The onset of the South-West monsoon and the Met Department warning that wet weather was likely to continue for some time in most parts of the country especially the Western, North-Western and Sabaragamuwa provinces, has increased fears of an outbreak of water-borne diseases due to several contaminants which surface from the water at this time around. Depending on the type of contaminant the health impact on an infected person could vary from mild to serious.
In addition to these common diseases, are fears that the spread of Covid-19 could also spike during these wet weather conditions.
Consultant Epidemiologist, Epidemiology Unit, Ministry of Health, Dr.Thilanga Ruwanpathirana, told the Sunday Observer what these numerous diseases are which range from Salmonella, Hepatitis A, Typhoid, Dysentery, Influenza, Leptospirosis, how they are caused, how they are treated, using home remedies where possible (such as ORS for those with diarrhoea) while admitting complicated cases to hospitals. He also told us what symptoms to look for in a person suspected to have contracted a waterborne disease, and most importantly how such diseases can be prevented with simple health rules and adhering to Safe Food guidelines issued by the Ministry of Health.
Excerpts of the interview:
 Dr. Thilanga Ruwanpathirana |
Q. The country is now experiencing flood situation following rains. Consequently, there is a likelihood for numerous waterborne diseases to surface from contaminants in the water. What are these contaminants?
A. There are many types of contaminants in water which we could categorise as
• bacteria (eg. Salmonella, Cholera),
• virus (eg. Hepatitis A),
• protozoa (eg. Amoebiasis)
• parasites (eg. Roundworm, Whip Worm)
Q. What are the common diseases in Sri Lanka during rains?
A. There are many types of diseases such as, diseases that are water-borne, vector-borne and caused by infected nasal droplets. Hepatitis A, Dysentery, Typhoid Fever are examples of water-borne while Leptospirosis, Dengue and Malaria are examples for vector-borne. Influenza is an example of a droplet infection.
Q. Which of them are considered as most serious? Are there different levels of health impacts on the human body?
A. The course of the disease could vary from self-limiting to serious or even life-threatening. The severity depends on many factors including the stage of the disease when diagnosed, how well managed, genetic predisposition, how many times infected (eg. second or third dengue episodes may be much serious).
Most water-borne diseases cause mild to moderate illness in many. However, in some, it is associated with profuse diarrhoea with or without passage of blood and mucous. Some people tend to get dehydration much faster than others (e.g. young children and the elderly). Severe dehydration is a serious complication which could result even in death.
Q. Are they all infectious?
A.Yes, they are infectious. These diseases are spread by ingestion of food and water which are contaminated by the stools of an infected person. We call it feco-oral transmission.
Q. How are they caused?
A.There are many ways on how the stools of an infected person could reach a healthy person/s. Contamination of the environment as a result of open defecation, leakages or overflowing from the sewerage tanks/toilet pits can pollute the drinking water sources (wells, rivers, lakes), and it is a high possibility during rainy weather and flood situations. Further, flies, rodents, cockroaches can bring the environmental contaminants to the foods/water which are consumed by humans. Poor personal hygiene including poor hand washing practices, unhygienic cooking practices (insufficient cleaning of green leafy vegetables), not covering the cooked food are also contributing factors. In addition, drinking un-boiled / un-chlorinated water could lead to ingestion of the contaminants.
Q. What are the signs? How soon will the symptoms show if you have a water-borne disease? A study in the US has revealed that the most common symptoms of infection are stomach cramps, watery diarrhoea, vomiting, fever, and weight loss, which usually begin seven days after infection and could last up to two weeks. Your comments?
A.Yes, general symptoms of food and water-borne diseases are those you mentioned. However, the symptoms and the duration to show the symptoms from the time of ingestion of the suspected food (incubation period) varies according to the type of the organism.
Following are the symptoms and incubation periods of commonly occurring food and water-borne diseases in Sri Lanka. Hepatitis A has an incubation period of 14-28 days and the symptoms include fever, dark urine, yellow colour discolouration of the body and poor appetite.
Typhoid Fever has an incubation period of 8-14 days and presents with fever, headache, and loss of appetite, diarrhoea or constipation. Diarrhoea with blood and or mucus, fever and vomiting are the symptoms of Dysentery (incubation period 1-7 days).
