Attachments
Background
Dengue fever has recently seen an increased infection intensity. It has expanded rapidly in many parts of the world, including Asia, affecting the most vulnerable. The history of dengue fever in Nepal reflects the broader trends seen in the global spread of the disease and is characterised by the increased morbidity and mortality rate. Dengue was not historically endemic in Nepal. The country's unabated proneness to it was identified relatively recently compared to many other countries, with significant reports of exposure emerging in the early 21st century. These outbreaks might be result of climate change, urbanisation, fragile socio-economic conditions, and population movement. In recent years, Nepal has seen periodic outbreaks of dengue fever and a rapid surge in infection, often coinciding with the monsoon season. These outbreaks pose significant challenges to public health systems and constrain humanitarian actors and public institutions to launch immediate actions to reach the most vulnerable to curb the intensity of loss of lives and the severity of the infection.
Since the Dengue outbreak, Nepal has witnessed a concerning surge in dengue cases, with over 21,000 instances diagnosed between June and August 2023, according to the Early Warning, Alert and Response System (EWARS) report from Epidemiology and Disease Control Division (EDCD). This rise is particularly alarming given that it marks the first-time dengue has occurred in consecutive years, deviating from its typical cyclical pattern in Nepal. Notably, cases began to appear even during the winter season and have been increasing steadily, showing an exponential rise in July and August. A mathematical model projection by the World Health Organisation (WHO) in 2022 indicated that the dengue cases in Nepal have surpassed the alert threshold since early 2023, compared to the EWARS reports. This suggests an ongoing dengue outbreak in the country. Given the relative novelty of dengue in Nepal, there is a low public knowledge and awareness level. Although dengue prevention was not a high priority in the country until the previous year, the Nepalese government has been actively engaged in addressing this emerging trend through joint planning and implementation starting this year.
In 2022, the number of dengue cases in Nepal reached a record high. The Nepal Red Cross Society (NRCS) initiated preventive measures following the government's declaration of an outbreak. However, the response was not as timely as needed, leading to overwhelmed hospital capacities and a significant increase in the mortality rate. Community-level preventive campaigns, including search and destroy missions, were conducted, but controlling mosquito breeding proved challenging. In response, the NRCS implemented early action activities in 2023, although the situation continues to worsen, highlighting the need for additional response measures and preventive actions.
Dengue has been regarded as an endemic in Nepal, with all four serotypes present. The EDCD and the Ministry of Health and Population (MoHP) report that Dengue Virus Serotypes (DENV) 1 and 2 are responsible for most cases. In 2022, Nepal experienced one of its most significant dengue outbreaks, with a total of 55,000 cases and 88 fatalities. In 2023, there has been a significant increase in dengue cases across 77 districts, with over 51,000 people grappling with infection and 16 districts recording over 500 cases. Twenty people have lost their lives to Dengue infection. The urban design of major cities in Nepal, characterised by poor infrastructures, improper and inadequate waste management and drainage systems, and inadequate sanitation facilities, creates optimal breeding environments for vector mosquitoes. Residents of slums and urban areas with poor sanitation are at higher risk. The current dengue outbreak strains the healthcare system and disproportionately impacts populations with lower socio-economic conditions and challenges by protection concerns.