The simultaneous spread of three highly contagious viral diseases -- measles, dengue, and chickenpox -- has increased the risk of multiple infections and, in some cases, co-infections, particularly among people living in overcrowded urban slums and low-income neighborhoods.
This grim reality -- marked by the successive and sustained circulation of infectious diseases -- points to a new public health threat, a prolonged wave of viral illnesses that has become increasingly evident since the Covid-19 pandemic.
Measles, which struck in March, continues to take a steady toll, while dengue hospitalisations have recently recorded a sharp spike amid an unusually high number of chickenpox infections.
‘I have been in this hospital for 16 days with my baby and husband. I have spent over two lakh takas over the past 20 days,’ said Arifa Begum, mother of a two-year-old baby boy, who came from Kushtia for measles treatment at the Bangladesh Shishu Hospital and Institute.
She said that she had to collect the medical expenses by selling goods and borrowing money from her relatives while she remains still uncertain when they will be released from the hospital.
Weighed down by four years of inflation, hundreds of families faced the costly battle against measles mostly alone, as the government failed to provide adequate support.
According to the Directorate General of Health Services on Sunday, at least 96,000 people have been infected with and 652 have died of measles or with its symptoms across Bangladesh since March 15.
Meanwhile, at least four children died and more than 1,127 were infected with measles in the 24 hours until 8:00am on Sunday.
The DGHS also disclosed that dengue infections had increased sharply in recent weeks. A total of 1,004 dengue cases, including one death, were reported in the first 14 days of June alone.
As of Sunday, the DGHS has reported six deaths and 4,201 dengue infections this year since January.
Health minister Sardar Md Sakhawat Husain past week warned of a severe dengue outbreak and urged collective efforts to combat the disease.
Hospital authorities have, meanwhile, raised alarm over an unusual occurrence of chickenpox cases as well.
The disease is not being officially monitored.
Officials at the Bangladesh Shishu Hospital and Institute said that more than 200 chickenpox patients had received treatment at its indoor and outdoor facilities over the past 15 days.
The Infectious Disease Hospital in Dhaka on Wednesday reported that six patients had been admitted to the facility with chickenpox and hundreds took outdoor services during the same period.
Physicians said that hospital admission rates for chickenpox remained relatively low as most patients could be treated at home with proper isolation and supportive care.
Health experts viewed that the simultaneous circulation of multiple infectious diseases reflected unpreparedness and weaknesses in the public healthcare system as people braced for health consequences of the changing climate.
The poor vaccination coverage and the disruptions in the vitamin A campaign have left children especially vulnerable to diseases that have thrived in the recent environmental conditions.
The fragile public health system — evident in the lack of life-saving treatment facilities such as oxygen support — is also ill-equipped to detect and contain disease outbreaks in a timely manner.
According to Bangladesh Medical University former vice-chancellor and virologist professor Nazrul Islam on Wednesday, although different viruses can circulate at the same time, it is unusual to witness several outbreaks affecting large numbers of people simultaneously as we are noting this year.
‘Chickenpox and measles primarily affect children, while dengue can infect people of all ages who are exposed to Aedes mosquitoes,’ he said.
Paediatric wards are already overcrowded as a measles outbreak and the seasonal rise in dengue cases have coincided with the monsoon onset.
Public health experts renewed calls for introducing the chickenpox vaccine into the country’s Expanded Programme on Immunisation, better known as EPI.
The EPI currently provides five vaccines free of charge to children under one year of age, protecting them against 11 life-threatening diseases.
They include the pentavalent vaccine against diphtheria, whooping cough, tetanus, hepatitis B and Haemophilus influenzae type B; BCG vaccine against tuberculosis; pneumococcal conjugate vaccine against pneumonia; oral polio vaccine; and the measles-rubella vaccine.
Experts have repeatedly blamed declining vaccination coverage and immunity gaps for the resurgence of measles, which has taken a heavy toll on children in recent months.
Bangladesh Shishu Hospital and Institute child specialist professor Md Atiqul Islam said that the hospital was also receiving patients with hand, foot, and mouth disease, a common and highly contagious viral illness affecting young children.
The symptoms of chickenpox as well as hand, foot, and mouth disease, and measles often appear similar to parents, creating confusion and anxiety, said Atiqul.
‘Even when children are infected with other viruses, many parents fear that it is measles because of the ongoing outbreak,’ he noted.
He further noted that fatality rates associated with dengue and chickenpox were generally lower than those with severe measles cases.
Professor Atiqul Islam said that while the number of measles patients had shown signs of declining in recent days, cases of pneumonia and dengue were increasing.
Pneumonia, a serious lung infection, can develop as a complication of several viral illnesses.
He added that chickenpox cases typically increased during summer months, but this year’s caseload appeared significantly higher than usual.
The paediatrician advised parents to vaccinate their children against chickenpox at private healthcare facilities until the vaccine became available through the national immunisation programme.
He also stressed the importance of preventive measures, including regular handwashing, maintaining hygiene, and avoiding unnecessary exposure to infected individuals.
Institute of Epidemiology Disease Control and Research former director Abu Muhammad Zakir Hussain said that chickenpox was significantly more contagious than Covid-19, while measles remained one of the most infectious viral diseases known.
He warned that children weakened by measles infection could become more vulnerable to secondary infections and other illnesses.
Zakir Hussain also cautioned that the dengue situation was likely to worsen in the coming weeks as the monsoon season would intensify across the country.
Infectious Disease Hospital superintendent professor FA Asma Khan said that admissions of measles patients had started to decline, but cases of dengue, chickenpox, and several other infectious diseases were increasing.
The hospital, however, does not maintain routine national data on chickenpox unless the disease reaches outbreak proportions, she said.
Health experts emphasised that strengthening disease surveillance, improving vaccination coverage, and ensuring timely public health interventions would be critical in preventing simultaneous outbreaks from placing further strain on the country’s healthcare system.
