Bangladesh is once again facing a rapidly intensifying dengue outbreak. By Saturday (September 26), the Directorate General of Health Services (DGHS) had reported more than 65,000 dengue hospitalisations and 214 deaths across the country since January this year. In the preceding 24 hours alone, 1432 patients were admitted to hospitals and three people died.
The trajectory is particularly concerning. Dengue is no longer a predominantly Dhaka-centred or strictly seasonal disease. Its geographical spread and recurring annual outbreaks have transformed it into a persistent national public-health challenge.
Yet much of Bangladesh's response remains seasonal. Mosquito-control activities intensify when cases rise. Hospitals prepare for pressure when beds begin filling. Awareness campaigns become more visible when public anxiety is already high.
This reactive model is no longer adequate.
Bangladesh needs to move from managing dengue outbreaks to managing dengue as a permanent public-health threat.
Fogging has a role in rapidly reducing adult mosquitoes in particular circumstances, but it cannot be the centrepiece of a sustainable dengue-control strategy.
Aedes aegypti breeds primarily in water-holding containers around human habitation, discarded containers and tyres, flowerpots, rooftop water storage and other sites where relatively small amounts of water can accumulate. The World Health Organization (WHO) therefore emphasises integrated vector management, including source reduction, larval control, adult mosquito control and entomological surveillance.
The starting point should be knowing where the mosquitoes are.
Authorities need reliable, regularly updated information on mosquito density, breeding-site prevalence and the types of containers producing the greatest number of mosquitoes. They also need to know whether local mosquito populations are becoming resistant to commonly used insecticides.
WHO specifically recommends entomological surveillance to monitor Aedes breeding potential and insecticide resistance. Bangladesh's own experience has already demonstrated why this matters: WHO has reported evidence of insecticide resistance in Aedes aegypti in Bangladesh and called for broader surveillance beyond urban areas.
Without such information, mosquito-control operations can easily become routine exercises measured by how much spraying was done rather than whether transmission risk actually fell.
The central policy shift should be from a seasonal campaign model to a permanent surveillance-and-response system.
Entomological surveillance should operate throughout the year, with intensified monitoring before and during periods of increased transmission. Ward-level information could identify areas where mosquito density or breeding-site prevalence is rising, allowing interventions to begin before hospitals experience a surge.
WHO's surveillance framework includes indicators such as house, container and Breteau indices, as well as measures of adult mosquito density. These indicators can help authorities identify high-risk locations and assess whether interventions are working.
This requires stronger coordination among the health sector, city corporations, municipalities, local administration and other institutions responsible for urban management.
A national vector-control framework could establish common technical standards, coordinate surveillance and allocate resources according to epidemiological and entomological risk rather than administrative boundaries.
The effectiveness of larviciding and adult mosquito control should also be independently assessed. The objective should be measurable: fewer productive breeding sites, lower vector density and, ultimately, reduced transmission.
Vector control is the primary means of reducing transmission, but hospital preparedness must operate in parallel.
A rapid increase in dengue admissions can place enormous pressure on hospital beds, healthcare workers, intravenous fluids, medicines and blood-product services. Early recognition of warning signs, appropriate fluid management and timely referral are central to preventing severe dengue and death. WHO recommends strengthening case surveillance, early detection and referral systems as part of dengue control.
Hospitals should therefore maintain predefined dengue surge plans. These should include buffer stocks of essential fluids and medicines, arrangements for rapidly expanding bed capacity, designated dengue treatment areas where necessary, and reliable access to blood and other essential services.
The supply chain deserves particular attention. Demand can rise sharply during an outbreak, precisely when hospitals are least able to tolerate shortages. Preparedness should therefore include advance procurement, buffer stocks and regular replenishment mechanisms rather than emergency purchasing after shortages appear.
Domestic production capacity for essential medical supplies, including intravenous fluids, should also be strengthened where feasible, alongside rigorous quality assurance.
Preparedness means anticipating demand rather than waiting for shortages to become a crisis.
The pressure becomes even more acute when critically ill children are involved.
Bangladesh Shishu Hospital and Institute has 68 intensive-care beds across several specialised units, including 16 PICU beds. During the current period of simultaneous infectious-disease pressure, hospital officials reported that demand was more than twice the number of beds becoming available each day.
This is not simply a dengue-treatment problem. Children with severe dengue may require close haemodynamic monitoring, respiratory support and management of shock or bleeding. At the same time, intensive-care beds are needed for children with pneumonia, measles, sepsis and other serious illnesses.
When critical-care capacity is saturated, a child with severe dengue can face dangerous delays in accessing specialised care.
Bangladesh therefore needs a specific paediatric critical-care surge plan.
Existing PICU and high-dependency capacity should be mapped nationally. Referral pathways between district hospitals, medical colleges and tertiary paediatric centres should be established before an emergency occurs. Selected hospitals should have plans for temporarily expanding high-dependency and intensive-care capacity during epidemic peaks.
This requires more than beds. Additional trained paediatric intensivists, nurses, respiratory-support equipment, monitoring facilities and appropriate infrastructure are equally important.
