Once bitten,better be twice shy

As the spread of mosquito-borne diseases across the country has put the government agencies on toes, the major concern of medical fraternity is why the viruses are becoming more virulent and deadlier by the day. The previous concept of the vector being more lethal every fifth year seems to have gone haywire especially given the dengue and chikungunya outbreak in Delhi this year.

The virus this year has already caused an almost same number of deaths as was the case in 2015, which was believed to be the peak fatal year for the five-year cycle. What has surprised and shocked the medical fraternity was the emergence in the National Capital of chikungunya both in terms of influence and fatalities.

However, it must also be remembered that chikungunya outbreak is not limited to just Delhi but several states including Bengal in the east and Maharashtra in the west are in the grip of the deadly disease as well.

 

The most disturbing element of the epidemic in Delhi this year is the emergence of chikungunya as a fatal disease. In this year over nearly 4,000 confirmed cases of chikungunya have been reported so far while last year it was a three-digit data with no death report. The sudden rise in chikungunya cases has also sparked a debate whether the disease is deadly or not. Delhi Health minister Satyendra Jain earlier declared that the virus cannot cause death because that is what he read on Google but later his ministry notified it into severe category disease. Meanwhile, rise in cases and fatalities exposed ill-preparedeness of Delhi’s health authorities to handle the situation.

Amid growing cases of chikungunya, the health experts have emphasised to stop mosquito breeding and to make people aware of it. “In such a situation the biggest challenge is how to keep oneself safe from mosquito bites. Sensitising people and creating awareness about the disease are the best options as, even fumigation is just a symbolic action,” said an expert.

“Now, the epidemic has occurred in the city. What should we do in order to secure our future from mosquito terror? Every house should talk of ‘no to mosquitoes’ and then only we can be safe from vector-borne diseases. Civic bodies will conduct fogging around our houses, not inside our houses. It’s our duty to make our home free of mosquito-friendly conditions,” he added.

Criticising Municipal Corporation of Delhi (MCD) for not doing early fumigation and failing to maintain drainage system before the onset of monsoon, experts said if the corporations and the government had taken appropriate anti-mosquito breeding measures, the present scenario of health crisis mainly chukungunya outbreak in Delhi could have been avoided or to least, controlled. “The fogging which is being done now is just symbolic. It will not have good results. People should maintain a mosquito-free environment in and around their house to protect their future. Currently, all government and private hospitals are flooded with patients suffering from high-grade fever, chikungunya and dengue,” he added.

Senior health officials from MCD said that the numbers for chikungyunya are much higher due to the outbreak this year. “As the peak time for vector-diseases is September, there is going to be a rise in the number of cases. However, from October onwards, there will be a slight decrease in the cases. There is nothing to panic due to CHIK V outbreak. Keep your body hydrated and maintain a good intake of fluid for a speedy recovery for those who are suffering.”

The symptoms of chikungunya are similar to dengue, but according to experts, chikungunya is generally not ‘life-threatening’ but in rare cases, it can trigger complications which would prove fatal, especially in the elderly and children.

In order to tackle the chikungunya outbreak, World Health Organisation (WHO) has also asked for strengthening India’s disease surveillance network by engaging private healthcare sector more for reliable counts of cases of chikungunya and dengue which have claimed over 80 lives and affected more than 50,000 people across the country. Terming engagement with private healthcare sector as ‘critical’, WHO said that even probable dengue cases during outbreaks need to be reported to get more effective estimates while noting that strong surveillance, vector control, early diagnosis and case management along with public awareness are keys to controlling these vector-borne diseases.

The WHO also said that in recent years, globalisation of travel and trade, unplanned urbanisation and environmental challenges including climate change has had a ‘significant’ impact on transmission of vector-borne diseases. “Surveillance for dengue and chikungunya in India presently captures only those patients that are laboratory confirmed at government identified sentinel hospitals, most of these are in the public sector. Given that substantial population visits the private sector for seeking health care in India, it is important that information from private hospitals and facilities is captured and well-represented for better understanding and estimation of the national disease burden of these infections,” said a WHO representative to India.

Noting that preventing chikungunya virus transmission depends entirely on controlling the mosquito vectors or interruption of human-vector contact, WHO India said that it promoted an Integrated Vector Management (IVM) to control mosquito vectors, including those of dengue. “Transmission control activities should target vector in its immature (egg, larva, and pupa) and adult stages in the household and immediate vicinity. Schools, hospitals and workplaces need to work towards making their premises mosquito-free by reducing any sources where vector breeding can happen.

 Till date, no vaccine is available to prevent dengue and Chikungunya infection, although research is ongoing and the only effective preventive measure is protection against mosquito bites and vector control. Not everyone needs hospitalisation and it is good to know early warning symptoms to seek referral care and very young children and elderly with underlying comorbidities are at greater risk of severe disease and need to be monitored carefully,” he added.

As far as dengue is concerned, with more than 1,600 confirmed cases and nearly 20 deaths, Delhi city has been witnessing severe outbreak this year. The sordid state of affair is that the outbreak is on peak despite knowing culprits and reasons. A study has revealed that maximum breeding has taken place due to rising pollution, unauthorised construction and waterlogging due to faulty drainage system. Experts claim that heaps of garbage, lying unattended in and around the city, has also emerged key place for mosquito breeding. Ill-preparedness and lack of coordination of Delhi’s health agencies have added fuel in the fire.

With more than 60 dengue deaths this year alone, West Bengal is witnessing massive spread in diseases this year. In Darjeeling alone, 56 people have contracted the disease, including 11 from Darjeeling Hills. The number of positive dengue cases is five in Cooch Behar, three in Alipurduar, four in Jalpaiguri, three in North Dinajpur and 70 in South Dinajpur, respectively. Ten cases have been reported in Malda. The state had recorded 15 deaths caused by dengue during the same period last year. 

The only exception is the state capital, Kolkata, where preparedness of government agencies especially Kolkata Municipal Corporation (KMC) have controlled vector-borne disease up to a certain extent.

Darjeeling district chief medical officer of health, Asit Biswas, confirmed that the number of deaths in the district in 2016 is higher as compared to 2015. “There were 56 dengue positive cases reported till September 14 in Darjeeling, of which 33 from SMC. Of 56 cases, 23 have travel history from South Bengal. We’re taking all necessary measures to deal with this,” he told media persons.

To counter the spread of the mosquito-borne disease, Siliguri Municipal Corporation (SMC) will conduct an intensive awareness campaign on dengue, he said. “We will start door-to-door survey to get proper information on dengue cases and will also conduct meet with SMC and other health officers,” Biswas added. “We don’t have complacency, but have instructed all staff, employees and health workers so that they can do the needful. We have also asked counsellors to organise health camps and health awareness programmes,” Siliguri mayor Asok Bhattacharya said.

Kolkata authorities, by chalking a foolproof plan in mid-July, have reportedly minimised the number of cases of vector-borne diseases. The authorities especially Kolkata Municipal Corporation (KMC) has claimed to take elaborate measures on the onset of monsoon to stop the outbreak in the city. The Corporation have claimed not a single death in the city this time and number of affected persons are also lesser. 

“No death of city resident has taken place due to vector-borne disease. Those who have died in the city hospitals are from outside. To maintain the tempo, senior officials of KMC’s health department have been conducting weekly review meeting,” said an official. In a meeting under the National Vector Borne Disease Control Programme in Delhi, the Union Health ministry has lauded the efforts taken up by the Kolkata Municipal Corporation to control malaria and dengue in the areas under its jurisdiction.