Papaya leaf extract for dengue fever

Current dengue outbreak in Singapore

COVID-19 is on the mind of everyone for the past few months. However, many do not know there is another virus outbreak in Singapore: dengue. The number of weekly reported dengue cases has surged up to 1,671 in the week ending 11 July 2010. This number is nearly double the highest record of 891 previously recorded in 2014 [1]. As of 13 July 2020, the cumulative number of dengue cases has already reached 17,200, and the number is expected to exceed the highest available record of 22,170 cases reported in 2013 [1]. Unlike the coronavirus of COVID-19, dengue virus is not airborne. Instead, the dengue virus is spread by the mosquitoes, specifically Aedes. As such, public health measures have been focusing heavily on reducing and eliminating mosquito breeding habitats.

**Dengue fever is spread by mosquitoes.**

The common symptoms of dengue are a sudden onset of fever for two to seven days accompanied by severe headache with pain behind the eyes. Many also have joint and muscle pain and skin rashes. Dengue infection is known to destroy platelets, colourless blood cells that help blood clot, causing a condition called thrombocytopenia [2]. For severe cases of dengue, patients may develop internal bleeding that can be fatal if not treated properly. For most cases, however, the infection is self-limiting, and the patient will recover after 3 to 10 days [3].

A plant-based traditional remedy supported by research evidence

Papaya leaf extract is a popular traditional medicine for dengue fever in East and Southeast Asia. A study in Malaysia found 22.2% of the 306 patients with dengue fever who visited a hospital in Kuala Lumpur had tried this remedy [4]. Its use is even more common in the less-developed, northeast region of Peninsular Malaysia in the states Kelantan, Terengganu and Pahang. Another study found 64.2% of the surveyed patients used papaya leaf extract [5]. This remedy is also reported to be a widely used plant-based formula for dengue fever in India [6]. The question is, “Does it help?”

**Papaya tree is a common sight in Southeast Asia.**

Due to its popularity, there have been several clinical trials conducted on the use of papaya leaf extract for dengue fevers. A system review published in 2019 found a total of nine randomised controlled studies [7]. Papaya leaf extract was administered in many different forms, including fresh juice, capsule, tablet, and syrup, in these clinical trials. Seven of the studies showed an increase in platelet counts in patients who received papaya leaf extract.

**Papaya leaf is now sold as dietary supplement in health stores.**

A meta-analysis of these studies showed that the use of papaya leaf extract might reduce the duration of hospital stay and improve platelet counts between the first and fifth day of treatment. There was no reported adverse effect. However, the quality of the studies is considered low [7]. A more recent clinical trial used papaya leaf extract to treat dengue patients with severe thrombocytopenia (≤30,000/μL). Papaya leaf extract treatment was found to be more effective than placebo in increasing platelet counts. It also reduced the need for platelet transfusions and caused faster recovery of platelet count to ≥ 50,000/μL [8]. Hence, promising evidence supporting the use of papaya leaf extract for dengue fever is emerging.

A method of preparation

Here is a method of preparing papaya leaf extract syrup at home, as suggested in an article published in the British Medical Journal [8]:

Use only fresh, healthy mature papaya leaves from a fruit-bearing tree.
Wash the leaves thoroughly with running tap water.
Remove the main stem and chop the leaves into small pieces.
Put papaya leaves (50g) and put it into a mortar and pestle.
Add cool water (50ml) and sugar (25g).
Pound the mixture well into a uniform pulp (15 min).
Mix the pulp thoroughly and keep for 30 minutes.
Squeeze the pulp by hand and get the papaya leaf extract (the author advised not to use a cotton sieve to extract the juice).
Store this preparation for 24 hours in the lower compartment of the refrigerator (+4 ^oC).
Shake well before serve.

**You can also make your own with fresh leaves.**

Guidelines for use

For anyone interested in using this papaya leaf extract for dengue, here are some guidelines [8]:

If suffering from fever, headache or body pain, please get a dengue test as soon as possible.
If the result is positive, please receive medical treatment immediately. Papaya leaf extract should be used as a supplement.
For best results, start taking papaya leaf extract from the first day of fever.
The dosage is 30ml three times a day before meals for an adult and 5-10ml three times a day for a child.
Take until full recovery; do not stop halfway.
Drink the extract neat without mixing with water or juice. To overcome the bitter taste, take a few sips of cold water immediately after receiving the extract.
If you are allergic to papaya, do not try this remedy.

You can make papaya leaf extract at home with a mortar and pestle.

References

[1] NEA | Dengue Cases, (n.d.). https://www.nea.gov.sg/dengue-zika/dengue/dengue-cases (accessed July 17, 2020).

[2] T.A. da C. Barros, L.M. De-Oliveira-Pinto, A view of platelets in dengue, in: Pankaj Abrol (Ed.), Thrombocytopenia, IntechOpen, 2018: pp. 7–31. http://dx.doi.org/10.5772/intechopen.73084

[3] S. Hasan, S.F. Jamdar, M. Alalowi, S.M. Al Ageel Al Beaiji, Dengue virus: A global human threat: Review of literature, J. Int. Soc. Prev. Community Dent. 6 (2016) 1–6. http://doi.org/10.4103/2231-0762.175416

[4] S. Ching, V. Ramachandran, L.T. Gew, S.M.S. Lim, W.A.W. Sulaiman, Y.L. Foo, Z.A. Zakaria, N.H. Samsudin, P.C.M.C. Lau, S.K. Veettil, F. Hoo, Complementary alternative medicine use among patients with dengue fever in the hospital setting: a cross-sectional study in Malaysia, BMC Complement. Altern. Med. 16 (2016) 37. http://doi.org/10.1186/s12906-016-1017-0

[5] I.S. Ismail, S.M. Hairon, N.M. Yaacob, A.M. Besari, S. Abdullah, Usage of traditional and complementary medicine among dengue fever patients in the northeast region of peninsular Malaysia, Malays. J. Med. Sci. 26 (2019) 90–101. http://doi.org/10.21315/mjms2019.26.3.7

[6] P.K. Singh, P. Rawat, Evolving herbal formulations in management of dengue fever, J. Ayurveda Integr. Med. 8 (2017) 207–210. http://doi.org/10.1016/j.jaim.2017.06.005

[7] S. Rajapakse, N.L. de Silva, P. Weeratunga, C. Rodrigo, C. Sigera, S.D. Fernando, Carica papaya extract in dengue: a systematic review and meta-analysis, BMC Complement. Altern. Med. 19 (2019) 265. http://doi.org/10.1186/s12906-019-2678-2

[8] D.T. Sathyapalan, A. Padmanabhan, M. Moni, B. P-Prabhu, P. Prasanna, S. Balachandran, S.P. Trikkur, S. Jose, F. Edathadathil, J.O. Anilkumar, R. Jayaprasad, G. Koramparambil, R.C. Kamath, V. Menon, V. Menon, Efficacy & safety of Carica papaya leaf extract (CPLE) in severe thrombocytopenia (≤30,000/μl) in adult dengue – Results of a pilot study, PLoS One. 15 (2020) e0228699–e0228699. http://doi.org/10.1371/journal.pone.0228699