done to confirm it.

“Following this, you will be given medicines and under certain circumstances also isolated for a few days. But the best way to deal with this is to comply with the MoH and municipality and allow for your homes to be fumigated.

“The best precaution one can take with regard to dengue is to not get in contact with mosquitoes. And while that can come across as a bit vague, there are several countries in Africa and even in Asia that have been actively doing this.

“Don’t take any chance with dengue. And even if it may not seem like a concern of great levels now, it’s not worth putting your life at risk. As they say, prevention is better than cure.”


How to protect yourself from dengue


There is no vaccine to prevent dengue fever. The best way to prevent the disease is to prevent bites by infected mosquitoes, particularly if you are living in or travelling to a tropical area. This involves protecting yourself and making efforts to keep the mosquito population down.


To protect yourself:


 Stay away from heavily populated residential areas, if possible.

  1. Use mosquito repellents, even indoors.
  2. When outdoors, wear long-sleeved shirts and long pants tucked into socks.
  3. When indoors, use air conditioning if available.
  4. Make sure window and door screens are secure and free of holes. If sleeping areas are not screened or air conditioned, use mosquito nets.
  5. If you have symptoms of dengue, speak to your doctor.

To reduce the mosquito population, get rid of places where mosquitoes can breed. These include old tyres, cans, or flower pots that collect rain. Regularly change the water in outdoor bird baths and pets’ water dishes.

If someone in your home gets dengue fever, be especially vigilant about efforts to protect yourself and other family members from mosquitoes. Mosquitoes that bite the infected family member could spread the infection to others in your home.

Source: WebMD


Effects of dengue on the human body


Symptoms can appear up to 7 days after being bitten by the mosquito that carries the virus.


Mild dengue fever


  1. They include:
  2. aching muscles and joints
  3. body rash that can disappear and then reappear
  4. high fever
  5. intense headache
  6. pain behind the eyes
  7. vomiting and feeling nauseous.

Symptoms usually disappear after a week, and mild dengue rarely involves serious or fatal complications.


 Dengue hemorrhagic fever (DHF)


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:

  1. bleeding from the mouth, gums, or nose
  2. clammy skin
  3. damage to lymph and blood vessels
  4. internal bleeding, which can lead to black vomit and feces, or stools
  5. a lower number of platelets in the blood
  6. sensitive stomach
  7. small blood spots under the skin
  8. weak pulse.

Without prompt treatment, DHF can be fatal.


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:

  1. intense stomach pain
  2. disorientation
  3. sudden hypotension, or a fast drop in blood pressure
  4. heavy bleeding
  5. regular vomiting
  6. blood vessels leaking fluid

Without treatment, this can result in death.

Source: Medical News Today


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