Abstract

MARTINEZ, Eric. Medical Care Organization to Face Dengue Epidemics. Rev Cubana Med Trop [online]. 2009, vol.61, n.2. ISSN 0375-0760.

INTRODUCTION: dengue is only a disease with a wide clinical spectrum including undifferentiated fever or fever with malaise and general manifestations, and severe dengue, induced mainly by plasma extravasation leading to prolonged or recurrent shock and death. Medical care organization during epidemics is crucial to prevent fatalities and includes at least five components: 1. Training of medical and nurse personnel. It is an investment that shall be programmed, controlled and evaluated. The time and resources for training must be considered as the equivalent of the expenses in still unavailable vaccines or drugs against dengue. 2. Health education. To involve patients and their families in their own care, so that they can be prepared to ask for medical care at the right time, avoid self medication, identify skin bleedings (petechiae), and look for warning signs. 3. Classification of every suspected dengue case (triage). A good classification of patients should be simple to be used in every place and should be dynamic to allow changes in treatment. Early recognition of warning signs that announce dengue severity and intravenous fluids (crystalloids) given at that very moment can prevent dengue shock and other complications. 4. Rearrangement of medical services and warranty of some resources. It is not correct to think that the preparation to face a dengue epidemic will include big amounts of drugs, blood and blood products. The most important resource continues being the human resource. If doctors and nurses are well trained, the prescription of such drugs and procedures will decrease, including platelet transfusion or blood transfusions. 5. Research. Biomedical and social research are needed, with emphasis on the impact of health education on patients and their families, the natural course of the illness and the best way to do ambulatory treatment. CONCLUSIONS: The future of the severe dengue cases will be usually decided upon not in the Intensive Care Unit but long before, in the Primary Care unit, Hospital Emergency Department or hospital ward. Good health managers can save more lives than physicians or intensive care specialists during dengue epidemics.

Keywords : dengue shock; clinical warning signs; health education; capacity building; dengue case management; medical care organisation.

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