The country is in the throes of vector-borne diseases epidemic and diseases like dengue and chikungunya continue to create havoc across the India including National Capital Region (NCR) and northern states especially Uttar Pradesh and Haryana. Story discusses the scale and sweep of the diseases and what we need to learn from this year
Dengue is one of the most common mosquito-borne viral disease in the world - around 40% of the world’s population lives in places of risk of dengue infection. In a year, 400 million new infections are recorded and about 5% of the patients present a severe form of dengue, with 25,000 deaths being reported each year. Before 1970, dengue was reported from only nine countries, however, by 2015, the World Health Organization (WHO) records over 100 countries in the world reporting locally contracted dengue fever.
In India, besides dengue, chikunguniya – another mosquito-borne disease has been playing havoc with the health of people. While previously it was limited to some parts of the country, over the years it has pervaded the entire country as the chart shows.
Already, 12,255 cases of chikungunya and 28,000 cases of dengue were reported until August 2016. So far, over 60 deaths have been recorded from dengue fever this year. The national capital alone has recorded over 1,600 dengue cases this season.
Earlier, these diseases were mostly confined to the south and eastern parts of India that are closer to the equator and the warm seas, but today both these diseases are spreading their fatal footprints across north India. Nearly 4,000 cases and 35 deaths due to vector-borne diseases alone have been recorded in the national capital so far this year.
According to municipal corporation’s data released in the end of third week of September, 2,625 - chikungunya cases and 1,378 dengue cases have been found. Till mid of September, AIIMS laboratory has noted 1,748 chikungunya cases.
According to Municipal Corporation of Delhi (MCD) records there have already got 240 new cases of dengue have been reported in the last week (last week of September) while over a 1000 cases have been recorded this month, 628 of chikunguniya in Delhi and 714 in the neighboring Gurgaon and Noida.
Compared with the previous figure 1,057 released in the second week of September, a jump of 150 per cent is seen with 1,568 of them being recorded in just the last week of September.
And these are cases mostly from government-run hospitals. Fifteen deaths due chikunguniya were reported this month at Sir Ganga Ram Hospital, Apollo and AIIMS, as per the report.
The cases with thousands of smaller, independent private practitioners and those working in a volunteering capacity in slums and informal settlements are not collected, so many doctors agree that actual cases are much more.
“There are many people, especially from the poorer sections of society who are suffering from one of these VBD’s but cannot afford or just avoid blood tests, in addition, there are others from across all sections of society in the blood tests of whom it may not show up,” says Dr. Pushpinder who runs a clinic both in an up-market neighborhood in south Delhi as well volunteers with Chikitsa, a primary health-care initiative for slum-dwellers.
Doctors in Apollo Hospital, Fortis, Batra Hospital and Max Healthcare report they are receiving more than 200 cases, complaining of high fever along with acute pain per day and claim they have no space to deal with such large numbers of patients.
All private and government hospitals are flooded with dengue and chikungunya patients with thousands suffering from acute high grade fever (viral fever). The need of the hour, additional beds have been placed to accommodate thousands of patients at all the hospitals in the NCR.
Besides, about 375 positive cases of dengue have been reported in health centres located in Chandigarh. Out of these, 98 patients belong to the union territory. The Malaria Wing of Health Department of Chandigarh Administration has beefed up field activities for Prevention and Control of Dengue.
The Ministry of Health and Family Welfare continue to downplay the seriousness of the situation insisting that the disease can hardly be described as having reached `epidemic’ proportions.
Expressing concern over rise of dengue and chikungunya cases, Union Health Minister JP Nadda has been meeting state health ministers across the country, including Delhi Health Minister Satyendra Jain to discuss the situation. He has assured all support to the city government even as they asserted that no patients were being turned away without treatment and there was no shortage of doctors and drugs, and the problem was under control.
Even though 2015 statistics show the reporting of over one lakh dengue cases, and in independent studies, scientists from the US-based Johns Hopkins Bloomberg School of Public Health (JHBSPH) reported the number of dengue and chikungunya cases are much higher than what are being officially recorded.
This denial marks the official attitude towards malaria and dengue cases also which has shown an upward swing this year. Official figures show that around two million get malaria and around 700 people die from it.
