A vaccine for dengue fever would actually increase rates of dengue infection over the first few years, according to a study conducted by researchers from Oregon State University and Clemson University, and published in the journal Epidemiology & Infection.
“Our analysis suggests that if we develop and widely use a vaccine for dengue fever, there may later be spikes in the incidence of the disease that are two to three times higher than its normal level,” researcher Jan Medlock said.
At times, use of a vaccine could cause infection levels to increase as much as sevenfold, the study found.
Vaccine less potent than natural immunity
Researchers designed a mathematical model to predict dengue infection patterns following vaccination. Although the computer program was designed to look specifically at dengue fever, the researchers noted that its findings may also be applicable to other diseases.
Dengue fever is a mosquito-borne disease that affects about 50 million people each year worldwide. Although very common in tropical and subtropical regions, the disease is rarely fatal. Because there are several different strains of the dengue virus, being infected a single time does not typically confer lifelong immunity; a second exposure, however, usually does the trick. In Thailand, for example, 80 percent of children have been infected with dengue twice and therefore developed immunity by the age of 11.
“The problem, if and when we develop and use a vaccine, is that it will provide some, but not complete protection, and it will interrupt the natural, fairly steady rate of infections among children,” Medlock said.
According to the computer model — which presumes that, like other vaccines, a dengue vaccine would be less than 100 percent effective — a vaccination program would initially reduce the rate at which children contracted dengue fever. At some point, however, natural fluctuation in mosquito populations would expose these children to the disease again. Because vaccinated children’s immunity would be less than that of people who had actually had the disease, this would create a surge in infection rates.
Given the right cluster of variables, dengue infection rates could jump to as high as seven times pre-vaccination levels, overwhelming healthcare facilities.
Although the specifics of the infection surge from a dengue vaccine are determined by the characteristics of that particular disease, the researchers note that similar effects may have happened in the past, following the introduction of other vaccines.
Could vaccine make dengue more lethal?
The new study provides a vivid example of the law of unintended consequences: You never know what might happen when you interfere with natural processes. Another recent example was the way that dengue fever infection rates actually appear to have increased following the introduction of genetically modified (GM) mosquitoes intended to combat the disease in a region of Brazil.
The mosquitoes are all males engineered to carry a gene in their sperm that kills all their offspring before they reach sexual maturity. When the plan was first announced, biologists and civil society groups warned that killing off dengue mosquitoes could actually increase prevalence of the disease over time, by removing people’s natural immunity. Indeed, this already appears to be happening.
Another concern raised with the GM mosquitoes might also be of relevance to a dengue vaccine: The most dangerous form of the disease, dengue hemorrhagic fever, is most common in people who have had dengue fever twice, but with a long gap between infections. Artificially disrupting the natural rate of dengue infection, whether via GM mosquitoes or vaccines, could actually turn dengue fever into a far more lethal disease.
Sources for this article include:
If people aren’t as concerned about climate change as they should be, one reason may be that the gradual rise of temperatures and ocean waters seems to give us plenty of time to take mitigating measures, such as seawalls to protect coastal cities and genetically-engineered crops that would be able to flourish in the altered environment. It’s harder to understand that climate change may endanger us in other ways that will be more difficult to combat. For example, it may cause a slew of deadly diseases, which are now seen mostly in poorer regions in the tropics, to spread to developed nations in temperate zones.
The latest concern: A newly-published study in BMC Public Health looked at dengue fever, avirus spread by mosquitoes that sickens 50 million people and kills about 12,000 people worldwide each year, mostly in tropical areas.
The researchers found that dengue eventually could become a significant health problem in parts of Europe, including Mediterranean and Adriatic coastal areas that are popular with tourists. Europe is becoming hotter and more humid, conditions that foster the growth of the mosquitoes.
The researchers studied data from Mexico about the occurrence of dengue fever and the effect of climate variables such as temperature, humidity and rainfall, as well as socioeconomic factors, such as population density and income, on the spread of the disease. They then used that data to model the infection rate in various regions of Europe over the next century. In some places, they predicted that rate of dengue fever cases will quintuple, to up to 10 cases per 100,000 inhabitants.
Almost all of the excess risk will fall on the coastal areas of the Mediterranean and Adriatic seas and the northeastern part of Italy, particularly the Po Valley, University of East Anglia medical school professor Paul Hunter said in a press release.