The issue also extends beyond Dhaka. The pressure currently being seen in paediatric facilities reflects a broader weakness in critical-care capacity that dengue can expose very quickly.
A national hospital-capacity dashboard should therefore include not only general beds and ICUs, but also PICU and high-dependency beds. Real-time information could help clinicians coordinate referrals and reduce the dangerous search for a vacant bed after a patient's condition has already deteriorated.
Hospital preparedness should not begin at the tertiary-care level.
Diagnostic and triage capacity needs to be strengthened closer to communities. Appropriate access to dengue testing at primary and secondary healthcare facilities can support earlier diagnosis and help distinguish patients who can be safely managed as outpatients from those who require admission or urgent referral.
A coordinated referral network should connect community-level facilities, district hospitals, medical colleges and specialised centres.
Patients should not have to move from one hospital to another in search of an available bed while their condition worsens.
Dengue prevention cannot be delegated entirely to government agencies, or entirely to households.
Families have an important role in eliminating breeding sites, but individual action cannot compensate for poor management of construction sites, public spaces, institutional premises, rooftops and other shared environments.
A structured community-based programme could combine regular household and neighbourhood inspections with municipal vector-control activities.
Ward-level teams involving health workers, local representatives, teachers, community organisations and trained volunteers could identify breeding sites and monitor local conditions.
A simple weekly "10-minute rule" could make prevention easier to understand: once a week, every household should spend ten minutes checking its home and immediate surroundings for stagnant water and potential breeding sites.
Schools and colleges can reinforce these behaviours, as can workplaces, garment factories, markets and other high-density settings.
Communication should also become geographically specific. National case counts matter to policymakers, but residents need to know whether risk is increasing in their own neighbourhood.
Where reliable data are available, ward- and thana-level information could make public-health messaging more relevant. Mobile alerts and targeted digital communication could then be used when transmission rises in particular areas.
Dengue control is not only about preventing mosquito bites. It is also about ensuring that patients seek appropriate care at the right time.
Public messaging should provide clear guidance on fever management, appropriate testing, medicines that should be avoided without medical advice, warning signs and when urgent medical attention is necessary.
The message should be neither alarmist nor complacent.
People need practical answers: What should I do when fever starts? When should I seek testing? Which symptoms require urgent assessment? Where should I go if symptoms worsen?
Consistent communication from health authorities is essential, particularly during periods when dengue overlaps with other illnesses that can also cause fever.
Bangladesh should not rely indefinitely on chemical insecticides as its only vector-control tool.
One approach that deserves serious scientific consideration is Wolbachia-based population replacement. This involves introducing Aedes aegypti carrying the naturally occurring bacterium Wolbachia into local mosquito populations, with the aim of reducing the mosquitoes' ability to transmit dengue.
Evidence from Indonesia is encouraging. A landmark cluster-randomised trial in Yogyakarta found a 77.1% reduction in symptomatic, virologically confirmed dengue and an 86.2% reduction in dengue hospitalisation in areas where Wolbachia-infected mosquitoes were deployed.
More recent evidence has also strengthened the case for further research. A 2026 systematic review and meta-analysis covering nine studies and more than eight million people found an association between Wolbachia deployment and substantially lower dengue incidence. However, the review also found substantial heterogeneity in some analyses, and results from other countries cannot automatically be assumed to apply to Bangladesh.
The evidence therefore supports serious consideration, not uncritical adoption.
For Bangladesh, the sensible next step would be carefully designed pilot programmes accompanied by independent entomological and epidemiological monitoring. Any decision on wider deployment should consider locally generated evidence, cost-effectiveness, operational feasibility, community acceptance and long-term sustainability.
Bangladesh should be willing to test new technologies, but it should test them scientifically.
The debate over dengue-control spending should move beyond how much money is allocated.
The more important question is what that money achieves.
Procurement of insecticides should be transparent. Their effectiveness and resistance profiles should be independently assessed. Vector-control operations should be evaluated using measurable entomological indicators. Community programmes should have defined coverage targets. Hospital preparedness should be measured against capacity and response indicators.
In other words, dengue spending should be treated as a public-health investment that requires performance measurement, rather than simply as an annual operational expense.
Every taka spent should have a demonstrable purpose in reducing risk.
Bangladesh has accumulated enough experience to recognise that dengue cannot be controlled through emergency campaigns alone.
A permanent national dengue-control framework should rest on five interconnected pillars: year-round surveillance, evidence-based vector control, community participation, hospital preparedness and accountability.
Dengue is no longer a seasonal inconvenience. It is a recurring test of Bangladesh's public-health capacity.
The country does not lack individual interventions. What it lacks is a sufficiently integrated system that connects surveillance to prevention, prevention to preparedness, and preparedness to accountability.
The goal should therefore be more ambitious than managing the next outbreak better than the previous one.
It should be to reduce transmission before hospitals begin filling, identify high-risk areas before outbreaks accelerate, protect vulnerable patients through timely care, and build a system capable of responding continuously rather than episodically.
Bangladesh now needs continuity of policy, stronger institutional coordination, sustained investment in surveillance and a willingness to measure whether interventions actually work.
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Nayema Tasnim is a trainee doctor of cardiology.