“Be vigilant of your environment. Be responsible for your own health. Clean up your act and ensure your surroundings are clean, both within the house and outside.”
This in a nutshell was the crux of the message that underpinned the sentiments of health officials contacted by the Sunday Observer, Friday. Our conversation focused on current trends in the dengue epidemic and efforts by the Health Ministry, Dengue Control Unit, Epidemiology Unit and other related units to mitigate the impacts of the disease. Dengue fever (DF) is a mosquito borne viral infection spread to humans by the Aedes Aegypti and Aedes Albopictus vectors widely adapted to urban and suburban environments. Outbreaks such as what Sri Lanka has been witnessing from the beginning of this year are not uncommon after the rains which provide optimal environment for mosquito breeding.
“This is why we need to start by removing the source .i.e the breeding sites which proliferate after showers, followed by bursts of sunshine, which spawn thousands of mosquito larvae, as a mosquito requires only a tiny drop of water to breed”, Community Physician, Dengue Control Unit, Dr Nimalka Panihaletti said.
As of August 28, the Epidemiology Unit has recorded a total of 146,427 cases of suspected dengue islandwide, from the beginning of the year. Starting with an accumulated number of 10,927 cases in January, the figures shot to 25,308 in June this year, peaking at 40,781 in July (last month). The Western Province, with the Colombo District led the other districts in the highest suspected dengue incidence of 29,399, with Gampaha close on its heels with 26,764 cases. Other ‘highs’ included Kalutara ( 8,492), Kandy (10,488), Batticaloa ( 4,482), Kurunegala (8,781), Ratnapura (8,936) and Kegalle (7,704).
Suspected cases tumble
Epidemiology sources said, the number of cases were now down by three to four or five times .
Colombo district which registered 7,471 cases in July recorded half the number, at 3,552 this month, while Gampaha dipped from 9,039 cases in July to 2,577 this month. In the Kandy district the July figures fell from 3,855 to 2,186 in August. The Colombo Municipal area which saw 1,002 cases in July had perhaps the most impressive dip when the number of suspected cases fell to just 473.
Hospital sources also said, the number of dengue patients had reduced drastically. President, Sri Lanka College of Paediatricians, Dr. LakKumar Fernando, in charge of the dengue ward at the Negombo Base Hospital told the Sunday Observer that there was “almost a 7-8 fold reduction of dengue patients at the Negombo Hospital. Whereas, the daily dengue inward hospital number was 700 plus, we now see below 100 patients on a daily basis”.
Virus causing dengue
Explaining the viruses causing dengue fever, Acting Chief of the Epidemiology Unit Dr Samitha Ginige said, “This viral infection is caused by four dengue virus serotypes DENV-1, DENV-2, DENV-3 and DENV-4. We are now experiencing dengue fever predominantly due to type 2. Infection with one sero type provides long term immunity to that particular virus type, but not to the other sero types”.
Was this particular strain more severe? Can it mutate and get worse in the near future?
“ Yes”, he said to the former question. “Type 2 causes relatively more complications than other strains. It can lead to Dengue Haemorrhagic Fever. Secondary infection from it can put people at increased risk of severe dengue fever complications like Dengue Haemorrhagic Fever (DHF )”. As for the second part of our question he said, “ Although it is difficult to predict, going by previous experience, it is not likely to mutate. Most likely, this virus (DENV-2) will last for some time. But, anything can happen as it is so unpredictable”. He added that the prevailing climatic conditions had aggravated the problem. Just curing the disease alone is not enough. We need the public as a whole to co-operate as we alone can’t eliminate the breeding sites. Just as the causes are multi sectoral, the solutions also require a multi sectoral approach, such as motivation, community involvement and involvement of all other sectors” he stressed.
Prevention
That is why we appeal to all sections of the pubic to take on that responsibility. From schoolchildren to parents, to school heads and to officers and the public and religious institutional heads, right down to the Grama Niladharis and Regional Development Officers, and PHIs, we need everyone’s help to clean up our environment”, Dr.Pannihaletti said.
She said, Dengue eradication was part of the Healthy Schools concept and every child should be inculcated with a sense of responsibility regarding, dumping of garbage, cleaning his room, the house, garden, lane, beaches. She noted, “ If they grow up with this concept they will learn to be eco friendly . It has to have a multi sectoral approach, with all sectors involved, including the media”.
Prior to the school term commencing, she said, there was a meeting, Wednesday, where the Education Ministry gave its nod for a circular to be sent to all Principals to keep their school premises clean. “ They can’t do this alone. They would have to get the parents and children involved as well”, she said. An islandwide Dengue Prevention program was conducted from August 29-31, in all high risk areas in the country. It will be an on going program and will be carried out ahead of the expected monsoonal rains . As Dengue is a seasonal disease we can’t afford to relax, even if the number of cases tumble”, she noted.
Guidelines to GPs and MOHs on Dengue management
Meanwhile, the Epidemiology Unit has issued guidelines to all first point contacts of dengue patients in all districts, warning them to watch out for signs and symptoms of the disease and the onset of more severe complications of the disease. In the event of sudden high fever, severe headaches, retro orbital pain, rash, bleeding and platelet count below 150,000 mml doctors have been advised to provide oral rehydration therapy, king coconut water, kanjee, fruit juices and soups to patients and avoid red and brown drinks that could confuse diagnosis. They have been asked to advise patients to avoid taking aspirin, and to take only paracetamol on doctor’s advice. Sponging patients with tepid water is encouraged if there is fever. Patients have also been asked to immediately contact their doctors on clinical deterioration with the settling of the fever, inability to tolerate fluids, lethargy and bleeding, as well as, not passing urine for over six hours.
“All our doctors are doing an excellent job in treating dengue patients. But the main solution is with the public. Safe disposal of household garbage, and keeping environments clean in a collective sustained effort is the best and most effective way of reducing the dengue burden”, he reiterated.