That comes after a 2013 study warned that people in the United States are also at risk from dengue due to climate change. Traditionally, America has only had a few hundred reported cases of dengue each year, usually involving international travelers. But the Natural Resources Defense Council says that the mosquito that transmits dengue now is found in 28 states.
Another 2014 study found that climate change may be increasing the spread of Lyme disease.
As dengue is a deadly disease with more than 90% mortality in untreated cases, no established treatment so far till date.
As an ardent fan of Ayurveda and also a medical doctor i had seen more than 500 cases of dengue.
This Ayurveda so called cure is just a supplement therapy, not a 100% cure.
Readers are advised to use in with the standard treatment modality.
Two (2) pieces of raw Pawpaw (Papaya) leaves. Clean the leaves and pound and squeeze with a filter cloth. You will only get one tablespoon of juice per leaf. So, take two (2) tablespoons of Pawpaw (Papaya) leaf juice once a day. Do not boil, or cook, or rinse the leaves with hot water, as it will lose its strength. Use only the leafy part of the Pawpaw (Papaya) plant, and not the stem or sap. The juice is very bitter, and you have to swallow it. But it works.
Simple and Effective – blend the leaves, squeeze the juice, drink immediately.
1. Male student was in a critical condition in the intensive care unit, when his blood platelet count dropped to 15, after a blood transfusion of 15-litres. The boy’s father was so worried that he sought a friend’s recommendation, and his son was saved. He gave his son the raw juice of the Pawpaw (Papaya) leaves. From a platelet count of 45 (after a blood transfusion of 20-litres), and after drinking the raw Pawpaw (Papaya) leaf juice, his platelet count jumped instantly to 135. Even the doctors and nurses were surprised. After two days in hospital, the boy was discharged.
2. Adult female had a very serious case of Dengue Fever, her platelet count had dropped to 28,000 after 3 days in hospital, and water had started to fill up her lungs, causing difficulty with breathing. She was only 32 years old. Her doctor said there was no cure for Dengue Fever, and she’d just have to wait for her body’s immune system to build up resistance against the Dengue Fever, and fight its own battle. She’d already had two blood transfusions, and her platelet count continued to drop since the first day she was admitted to hospital. Fortunately, her mother-in-law heard that Pawpaw (Papaya) Juice would help to reduce the fever. She got some leaves, pounded them, and squeezed the juice out for her. The next day, her platelet count started to increase, and her fever subsided. The Pawpaw (Papaya) Juice was fed to her, and she recovered after three days. Amazing, but true.
3. It’s believed that the body is overheated when suffering from Dengue Fever, and that Pawpaw (Papaya) Juice has a cooling effect. Thus, it helps to reduce the level of heat in the patient’s body, and the fever then goes away.
4. Pawpaw (Papaya) Juice has also been proven to have beneficial effects on sore throats, or when suffering from heat exhaustion (or overheating).
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Please share your views.
Honest comments and suggestions are always welcome.
Indian scientists have achieved an important breakthrough in their efforts to develop a vaccine to prevent the deadly dengue. Supported by the Department of Biotechnology under the Ministry of Science & Technology, scientists at International Centre for Genetic Engineering and Biotechnology (ICGEB) in New Delhi have developed a non-infectious dengue vaccine from yeast.
Preliminary animal trials of the vaccine have yielded good results.
“Search for a dengue vaccine has been going on across the world for past several decades. We, at our centre, started experiments seven years ago. The new technology we have used, i.e. recombinant DNA technology, to develop the dengue vaccine is a breakthrough,” said Dr Navin Khanna, group leader of Recombinant Gene Products Group, ICGEB. The initial trials done on mice gave encouraging results.
The research team explored virus-like particles which can provide “robust immunity” against the vector-borne disease that is endemic to more than a hundred countries. “There are four closely related dengue viruses (DENVs) that cause this disease. A vaccine that can protect against all four DENVs is an unmet public health need,” said Dr Khanna.
Explaining the need to explore a new technology to develop the vaccine, he said: “Efforts to develop a live attenuated vaccine (a vaccine created by reducing the virulence of a pathogen but still keeping it viable) have encountered unexpected interactions between the vaccine viruses, raising safety concerns. This underscored the need to experiment with non-replicating vaccine options.”
Among the disadvantages of the vaccine developed by live attenuated technology is that it can cause severe complications in patients with low immunity.
