Millennium Post

Battling dengue, chikungunya manace

More than 28,000 cases of dengue have been reported in the country, and it is not even October. This vector-borne disease has reached alarming proportions in Kerala, Telangana, Uttar Pradesh, and West Bengal. With 24 deaths reported so far, West Bengal is the worst-affected state. Last year, the death toll was 14. Already, 5,600 cases have been reported. The number of cases will increase in the coming six weeks before the incidence of the disease is expected to fall. Casualties have been higher in areas where stagnant water is a perennial problem. The civic agencies are being blamed for the alarmingly high number of dengue deaths this year.

Uttar Pradesh, which has seen a three-fold jump in dengue cases as compared to last year, suffers from the same problem: stagnant water, especially at construction sites. As many as 2,173 cases have been reported till September 12 as against 731 in the corresponding period in 2015. Three people have died. About 24 districts are currently under its grip. According to official data, 179 cases were reported in the past 24 hours.

Delhi ill-equipped
At least 1,158 cases of dengue have been reported in the national capital with nearly 390 of them being recorded in the first 10 days of September. This is the time when this vector-borne disease begins to peak. In October, the city recorded a staggering 7,283 cases in October alone. With October still a week away, the national capital is expected to see a major rise in dengue cases. At least nine deaths due to dengue have been reported so far.

The magnitude of the problem is realised when you know that government hospitals in the city are running out of beds. Serious questions have been raised about whether health infrastructure of Delhi can cope with the crisis since it has less than three beds per 1,000 people, far less than five per 1,000 recommended by the WHO.

Moreover, the flu outbreak has hit the capital’s primary labour force. Work on roads and bridges are delayed by weeks as migrant workers leave the city. Disease outbreak has also depleted sanitation workforce in East Delhi.

Kerala shows the way
Down south, 5,286 cases were reported in Kerala till August, as against 4,114 in 2015. However, thanks to early detection of the disease, the death toll has been contained. Nine people have died as against 29 last year. Health officials have managed the dengue outbreak effectively so far by setting up blood transfusion facilities in every districts and talukas. Getting platelets has become a lot easier for patients.

Hyderabad and Bhubaneswar struggle
Hyderabad has reported seven deaths till August this year against just two in 2015. In the same month, it recorded 135 cases, almost double the cases (73) it witnessed last year.

Dengue fever scare gripped Bhubaneswar after seven persons from the Salia Sahi slum here tested positive for the disease in the last week of August. It is only after the cases surfaced that the administration stepped up measures to prevent and curb incidents of dengue.

Under-reporting of dengue cases
The figures released by corporations and government agencies are not reflective of the crisis because there has been massive under-reporting of cases. In absence of a robust infrastructure in government health facilities, a good number of patients don’t visit government hospitals and resort to private practitioners close to their places of residence. Those cases often don’t get recorded in official data.
Chikungunya cases on the rise
Chikungunya cases are mounting in the country’s capital, crossing the 1000-cases mark. For the first time, chikungunya has led to three deaths in New Delhi.

The first of these was reported on Monday, September 13 when a 65-year-old man succumbed to the mosquito-borne infection at a private hospital. Details of the other two are yet to be known.

A total of 1,057 chikungunya cases were recorded this year till September 10. Of these, 497 cases were recorded in the past week alone.

A surge in cases was also seen in other parts of NCR including Ghaziabad and Noida. As per the district health department, 82 chikungunya cases have been reported in Ghaziabad.

While the municipal corporations in Delhi claim to check breeding regularly, the spread of chikungunya continues. So far this year, the civic bodies have sprayed over 15 lakh houses and conducted over two crore home visits to check for mosquito breeding, as per a media report.

Till August 31, 12,255 cases of chikungunya have been reported in India, as per the National Vector Borne Diseases Control Programme. Of these, nearly 73 percent or 8,941 have been in Karnataka. Other southern states of Andhra Pradesh and Telangana registered 492 and 404 cases respectively. Maharashtra reported 839 cases in the period. In East India, West Bengal reported 389 cases and Tripura and Meghalaya witnessed 86 and 32 cases respectively, as of August 31. The numbers can be expected to rise in September if the trends in other states resemble the capital, where almost half of the total cases were reported in one week.

The total number of chikungunya cases in India has been rising since 2012. The figure reached over 27,000 cases in 2015.

Chikungunya is a viral disease transmitted to humans by mosquitoes. It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue, and rashes. The disease spreads from the sting of an infected female Aedes aegypti mosquito. The spread of chikungunya can be curbed by checking open breeding grounds for mosquitoes.

Climate change and vector-borne diseases go hand in hand
A change of climate over time due to natural or man-made causes is increasingly playing an important role in spreading the extent of vector-borne diseases (VBDs).

According to the World Health Organization, one of the major consequences of climate change is the rise in the number of VBDs, besides heat strokes and skin diseases.

The development of mosquitoes and pathogens in their bodies is affected by climatic conditions, experts says. Ramesh Dhiman of the National Institute of Malaria Research told Down To Earth that temperature is essential for the development of malarial parasites. “Insects are cold-blooded. Temperature affects the development of vectors or pathogens,” he said.

In India, Jharkhand and Chhattisgarh are already suitable places for the transmission of vector-borne diseases. But the worrying thing is that in colder areas such as the Himalayan region, projected temperature rise can trigger the breeding of mosquitoes and the rate of transmission. Places like Jammu and Kashmir and Uttarakhand will have to deal with vector-borne diseases, according to Dhiman.

As dengue is the most deadly of all VBDS (others being malaria, filaria, Japanese encephalitis, chikungunya), Dhiman added that preventing water storage and community participation were vital to prevent outbreaks. The major cause of dengue is water storage in all types of containers. As it is not possible for the government alone to ensure that water does not stagnate, the participation of people becomes important here, he said.

The epidemiology of dengue in India has changed over the years in terms of strains, geographical location, and severity. Along with temperature rise, rainfall, and relative humidity, wind velocity also play an important role in the development of parasites in insects.

According to Asish Ghosh, the director of Centre for Environment & Development, a Kolkata-based non-profit, increasing cases of VBDs can be regarded as the indirect health effects of temperature variations. Temperature rise can lead to floods, especially in the coastal areas and this may, indirectly, lead to an increase in VBDs. Stagnant water serves as breeding grounds for mosquitoes, and thereby, increases the chance of dengue and malaria.

Ghosh said that all tropical diseases, especially malaria, are prevalent in the southern hemisphere. Mosquitoes breed faster due to high temperature and moisture level. Several studies have shown the higher rate of breeding and outbreak of VBDs occur in hot and humid conditions.   

“By 2030-50, India will witness a high level of malarial outbreak and will become the malaria capital of the world,” Ghosh added. The mosquito parasite is already present in the country and further temperature rise will make the situation worse.

Ghosh emphasised on adaptation measures, especially in coastal areas, to cope up with the situation. According to him, coastal areas should be equipped with vector-borne disease control programmes. People should be encouraged to use mosquito nets. Water should be purified to prevent contamination. 

In India, VBDs are also prevalent due to poor sanitary conditions, Ghosh said. Water-logging and open defecation make matters worse in the country, the expert added. 

(The views expressed are strictly those of Down to Earth.) 
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