Dengue Forum

The CSMC Pediatric Alumni Association, in coordination with the CSMC Dept of Pediatrics, conducted its 1st Dengue Forum in CSMC last September 30, 2011. The Alumni Association invited 3 experts from different institutions who shared their expertise on Dengue H-Fever, especially in the area of management. These are the role of parameters for coagulopathy - PT, PTT; beneficial or adverse effects of blood transfusion; and, the status of Dengue vaccine trials.

SPEAKERS: Meadina Cruz, M.D.
Pediatric Intensivist, PCMC

Eufrosina Melendrez, M.D.
Pediatric Hematologist, PGH, MDH, MCMC, RMC

Rosario Capeding, M.D.
Pediatric Infectious Disease Specialist, RITM
Principal Investigator, Dengue Vaccine Clinical Trials

Dr. Cruz discussed the importance of vigilant monitoring for warning signs of the potentially fatal vascular permeability of dengue hemorrhagic fever (DHF) and life-threatening circulatory failure defining dengue shock syndrome (DSS). These include signs of altered consciousness, confusion and neurological manifestations like lethargy, seizures and change in sensorium. She did not only emphasize the importance of adequate fluid but also the correct use and close monitoring of fluid management to prevent overload and circulatory congestion. More frequent Hematocrit determination (cheaper than CBC) is crucial in order to monitor efficacy of fluid management.

One highlight of the discussion is the exact role and indication of platelet transfusion in the management of hospitalized dengue patients. According to Dr. Melendrez, the indication for platelet transfusion may vary from different institutions and since there is inherent risk associated with the transfusion of blood/blood-component, it is imperative to lay down the criteria for transfusion of these blood components. She added that bleeding occurred significantly more often in patients with severe thrombocytopenia, most often in patients with platelet count less than 10,000/cumm. Bleeding during DHF may result from a combination of factors such as thrombocytopenia, coagulation defects and vasculopathy.
The development of the Dengue vaccine promises to be an interesting one. The Philippines, according to Dr. Capeding, is among several countries were the dengue vaccine is undergoing clinical trial. The Philippines was a relevant venue for this study given its location and experience with both endemic and epidemic dengue activity. Encouragingly, the dengue vaccine is in the final stages of clinical development and hopefully, would be available in the year 2014.
Indeed the forum was very informative and well- attended. Special mention to our indefatigable colleagues in the Academic Committee, Dr. Dolli Bustamente Dr. Doris Sta. Ines with the ever-supportive Pediatric residents, for organizing this Dengue Forum.

Dr. Brandon D. Ericta, FPPS
Pediatrician
Cardinal Santos Medical Center