The ICGEB scientists used the yeast ‘Pichia pastoris‘ to develop dengue virus-like particles. “Using recombinant DNA technology, we have created non-infectious dengue virus-like particles made of only the major DENV ‘envelope protein’ important for eliciting virus-specific immunity.
These virus-like particles elicit high levels of virus-neutralising antibodies which protected the mice significantly against lethal DENV challenge,” said Dr Khanna. “The encouraging data obtained for virus-like particles specific to one of the four DENVs warrant the development of virus-like particles specific to the remaining three DENV strains,” he added.
Mosquitos were born to bite us, and aside from lighting worthless tiki candles, haplessly swatting them away, or resorting to spraying toxic DEET all over ourselves, there’s really not a whole lot we can do about it. Imagine then, if you could be encapsulated in an anti-mosquito bubble simply by wearing a small square sticker. Not only would it save mosquito-magnets like myself some really uncomfortable moments, it could be a major game changer in the way we prevent mosquito-borne illnesses like Malaria, Dengue Fever, and West Nile Virus.
The good news is that a sticker like this is not some far away concept dreamed up by scientists in a lab–it’s actually a real thing that you’ll likely be able to find on the shelves of your local Walgreens sometime in the not-so-distant future.
Essentially, the Kite Patch is a little square sticker that emits a cloak of chemical compounds that blocks a mosquito’s ability to sense humans. According to its developers, users simply have to place the patch onto their clothes, and they become invisible to mosquitoes for up to 48 hours. This is big news for developing countries like Uganda, where residents have little beyond mosquito nets and toxic sprays to combat the illness-spreading insects.
That’s exactly where Kite’s creators, a collaborative team made up of innovation venture capital group ieCrowd and Olfactor Laboratories, intend to ship these off to as soon as they’re done blowing past their second goal on global crowdsourcing site Indiegogo. Launched just last month, the campaign surpassed its original goal of $75,000 in just four days and is now gunning for a new goal of $385,000 (currently at $336,000).
Though the Kite seems a little fantastical, it’s backed by some legitimate technology. Back in 2011, Dr. Anandasankar Ray, an entomologist at the University of California, Riverside (and founder of Olfactor Labs), found that certain chemical compounds can inhibit the carbon dioxide receptors in mosquitoes. These smelly compounds, which act like a anti-mosquito force field, are able to disorient the bugs, whose main method of tracking down humans is through our exhalation of CO2.
The findings were considered a breakthrough moment in the field, but the technology was far from ready to be applied to a consumer product mostly because the compounds were toxic and wouldn’t be able to pass through FDA and EPA approval. “It wasn’t ready to be placed into a product that could mean something globally,” explains Grey Frandsen, Vice President at ieCrowd. That’s where his company came in.
ieCrowd basically functions as the belt of an innovation assembly line, guiding an idea through the necessary steps so it can become a widely distributed, (hopefully) world-changing product. It begins with acquiring the intellectual property, like they did with Dr. Ray’s research. From there they provide all of the business infrastructure, marketing, and general support so subsidiary companies can focus exclusively on developing new technology. In the case of the Kite Patch, ieCrowd worked with a group of scientists at Olfactor Laboratories, a research facility in Riverside, Calif. that developed a new targeted library of chemical compounds based on Dr. Ray’s original research.
Olfactor’s non-toxic compounds work against mosquitoes’ long-range abilities to detect humans through CO2, as well as dampening the insect’s short-range ability to sense us from our basic human odors. These chemicals, which give off a “faint pleasant smell,” will be applied to a small sticker, which Frandsen notes is the cheapest, easiest, and most adaptable way to design a spatial insect repellant. The patches will then be shipped off to Uganda for field testing, which should begin before the end of the year. “Really, what we’re doing is creating a rapid scientific development process, a rapid prototyping process and then a very aggressive go to market strategy,” Frandsen says of ieCrowd’s method.
The product has had a little help along the way, namely from the National Institutes of Health, the Bill and Melinda Gates Foundation, and the Walter Reed Army Institute of Research. “The big names behind us have helped us advance the science,” Frandsen says. “But those grants do not cover product development.” All of the money raised from the Indiegogo campaign will be funneled into extensive field testing. Originally, the testing was going to provide 20,000 patches (around 1 million hours of coverage) to one district in Uganda. The extra money raised will double the number of Kite Patches shipped and expand the coverage to four million hours in three political districts in the country.
