The high frequency of DHF during the 2008 outbreak and the presence of three different dengue serotypes, emphasize the need to prevent and control dengue infection. Health authorities should consider strengthening surveillance for dengue infection, given the potential for future outbreaks with increased severity. It is also suggested that primary care physicians should be educated regarding recognition of DHF and to identify patients at high risk of developing DHF and DSS.

Dengue fever has huge public health implications and affects over 100 million people worldwide. This review pictures the current situation of Dengue in Pakistan and presents a review of published literature. Pakistan has seen recurrent epidemics of Dengue Fever recently. Unfortunately, these epidemics are becoming more severe in their clinical manifestation. Pakistan experienced large epidemics of dengue fever during 2008, 2010 and 2011 affecting thousands of people and claiming hundreds of deaths. A comparison of data during these epidemics indicates a shift from mild to a more severe disease, which could be interpreted as an epidemiologic transition pattern in the country. Expansion of Dengue in Pakistan seems to be multifactorial, including the climate change, frequent natural disasters, vector resistance to insecticides and lack of resources. This highlights the need for rigorous vector control. Continuing education of primary care physicians is crucial for early appropriate management to reduce mortality.

Background: Thrombocytopenia is a prominent feature of dengue fever and dengue hemorrhagic fever. Papaya leaves have been used by many patients due to their perceived beneficial effect on platelet count. However, scientific data on this beneficial effect is lacking.Methods: A single centre, single blinded, randomized placebo controlled trial was conducted at the Department of Medicine, Jinnah Hospital Lahore. Adult patients admitted with diagnosis of dengue fever (DF) or dengue hemorrhagic fever (DHF) and platelet counts ≤50 × 109/L were eligible for the study. After obtaining written informed consent participants were randomly assigned to either treatment or control group. 5ml of papaya leaf extract in syrup form was given twice daily for four days to treatment group and placebo solution was given to control group. Platelet counts were checked on daily basis. Outcome was measured in terms of platelet increments from baseline.Results: Thirty-nine (39) patients were enrolled and 28 (72%) were male. 19 (48.7%) patients received papaya leaf extract. Mean baseline platelet counts of treatment and control group were comparable, 36.2 × 109/L and 34.1 × 109/L respectively. Mean platelet counts at the end of treatment were 142.3 × 109/L and 116.5 × 109/L in treatment and control group respectively (p = 0.182). Platelet count normalized (i.e. ≥150 × 109/L) in 9 (47.4%) patients in treatment group and 5 (25%) patients in control group (p = 0.191). Similarly, no significant differences in mean platelet count increments from baseline were found between treatment and control group on day 2 (23.7 × 109/L vs 15.9 × 109/L, p = 0.242), day 3 (42.6 × 109/L vs 35.1 × 109/L, p = 0.424), day 4 (71.6 × 109/L vs 58.4 × 109/L, p = 0.309) and day 5 (106 × 109/L vs 82.3 × 109/L, p = 0.189). No significant adverse event occurred in either group.Conclusion: Papaya leaf extract, in this study, did not show any effect on platelet count in dengue fever.