Q. Can these diseases be cured? Will there be adverse health impact if they are not treated properly at an early stage?
A. Most of the food and water-borne diseases could be cured without long term sequel if treated properly and timely. However, repeated diarrhoeal diseases could cause nutritional inadequacies and lead to either weight loss or poor weight gain in growing children. This situation could not only affect their physical growth but also prevent them from reaching their maximum brain development.
Q. Treatment - How do you treat them? Can diarrhoea and vomiting be treated with home remedies?
A. Loose stools and vomiting occur in many food and water-borne diseases and it could lead to dehydration. Therefore, early identification and treatment for dehydration are of utmost importance as this could be lifesaving.
Q Symptoms of a dehydrated person?
A.A dehydrated person is generally irritable. However, when the condition worsens, he/she could become lethargic or even unconscious. Eyes will be sunken in moderate to severe dehydration. The tongue may be dry in moderate dehydration and in the severe form it will be very dry and furred. A good way of gauging the level of dehydration is skin retraction. In a healthy person when a skin fold is lifted and released with the thumb and the index finger, it will immediately go back to its original position. But in a dehydrated person skin fold will remain for a while to get back to the normal position. However, this cannot be demonstrated in an elderly person as their skin is very thin. A dehydrated person usually breathes rapidly and the colour of the urine is darker than usual.
Q Do these symptoms apply to most or all dehydrated patients?
A. These elaborate signs and symptoms are seen in many other conditions including normal situations. Therefore, it is always good to interpret them in relation to the background, and demonstrating more than one sign/symptom will give more weight.
Q. How are these patients treated?
A. Once the diarrhoeal (or vomiting) episode starts, the rehydration process should be started simultaneously. It will help for mild and moderate dehydration and is not an option for the severe form which needs immediate hospitalization and commencement of saline through veins. Oral rehydration can be done in many ways. There are several home remedies in the Sri Lankan context. In addition, it is always advisable to start an oral rehydration solution (ORS) (eg. Jeewani).
Abstaining from taking meals during the diarrhoeal episode which is a noticeable practice in the country is not advisable. One should take his / her normal diet despite poor appetite or nausea. Taking frequent small quantities will help to retain. If the symptoms are getting worse seek medical advice without delay.
Q. What is the value of ORS?
A. It is a mixture of sugar and salt in specific proportions. This exact proportion helps to absorb water in the gut despite the diarrhoeal condition. Therefore, it is important to prepare it according to the product information. The amount of water to be added is mentioned in the sachet.Nothing else (lime, salt, glucose, soda) should be added to the preparation which will distort the required proportions. Once prepared it has to be consumed within 24 hours. Some people complain that ORS induces vomiting. Therefore, it is good to take small sips frequently.
Q. Personal hygiene like hand washing – how important is it to prevent water-borne diseases and protect oneself against Covid-19?
A. Hand washing and good etiquette are important behavioural practices which prevent many diseases including diarrhoeal diseases. Moreover, it is one of the main personal health practices which prevents contracting Covid-19.
Q. What are the other methods available for the prevention of diarrhoeal diseases during the rainy season?
A. There are many and can be categorised as improvement of sanitary facilities, adhering to stringent food safety practices and immunisation.
Improvement of the sanitary facilities includes motivating to use a toilet for defecation. According to the demographic and health survey (DHS) done in 2016, there are 1.5% to 2% of individuals who do not use toilets for defecation in Sri Lanka. Similarly, it is important to dispose of the faeces of small children in a toilet too. Public water supplies need to be protected from faecal contamination.
Food safety practices include cleaning the green leaves/vegetables thoroughly before consuming, cook for an adequate amount of time and keep the cooked food and fresh cleaned fruit covered to avoid contamination by mechanical vectors such as flies.
Q. Are there vaccines for food borne diseases? Are they available in Sri Lanka?
A. There are vaccines available for several food and water-borne diseases in Sri Lanka. Eg. Hepatitis A and Typhoid Fever.
Q. What about dengue? There is a surge in dengue now.
A. Similar to previous years the number of dengue patients is rising with the monsoonal rains. It is important to pay attention to places which have been kept closed for a long period due to the Covid-19 pandemic. (E.g. Schools, factories) As the country is getting back to normalcy, these places need to be thoroughly inspected for mosquito breeding sites before starting routine functions.
Q. Your message to the public and some useful and practical easy to perform tips on preventing water-borne diseases at this time around?
A. Wash hands with soap and water for at least 20 seconds, drink an adequate amount of boiled cool water and eat food which is home-made as much as possible. It will help you to prevent from diarrhoeal diseases during these rainy days.