“This technology is too important to just funnel directly to the Walgreens.”
The idea is to refine the Kite as much as possible during the field testing and hone in on three main goals, the first being to analyze the adaptability of the patch. So, is it easy to apply and wear? Does it work well both at morning and at night? Does it fall off people’s clothing at after a certain point? The second is to test the effectiveness of the technology in harsh conditions found in places like Sub-Saharan Africa. Scientists have yet to determine exactly how far the sticker’s spatial radius extends and will be looking to see how it reacts to wind and extreme weather. Lastly, the field testing will evaluate how the sticker interacts with and can supplement current malaria prevention technology like bed nets.
“We’re looking at: What are any shortfalls specifically relating to the design that we can solve for that don’t come from testing it with 100 people in the Canadian Rockies or in Florida?” Frandsen says. “So there’s this real life, real world use and evaluation of that.” The Kite has reportedly performed well inside the highly-controlled confines of a lab, but Frandsen says the most vital evaluation will come from the Kite Patch’s time in Africa. “It’s a really unique way of doing product development,” he says of the extensive field testing. “It’s a lot easier to deal in private-equity markets or investments and just finish it.” But, he continues, “This technology is too important to just funnel directly to the Walgreens. It needs to be part and parcel of people’s daily lives all over the world.”
Dengue is the second most common mosquito-borne disease affecting human beings. In 2009, WHO endorsed new guidelines that, for the first time, consider neurological manifestations in the clinical case classification for severe dengue. Dengue can manifest with a wide range of neurological features, which have been noted—depending on the clinical setting—in 0·5—21% of patients with dengue admitted to hospital. Furthermore, dengue was identified in 4—47% of admissions with encephalitis-like illness in endemic areas. Neurological complications can be categorised into dengue encephalopathy (eg, caused by hepatic failure or metabolic disorders), encephalitis (caused by direct virus invasion), neuromuscular complications (eg, Guillain-Barré syndrome or transient muscle dysfunctions), and neuro-ophthalmic involvement. However, overlap of these categories is possible. In endemic countries and after travel to these regions, dengue should be considered in patients presenting with fever and acute neurological manifestations.
Clinical suspicion is essential for diagnosis of dengue because many symptoms are non-specific. Various methods are available for laboratory confirmation. During the first days of infection, dengue virus is present in blood; thus, at that time, detection of NS1 antigen or RNA by RT-PCR and viral culture are appropriate diagnostic methods.1 Dengue virus-specific IgM antibodies are present in serum samples 3—10 days after disease onset.1 IgM capture (MAC)-ELISA is the most widely used serological test. Antibodies against other flaviviruses (eg, Japanese encephalitis, West Nile virus, yellow fever) might cross-react with dengue virus, leading to false-positive reactions.136
In endemic countries, or among travellers who recently (<14 days) returned from such regions, dengue should be ruled out in patients with fever and neurological features (panel 2). If possible, lumbar puncture should be done and CSF analysed for abnormalities and for dengue virus-specific antibodies, NS1 antigen, or dengue virus RNA, depending on available laboratory facilities. Differential diagnosis in patients with febrile encephalopathy includes malaria, tuberculosis, leptospirosis, rickettsial infection, and other bacterial or viral diseases (caused by, for example, Japanese encephalitis, West Nile virus, or herpes simplex virus [HSV]), depending on the local epidemiology. In a prospective hospital-based study in Vietnam, most children with acute encephalitis of presumed viral origin were infected with Japanese encephalitis (26%), followed by enteroviruses (9%) and dengue virus (5%).30 In adults and adolescents in Brazil, dengue was the leading cause of viral encephalitis (47%), followed by infections with HSV-1.31
To differentiate dengue encephalitis from encephalopathy, detection of dengue virus, NS1 antigen, or dengue virus-specific IgM antibodies in CSF is helpful. Nevertheless, sensitivity of serological techniques can be low. Dengue virus-specific IgM antibodies have been recorded in CSF of 22—33% of patients diagnosed with dengue encephalitis (Table 1, Table 2).90Detection of dengue virus in CSF could be hampered by low sensitivity of RT-PCR in CSF, compared with findings in serum, because of a lower viral load.137 Moreover, measurement of IgM antibodies in CSF might not be a reliable diagnostic marker of dengue CNS involvement, owing to low titres in CSF.138 Abnormalities in CSF—such as lymphocytic pleocytosis—support the diagnosis of dengue encephalitis, but they are not always present (Table 1, Table 2, Table 3). A mild increase in CSF protein has been recorded.28 In a series of patients with neurological complications of dengue, four of seven with encephalitis had no alterations in CSF.90 Therefore, normal CSF cellularity should not exclude dengue encephalitis.
