Global Courant
As happened with covid-19, with the dengue epidemic, carrying out sufficient diagnostic tests allows adequate epidemiological surveillance in the country, keeping a record of cases and being certain of the serotypes of the virus that circulate in a certain geographical area, in order to to establish actions to stop contagion.
The Ministry of Health reported a total of 23,727 cases in the country as of September 16, 11,464 more than those recorded as of August 31, when the authorities declared a Health Emergency through ministerial agreement number 258-2023.
There are 20,187 (85%) dengue without warning signs, with 3,394 (14%) with warning signs. 42 are reported due to severe dengue and 34 deaths. The authorities hope that the cases will stabilize, but the rains that have occurred are an obstacle.
According to Juan Roberto Castro, director of the Roosevelt Hospital, the diagnosis of dengue continues to be clinical. That is, based on signs and symptoms that the person presents, such as nausea, vomiting, rash, general malaise. Although these may be present in other arboviruses – viral diseases transmitted by mosquitoes – such as Zika and chikungunya.
From this account, Óscar Conde, public health specialist and former head of the National Health Laboratory, points out that it is necessary to do a laboratory test, not only for dengue but for all diseases caused by vectors, in this case the mosquito Aedes aegypti, to avoid a poor diagnostic conclusion.
In the opinion of epidemiologist Kevin Martínez Folgar, at an individual level it may not be very relevant to do a test, because the treatment in the end is symptomatic. However, it is important to identify the type of virus, from a public health point of view, to know whether or not there is an outbreak of the disease.
“The importance of the test to diagnose dengue has a greater impact on the health of the population than on an individual level. It is important to identify that it is a case of dengue to count it and investigate where the contagion occurred in order to stop it,” adds Martínez Folgar.
Conde believes it is necessary for the Ministry of Health to be supplied with this input, especially when the country could be facing an epidemic similar to that of 2019, the year in which more than 50 thousand cases of dengue were reported. He adds that there could be a shortage of tests and reagents, which is already seen in some private laboratories, a situation that the authorities had to foresee given the high demand that is expected to continue.
“There is an obligation of the Ministry of Health, as the governing body, to provide for the increase in cases, the availability of tests for the health services and laboratories that make up the public network, as well as others that can support – the private ones. It is urgent to organize them so that they have tests, whether antigens, antibodies or molecular tests,” says Conde.
He adds that the advantage is that, due to the Covid-19 pandemic, there is already a platform of laboratories and access to technology that can cover any health emergency.
Detection
The Guide for the Clinical Management of Dengue says that “laboratory tests are not necessary to begin the management of patients,” so the diagnosis of dengue is based on the symptoms that the person has.
Although the disease is complex in its manifestations, authorities have indicated that treatment is relatively simple and effective, as long as the correct and timely interventions are carried out.
The Department of Social Communication of the Ministry of Health confirms that dengue screening is only for epidemiological surveillance at the first and second level.
In these services, the rapid test is performed only for clinical purposes, because some patients when performing the clinical examination report starting the febrile process with symptoms similar to a respiratory infection or other arbovirus diseases, and in this case it is done to provide treatment. accurate.
While at the third level (hospitals), where seriously ill patients are treated, screening is carried out to confirm the diagnosis. As of September 7, the hospital system had 12,703 tests to detect these cases.
Official information indicates that, of 10 positive samples, one is sent to the Directorate of the National Health Laboratory (DLNS) to confirm the presence of the virus and indicate which viral serotype it belongs to, and which ones are circulating in the country to have a better epidemiological surveillance.
Identified serotypes
There are four serotypes of the dengue virus—DEN-1, DEN-2, DEN-3, DEN-4—and they are present in the Americas region, according to the Pan American Health Organization (PAHO). Not in all countries there is simultaneous circulation of these, but in Guatemala it does occur.
This represents a greater risk, since a person can be infected with dengue up to four times. If you become infected with two different serotypes, for example, the risk of developing severe dengue fever (hemorrhagic fever) increases, which can cause death.
Diagnosis time
The results of the samples processed at the DLNS depend on the transportation time and distance of each health area. Once the process has started within the Arbovirosis Unit, the results depend on the type of analysis performed. If it is a PCR test, whose sample is taken from patients with symptoms for 1 to 5 days, it can be obtained between 5 and 7 days. If it is IgM Immunoglobulin, whose sample is taken from people with six or more days of symptoms, the results are obtained in about three days.
According to the Ministry of Health, the aim is to decentralize the PCR test process through sentinel laboratories. In addition, any private laboratory could do tests to determine the existence of dengue, in these the price ranges from Q170 to Q220, and it is through a blood test.