VBD in context of poor health indices
It is agreed that the dengue and chikungunia virus itself are usually not the cause of death unless it is of the hemorrhage type in the former, and afflicts very young children and old people in the latter. But VBD’s can have a fatal effect if the immunity system is already weak and the person has anemia, is under-weight, poorly nourished, etc.
Dr. Fuad Halim, GP in Kolkata said recently in a TV interview that unfortunately mosquitoes understand human psychology better than politicians. He said that given the fact that an overwhelming number of people in cities and towns of India depend on public sources of water that is available for just a few hours during the day – collecting and storing water is an inevitable part of life.
Municipal bodies need to work on safe, regular supply of water with properly monitored drainage systems to be able to tackle the unchecked breeding of mosquitoes.
Poor coverage of rural areas
The problem is that a large number of these deaths take place in rural and semi-rural areas where patients do not have access to laboratory facilities. The government figures are restricted to laboratory reports whereas a large number of people go to private doctors who do not insist on getting blood samples of the patient.
Doctors working with the recently launched National Framework for Malaria Eradication believe there is an urgent need to change the traditional strategies of destroying adult mosquitoes and their larvae and moving to a parasite control strategy to contain the infection. The JHBSPH team of doctors took blood samples of more than one thousand people across 50 Chennai colonies of both affluent and poor and found almost all had dengue while half suffered chikungunya.
Dr Izhar Gauri, director of Alpine Hospital, Gurgaon shared, “From October, there will be a slight decrease in cases, but the need to start learning from this year’s experience and ensuring that we are much better prepared cannot be overestimated.”
Perhaps the government’s own wings need to be more closely listened to. In February this year the National Vector-borne Disease Programme under the Ministry of Health had stressed the importance of vector management as being the single most effective way to reduce impact of vector-borne diseases in its Manual.
This is far less a health issue and much more an environmental and municipal hazard as the manual clearly underscores. Draft provisions have been laid down.
The key difficulty that patients and doctors face is in recognizing which is what, given the similar symptoms of diseases. Chikungunya is a viral disease which has symptoms similar to that of dengue fever.
Malaria: Malaria is caused by the transmission of plasmodium though the spit of Anopheles mosquitoes into the body’s system. The female mosquitoes generally attack during the day. Malaria is recognised through high fever, which generally comes over a period of 2-3 days. Along with fever, patients will experience chills, and may also suffer from constipation, kidney dysfunction and disorientation.
Anti-malarial drugs are easily available in medical stores. Drugs like chloroquine and artemisinin can be purchased after consultation with a trained doctor.
Chikungunya: It is caused the female Aedes mosquitoes. It mainly affects muscle cells of the body and may cause it excessive pain and swelling in the joints. Rashes are common too. Patients may feel pain behind the eyes and retro-orbital pain. Joint pain is more severe in Chikungunya than in dengue.
Dengue: This too is transmitted through female Aedes mosquitoes. It is a viral disease. In cases of blood transfusion, the Aedes mosquito transfers disease from one infected human to another. Aedes mosquitoes attack during the night. Symptoms of dengue are similar to that of Chikungunya. Bouts of fever is followed by severe body pain. Pain behind the eyes and decreased urine output is also common. Patients may also suffer respiratory difficulties.
Problem worsening over the years
The sudden spike in chikungunya cases in Delhi and several other parts of north India, has come nearly 10 years after a big outbreak of the mosquito-borne disease across the country.
The national capital has now turned into a breeding for mosquitoes, as an outcome of comparatively heavy rainfall this year.
In 2006, over 13 lakh suspected chikungunya fever cases were reported across the country, according to National Vector Borne Disease Control Programme (NVBDCP).
In 2015, only six cases were reported in June, while 36 were registered in July. In 1996, a severe outbreak of dengue had occurred in Delhi when about 10,252 cases and 423 deaths were reported.
With the growing incidence of severe dengue epidemics since the 1970s, the World Health Organization (WHO) has reported cases across the Americas, South-East Asia, and the Western Pacific exceeding 1.2 million in 2008 and more than 3 million in 2013, based on official data submitted by member states.