The case definitions in panel 2 are designed to be used epidemiologically and clinically and to guide diagnosis and prognosis. Although we propose criteria for a classification scheme, a topic as challenging and as controversial as dengue encephalitis needs to be addressed in a standard way. Prospective studies are needed to assess the specificity and sensitivity of the proposed case definitions and to generate supporting evidence. Cases fulfilling neither the definition for encephalitis nor that for encephalopathy—eg, without CSF testing or when categories are overlapping—can be categorised as other or non-specified dengue CNS involvement.
Neuroimaging might provide additional clues in the diagnosis of neurological complications of dengue. In dengue encephalitis, brain MRI can be normal or show focal parenchymal abnormalities.22, 41 Nevertheless, no specific MRI findings suggestive of dengue encephalitis have been reported. Neuroimaging features of patients with dengue are diverse, with cerebral oedema the most commonly reported finding.77 Meningeal enhancement on post-contrast MRI has been reported occasionally as well.77
Finally, EEG abnormalities can be seen in dengue patients with neurological complications. In a study of 23 patients with dengue virus infection and neurological symptoms, EEG abnormalities were recorded in 12 people.139 Slowing on EEG can be seen, but this finding is unspecific and could be attributable to seizures, intracranial haemorrhage, and viral infection per se, besides encephalopathy.77
Currently, no effective antiviral agents are available to treat symptomatic dengue virus infection.140 Therefore, management remains supportive. In mild cases, antipyretic drugs and oral fluids could be useful. Acetyl-salicylic derivatives and other non-steroidal anti-inflammatory drugs should be avoided. Management of haemorrhagic complications should be initially conservative. Precise management of intravenous fluids is needed, and blood or platelet transfusion is only necessary when severe bleeding takes place.1
In patients with severe dengue and signs of plasma leakage, prompt fluid resuscitation is imperative, with close monitoring of packed-cell volume to avoid fluid overload. Isotonic crystalloid solutions should be used, with isotonic colloid solutions reserved for patients presenting with profound shock or those who do not have a response to initial crystalloid treatment.140, 141 In a randomised controlled trial from Vietnam,142 use of oral prednisolone during the early acute phase of dengue infection was not associated with a reduction in the development of shock or other recognised complications of dengue virus infection.
For supportive management of patients with neurological manifestations, possible underlying causes such as intracranial bleeding, liver failure, hyponatraemia, hypokalaemia, or metabolic acidosis should be ruled out and—if possible—corrected. Management of dengue encephalitis remains supportive and should include adequate hydration, nutrition, monitoring of consciousness, and maintenance of airways.143 Symptomatic seizures should be treated with non-hepatotoxic anticonvulsants. Decompressive craniotomy and cerebral haematoma evacuation were done in two patients with dengue after correction of prothrombin time and platelet count.92 Nevertheless, prognosis is not good and, in one case series, two of five patients died.92 At this moment, haematoma surgery cannot be proposed as a routine treatment for dengue virus intracranial bleeding.
Some clinicians recommend treatment of immune-mediated dengue CNS involvement with pulses of intravenous methylprednisolone for several days.50, 69, 72 However, up to now, no randomised controlled trial has been undertaken to show the efficacy of this approach in patients with dengue myelitis or acute disseminated encephalomyelitis. High doses of intravenous immunoglobulin might be useful to treat post-dengue Guillain-Barré syndrome. Supportive treatment—including hydration and analgesic drugs—is used for myalgia and transitory muscle dysfunction. The effectiveness of corticosteroids in dengue myositis remains to be proven.
No treatment has been approved for neuro-ophthalmic manifestations of dengue. Steroids have been administered previously because of possible underlying immune mechanisms, although up to now no randomised trials have been done. Topical steroids have been used to treat anterior uveitis, whereas pulsed intravenous methylprednisolone or systemic oral steroids might be indicated for extensive retinal vasculitis.120
Currently, no vaccine is available for protection against dengue. However, several vaccine candidates are in development.
