A 32-year-old female from rural Odisha presents with fever for 5 days, severe headache, myalgia, and a maculopapular rash that appeared on day 3. On examination, she has a temperature of 39.5°C, petechial rash on the trunk and limbs, hepatomegaly, and mild jaundice. Her platelet count is 65,000/μL (normal 150,000–400,000/μL), haemoglobin 11.2 g/dL, and serum bilirubin 2.8 mg/dL. IgM ELISA for dengue is positive. What is the most appropriate public health action for this case under NVBDCP?

Explanation

## Dengue Case Management Under NVBDCP ### Clinical Diagnosis This patient presents with **dengue fever with warning signs** (thrombocytopenia <100,000/μL, hepatomegaly, jaundice). IgM positivity confirms dengue. ### NVBDCP Surveillance & Response Protocol **Key Point:** Dengue is a **notifiable disease** under the Integrated Disease Surveillance Programme (IDSP). Every confirmed or probable case must trigger immediate public health action. **High-Yield:** The NVBDCP mandates: 1. **Immediate notification** to the district surveillance officer 2. **Vector control operations** (fogging, larval surveys) within **400 m radius** of the patient's residence 3. **Entomological surveillance** to detect Aedes breeding sites 4. **Community mobilization** for source reduction ### Why This Case Requires Urgent Vector Control Dengue transmission occurs through *Aedes aegypti* and *Aedes albopictus* mosquitoes. A confirmed case in an endemic area (rural Odisha is a known dengue zone) indicates active transmission and risk of secondary cases. Immediate vector suppression is the cornerstone of outbreak containment. **Clinical Pearl:** Dengue with platelet count <100,000/μL and hepatomegaly suggests **dengue with warning signs** — this patient requires hospitalization for monitoring but does NOT require plasma exchange unless frank haemorrhage or shock develops. ### Treatment Approach - Supportive care (IV fluids, paracetamol, avoid NSAIDs) - ~~Artemisinin combinations~~ — NOT indicated; dengue is viral and self-limited - Monitor for progression to dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS) **Mnemonic: NVBDCP Response — SCAN** - **S**urveillance notification (immediate) - **C**ontact tracing & vector control (400 m radius) - **A**ctive case search in neighbourhood - **N**ew breeding sites elimination [cite:Park 26e Ch 8]