These numbers continue to increase: 2.35 million cases of dengue were reported in the Americas alone in 2013; of this number, 37,687 were cases of severe dengue
Ø Dengue is endemic in Jamaica, with epidemics reported as recently as in 2012. In that year, 93% of American missionaries returning from Jamaica showed serologic evidence of recent or past infection with the Dengue Virus. The Dengue Virus-1 serotype was first reported in the Americas region in 1977 after an outbreak that began in Jamaica and expanded to Cuba, Puerto Rico, and Venezuela and eventually to the rest of the Caribbean countries, Mexico, Central America, and the northern countries of South America
The Jamaican Ministry of Health has been working tirelessly to prevent dengue outbreaks and fatalities through the implementation of control interventions
Ø Florida has also seen other, related mosquito borne diseases this year via travel. Forty cases of dengue with onset in 2016 have been reported in individuals with travel history to a dengue endemic country in the two weeks prior to onset. Countries of origin were: Brazil (3), Colombia (3), Costa Rica (5), Cuba (7), Dominican Republic (2), El Salvador, Ghana, Haiti (3), Honduras, Indonesia, Jamaica (5), Mexico, Puerto Rico (2), St. Barthelemy, Singapore, and Venezuela (3).
Six cases of chikungunya with onset in 2016 have been reported in individuals with travel history to a chikungunya endemic country in the two weeks prior to onset. Countries of origin were Bahamas/Mexico, Bolivia (2), Brazil (2), and Jamaica. Counties reporting cases were Broward, Duval, Hillsborough, Palm Beach (2), and Pinellas.
Ø In Sri Lanka, the warnings over chikungunya and Zika were issued after two deaths were reported in Chilaw in Northwest Province, last week.
Sri Lanka's Health Minister Dr Rajitha Senaratne has said that the island nation is faced with the threat from the two viral diseases but the state hospitals were being geared to cope with the diseases.
Sri Lanka's main international airport in Katunayake and the Colombo Port have been placed on high alert to prevent the spread of the Zika virus and chikungunya, a media report said. The airport's health desks have been told to caution passengers travelling to the affected countries.
Ø Brazil: The number of dengue fever cases reported in the Americas through the first week of September is closing in on the 2 million mark with 1,977,812 probable and confirmed cases. Like in all recent years, Brazil is reporting the bulk of the cases with more than 1.4 million cases this year.
Ø Argentina: Other countries reporting notable numbers include Argentina, Paraguay and Colombia. So far, 826 people have died due to dengue in the Argentina. Chikungunya made it’s presence known in the Argentina for the first time in late 2013. Since that time, millions of cases have been reported.
Ø Singapore, which has confirmed several dozen cases of the Zika virus in recent days, expects to identify more previously undiagnosed infections as it steps up measures to halt the spread of the mosquito-borne disease, according to the government.
The city-state’s Health Ministry had confirmed 82 Zika cases. At least 36 of the people known to have been infected were foreign workers at a construction site in eastern Singapore, the ministry said. It said the government had inspected about 5,000 premises in the city-state’s east, including the construction site, for mosquito breeding habitats.
Ø Malaysia is bracing for more Zika cases, officials said on Sunday, after detecting the first locally infected patient, which could further stretch a health system struggling with dengue, another mosquito-borne virus that can be fatal.
Both Zika, which is of particular risk to pregnant women, and the dengue virus are spread by the Aedes aegypti mosquito, which is common in tropical Malaysia, Southeast Asia's third largest economy, and across the region.
Neighboring Singapore has reported more than 200 cases of Zika. Three days ago, Malaysia reported its first Zika infection - a woman living near Kuala Lumpur who contracted the virus during a visit to Singapore.
Indonesia, like India is also experiencing the worst dengue problems in the world. The disease is also on the rise elsewhere, mirroring the expanding territory inhabited by the mosquitoes that spread it, according to reports. Since 2005, India, Indonesia, Maldives, Myanmar and Thailand have reported more than 1.9 million cases of Chikungunya including around 2 lakhs cases individually from Indonesia.
Ø In Australia, Aedes aegypti currently is found in north Queensland while Aedes albopictus is found in a few locations in the Torres Strait. Infections reported in Australia are from people who have travelled overseas to regions where the chikungunya virus is present.
Currently, chikungunya virus infection has not been transmitted by mosquitoes in Australia. However, since the mosquitoes capable of transmitting the infection are found in northern Australia there is the potential for this to occur.
Ø Kenya: Due to the lack of investment in proper water and sanitation in many cities and towns, the spread of chikunguniya in parts of the country was compounded the already rampant cholera epidemic this year with the number of patients crossing a thousand within just a month between April and May this year.