Why dengue is deadlier the second time

"When the fever first struck, I couldn't even articulate words," said Tahmid Bashar Mahin, a 27-year-old battling dengue for the first time. 

For him, the diagnosis came after three days of unrelenting fever. 

"I am not experiencing any specific challenges regarding my treatment. To say the least, the price of getting the platelets test is Tk250, which has to be done repeatedly so the cost can be too much for patients from humble families," he said. 

The current dengue outbreak in Bangladesh has reached unprecedented levels, with a death toll of 488 this year as of 30 November, with six more deaths yesterday, and three more today. With each day, the death toll is nearing a record 500 deaths in 2024.

"My platelet count dropped to 19,000 during the second time, leading to blood clots and gum bleeding"

said Mahbubur Rahman, a 28-year-old who endured dengue three times

Last year, 1,705 people lost their lives due to dengue, making it the deadliest year on record.

Over 3,000 patients are receiving treatment in hospitals across the country. 

Since 1 January, a total of 91,469 dengue cases have been reported. 

Repeat infections are particularly dangerous, as they significantly increase the risk of severe complications like hemorrhagic fever, massive internal bleeding, and liver damage.

One of the key challenges lies in delayed treatment. Many patients initially treat symptoms at home, only seeking hospital care when their condition worsens. This, coupled with an overstressed healthcare system, has led to patients being referred from one hospital to another, further exacerbating the crisis.

The emotional toll of dengue is immense. In Dhaka, where the majority of cases are concentrated, families of victims are grappling with sudden losses.

Among the recent fatalities, many were young adults, aged 16 to 35, who succumbed to complications from reinfections. 

Tahmid also noted some precautions to avoid getting infected the second time. "I have become more aware of my environment. I try to avoid places with mosquitos in the morning and the afternoon. 

"I have thought about applying mosquito repellent cream but have not done so yet but I am trying to be in the mosquito net when I sleep."

Here's why the second time is far riskier 

Dr Eshita Bishas, assistant professor at the National Medical College, 

explains, "Dengue can occur in four variants: DENV-1, DENV-2, DENV-3, and DENV-4. This means a person can be infected up to four times in their lifetime. However, research shows that complications are higher during the second infection due to a cross-reaction between antibodies."

When someone contracts dengue for the first time, the body develops antibodies to fight the virus. However, during a second infection, these antibodies can trigger a severe immune response, leading to complications such as Dengue Shock Syndrome (DSS) or internal bleeding. This immune reaction makes a second infection deadlier and requires immediate medical attention.  

Differentiating between first-time and subsequent dengue infections isn't always straightforward as many people don't even notice or go through treatment when they are first infected with dengue.  

"Clinically, the symptoms might appear similar," Dr Bishas noted, adding that specific antibody tests—measuring IgM and IgG levels can help identify the infection stage.  

This diagnostic distinction is crucial because the second infection's severity often depends on how early it is detected and treated.  

For Mahbubur Rahman, a 28-year-old who endured dengue three times, the second infection was the most harrowing.  

"My platelet count dropped to 19,000 during the second time, leading to blood clots and gum bleeding," he shared. 

By the third time, while his platelet count was higher, he faced chronic digestion issues that persist to this day.  

Despite taking precautions—like using mosquito nets and avoiding mosquito-prone areas—Mahbub believes his living environment, a crowded university hall, contributed to his repeated infections. 

"There's no vaccine or medicine to prevent it, and the conditions here [University hall] are perfect for Aedes mosquitoes to thrive," he lamented.  

The recent spike in dengue fatalities in Bangladesh brings out the importance of early intervention. 

According to Dr Bishas, "Most deaths occur due to negligence or delayed medical attention." 

The World Health Organization (WHO) recommends the TAK-003 vaccine for those travelling to dengue-endemic regions. 

While this vaccine is not yet commercially available in Bangladesh, raising awareness about prevention and timely treatment remains critical.  

In Dr Bishas's experience of dealing with dengue for the last 24 years, she urged the authorities concerned to come to a permanent solution to this long-standing health crisis.

A wake-up call for all 

Mahin, now more cautious, avoids mosquito-prone areas during peak times and uses mosquito nets religiously. Yet, the anxiety of a potential second infection lingers.  

For Mahbub, each infection left lasting scars—physical and psychological. 

"The doctors told me I'm a high-risk patient now. Anything can happen."  

Their stories, alongside countless others, stressed the urgency of tackling dengue at its roots – improving environmental conditions, investing in healthcare, and making vaccines accessible.  

As Bangladesh grapples with this outbreak, the lesson is clear that dengue is not a one-time battle. For many, the second time can be the hardest—and sometimes, the last.