When the monsoon season started in Pakistan in July this year, clinicians and public health experts were fearing an increase in vector-borne diseases including dengue fever and malaria in urban areas of the country. But the spread of dengue viral infection before the formal end of monsoon was beyond their expectations. In the past, the number of dengue cases had started increasing in September and the peak occurrence was seen in October.

“When reported dengue fever cases started increasing in August this year while it was still raining in Karachi, we were a little surprised. It was just the start of the season and more than the usual number of people had started visiting our Out-Patient Department (OPD). The number of those requiring admissions also started rising. What we have seen in the first 14 days of September is an unprecedented increase in dengue cases this year. The peak has yet to come,” says Dr Faisal Mehmood, an infectious diseases expert associated with the Aga Khan University Hospital Karachi.

The data show that nearly four times the patients have tested positive for dengue fever in Karachi in the first 14 days of September compared to the entire month of August. Experts fear that there could be hundreds of thousands of patients who never got tested and hundreds whose tests came out negative due to technical error.

At least 35 people so far have lost their lives due to dengue virus infection at seven leading health facilities in Karachi following an unprecedented surge in the vector-borne disease during the last six weeks. In the Punjab, seven deaths have been attributed to dengue so far and in Islamabad, five patients have lost their lives.

An investigation carried out by The News on Sunday revealed that deaths due to dengue fever in Karachi occurred at the Aga Khan University Hospital (AKUH), Civil Hospital Karachi (CHK), Indus Hospital Karachi, Darul Sehat Hospital, South City Hospital, National Institute of Child Health (NICH), Karachi and Liaquat National Hospital.

Many health facilities refused to provide data to TNS. Others confirmed that dengue fever had caused deaths during the last few weeks but sought time to provide the number of dengue cases and deaths.

The Health Department has reported only nine deaths due to dengue virus infection in Karachi, which it says occurred in District East. The disease surveillance officials associated with the Directorate General of Health said that the number of deaths due to dengue fever reported to them so far was six.

Federal Minister for Climate Change Sherry Rehman blames climate change for the unprecedented increase in the number of dengue fever cases across Pakistan, especially in Karachi. She has said that there has been at least a 50 percent increase in dengue fever cases following recent rains in the country, especially in Karachi where thousands are getting infected with the virus. She has also warned that more rains in the current month could prove detrimental to relief and rescue operations in the flood-affected areas.

Sherry Rehman says that floods have brought the menace of water-borne and vector-borne diseases such as dengue and cholera. Karachi, she says, is seeing an outbreak of dengue fever. With 584,246 people in camps throughout the country, an unattended epidemic could wreak havoc.

Rehman has said that clearing water in Sindh might take three to six months. She fears that this could lead to a catastrophe through dengue fever and malaria in Sindh. She says public health experts are being consulted to prevent a health crisis.

On the other hand, as the number of dengue cases is on the rise and wards overburdened with patients, senior health experts, including infectious diseases experts and gastroenterologists, have warned people not to give papaya leaf juice to dengue patients as instead of curing them, it can cause severe diarrhoea that can prove fatal for patients who need adequate fluids to avoid going into dengue shock syndrome.

“A couple of days ago, a young dengue patient in a serious condition almost died. Her attendants had given her papaya leaf juice without telling the physicians. Her platelet count was dropping every day and she had severe diarrhoea and was vomiting. The medication was failing to control the diarrhoea. Later, papaya leaf juice emerged as the culprit for diarrhoea and vomiting,” says Dr Saqib Ansari, a senior clinician.

Interviews with several other infectious diseases experts, professors of medicines and gastroenterology revealed that papaya leaf juice had absolutely no role in the treatment of dengue fever and had no potential to increase platelets in patients having dengue virus infections. They warned that papaya leaf juice could cause severe diarrhoea to dengue patients, who require fluid maintenance to avoid going into dengue shock, and urged people not to use anecdotal treatments and experimental remedies (totkay) as these can result in loss of lives.

Asked about papaya leaf juice’s medicinal properties with respect to curing dengue fever, former special assistant to prime minister Dr Faisal Sultan, categorically rejected the suggestion saying it had no role in dengue fever management.

Dr Naseem Salahuddin, head of infectious diseases at Indus Hospital Karachi, also advised people to avoid giving papaya leaf extracts to dengue patients. She said people should trust the physicians with the treatment. She also said dengue fever was no longer an unfamiliar disease.

“The papaya leaf extract has no role in treatment or cure of dengue fever. None at all. Platelet counts will rise in most cases without any medicine. The only treatment for dengue is to give the patients plenty of fluids and reduce the fever with antipyretic analgesics,” she says.

According to Dr Salahuddin, this is the natural history of dengue viral fever. In this disease, platelet counts drop before they start increasing without any pharmaceutical intervention. “In exceptional cases, platelets may rise more slowly or continue decrease, causing serious complications. This happens in less than 2 percent of cases,” she adds.

The writer is an investigative reporter, currently covering health, science, environment and water issues for The News International