Conclusions and future research
Dengue should be included in the differential diagnosis of acute febrile disease with neurological manifestations in dengue-endemic countries and in patients with a recent travel history to an endemic region. Many neurological manifestations of dengue have been recorded, ranging—with substantial overlap—from encephalitis and encephalopathy to immune-mediated syndromes and muscle involvement. Recent evidence suggests that dengue virus has neuroinvasive capacity. In several studies in endemic areas, a large proportion of viral encephalitis was caused by dengue virus.26—32 However, even though CNS involvement is included now as a criterion for severe dengue in the 2009 WHO case classification,1 no standardised case definitions or diagnostic criteria for dengue encephalitis or encephalopathy have been agreed, which leads to inconsistent use of these terms in published work.
An updated WHO dengue guideline should include a case definition for dengue encephalitis and encephalopathy, to guide clinicians and clinical epidemiological researchers into this topic. A case classification—such as the one proposed in panel 2—could serve as a starting point, which could be reviewed by WHO, agreed by consensus and best available current evidence, and refined as additional data become available from prospective studies. For this reason, assessment of CSF in patients with suspected neurological manifestations of dengue should be standardised. Very few published reports present findings of CSF testing for dengue virus, dengue virus-specific IgM antibodies, or NS1 antigen combined with CSF cellularity and confirmation of dengue in serum samples in a consistent way. Further epidemiological and neuropathological studies are needed to ascertain the true incidence and burden of neurological complications of dengue, to elucidate the underlying pathophysiology, and to assess the sensitivity and specificity of diagnostic markers for dengue encephalitis.
The global health burden of dengue could be much higher than previously thought. In modeling work published, a team led by Simon Hay, an epidemiologist at the University of Oxford, UK, estimated that 390 million people around the world were infected with the mosquito-borne virus in 2010, a figure more than three times greater than that given by the World Health Organization.
Only around a quarter of all the dengue cases were ‘apparent’—requiring medical treatment or making people miss work or school—so the findings are unlikely to greatly affect clinical practice. However, the large number of previously unrecognized people with mild or asymptomatic infections could have an impact on future mosquito control efforts or vaccination campaigns. “The bigger the problem, the more important become any efforts to prevent it,” says Donald Shepard, a health policy researcher at Brandeis University in Waltham, Massachusetts, who studies dengue.
With the rising number of people catching dengue fever, the demand for papaya leaf juice has soared. The extract of raw papaya leaf helps boost platelets, also known as thrombocytes.
Dengue is transmitted by mosquitoes and can be fatal. Common symptoms include fever with headache, severe muscle pain, joint pain and rashes on the body. There is no effective medicine for dengue.
Traditionally, the juice of papaya leaf has been found to be useful in the treatment of dengue fever. Few recent studies have shown the effect of papaya leaf juice in curing dengue fever. A recent study done on five dengue patients by Indian Institute of Forest Management has shown some interesting observations.
Among five patients, papaya leaf juice was found to be effective in curing dengue.
The number of platelets increased in all five patients within 24 hours of drinking the juice, with all patients reporting significant improvement in their health. It seems that this bitter green juice is promising without posing any serious ill-effects. As a result, pharmaceutical and nutraceutical companies are already formulating papaya leaf extract preparations.
Interestingly, papaya leaf has also been found to possess powerful anti-malarial and anti-cancer properties. Papaya leaf extract has been used in some parts of the world as a prophylactic to prevent malaria in endemic regions. According to research published in the Journal of Ethnopharmacology published in 2010, doctors and researchers from US and Japan have discovered that enzymes found in papaya leaf have cancer fighting properties and are known to work against cervix, breast, liver, lung and pancreatic cancers. According to the study, papaya leaves are not known to have toxic effects and their consumption does not have side effects. Some doctors are beginning to recommend papaya leaf tea as part of chemotherapy.
These benefits may not be surprising as a study by Purdue University in United States showed that papaya leaf consists of over 50 active ingredients found to kill fungi, worms, parasites, bacteria and many forms of cancer cells. Papaya leaves contain important nutrients that support the immune system, including vitamins A, C, and E.
For dengue fever it is suggested that the juice is extracted by crushing fresh leaves of papaya. One leaf of papaya gives about one tablespoon of juice. Two tablespoons of papaya leaf juice are given to dengue patient three times a day — once every six hours.
Remember, this is not a substitute for medical advice.