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Kerala

Kerala health department on toes as amoebic meningitis deaths spark fear

Recent amoebic meningitis deaths have raised concerns among the public and the health department about the safety and hygiene of swimming pool water.

Pooja Nair

KOZHIKODE: The first question posed to a person who walks into a hospital these days with an infection is whether the patient has come into contact with water in a swimming pool.

Recent amoebic meningitis deaths have raised concerns among the public and the health department about the safety and hygiene of swimming pool water. Over the last two months, Naegleria fowleri, commonly referred to as brain-eating amoeba, which causes amoebic meningitis, claimed the lives of two children who had come into contact with swimming pool water. A boy is also in critical condition in a private hospital here following a similar infection.

The state department, in collaboration with the Union health ministry, has initiated a study on the threat posed by Naegleria fowleri.

On June 12, Dakshina, a 13-year-old girl from Thottada, in Kannur, died while undergoing treatment at a private hospital in Kozhikode. while Fadwa P P, a five-year-old girl from Malappuram, succumbed to the infection in May. Dakshina’s symptoms, including headache and vomiting, appeared months after a school trip to Munnar, with posthumous tests confirming the presence of Naegleria fowleri. Fadwa died while undergoing treatment at Kozhikode Government Medical College Hospital.

A 12-year-old boy from Irumooliparambu in Feroke, Kozhikode, is currently in hospital with symptoms consistent with an amoebic infection. The boy reportedly bathed in Achamkulam pond, near Farook College, raising concerns about the water source. Health workers are now tracing and testing others who may have come into contact with the water.

Amoebic meningitis, also known as primary amoebic meningoencephalitis (PAM), occurs when water containing the amoeba enters the nose, travels to the brain and destroys brain tissues. Symptoms, which include fever, headache, vomiting, and sensitivity to light, typically appear within five days of infection and progress rapidly. Health expert Dr Sudha Chandran emphasised the importance of public awareness and proper treatment of water to prevent further cases. Dr Chandran advises that all water used for recreational purposes such as in pools, spas, garden hoses, sprinklers, and wading pools should be properly treated and maintained.

Another health expert stresses the need for vigilance, especially in temperatures between 28 and 40 degrees Celsius, which are ideal for the proliferation of amoeba. Pool and spa owners should regularly monitor chlorine levels to ensure safety. Additionally, water in wading pools should be changed regularly to prevent the amoeba from growing.

Manoj Panicker, of the Wayanad Aquatic Club, highlights several concerns about privately owned swimming pools, including lack of proper permissions and the absence of mechanisms to ensure water quality. According to him, there are more than 20,000 privately owned swimming pools in the state, a number that is expected to double. This raises significant public health concerns, particularly regarding water quality and the proper use of chlorine. Chlorine is essential in maintaining safe swimming conditions, as it protects against waterborne germs. The recommended chlorine levels are 1.0 parts per million (PPM) for residential pools and 1.5 - 2.0 PPM for commercial pools.

Additionally, maintaining the correct acidity, or pH, level is crucial, with the optimum being 7.4 (or between 7.2-7.6). Deviations from these standards can lead to issues such as skin irritation or insufficient germ protection.

An epidemiologist, Dr Shiva Prakash, emphasised the dangers of waterborne pathogens like Naegleria fowleri. He noted that while the risk is low, the infection is serious, and higher temperatures increase the likelihood of encountering Naegleria in natural water bodies.

To mitigate risks, Dr Shiva recommends that the government issue amoeba warnings and ensure that pool owners properly chlorinate their pools. Individuals should avoid activities that might force water up their noses and be cautious with natural water bodies, especially as temperatures rise.

The recent fatality in Kannur is particularly concerning owing to the delayed onset of symptoms, which manifested five months after the initial exposure. This anomaly is being closely studied by health authorities. Interestingly, tests done on Dakshina revealed the presence of Vermamoeba vermiformis, a rare variant not typically associated with amoebic meningitis, complicating the understanding of the infection.

The health department is conducting studies on these bacterial infections. Meanwhile, people have been urged to take necessary precautions while engaging in water-related activities, particularly in untreated or warm freshwater environments.

Govt issues warning amid continued rain

With heavy rainfall persisting, the health department has issued a warning for amoebic meningitis and other diseases. People have been advised to avoid bathing in stagnant water and diving into water bodies. It is also recommended that water in theme parks and swimming pools be properly chlorinated. Health Minister Veena George urged people to seek expert treatment if they experience symptoms such as prolonged fever, shortness of breath with fever, excessive palpitation, chest pain, slurred speech, loss of consciousness, blood in sputum, or excessive fatigue.

‘Brain-Eating Amoeba’

Don’t Be Fooled By Pools

Recommended chlorine (CL) levels in swimming pools

  • Residential: 1.0 PPM

  • Commercial: 1.5-2.0 PPM

  • Standard acidity, or pH, levels in pools

  • The optimum pH for a swimming pool is 7.4 (or between 7.2-7.6).

  • If the pH is below 7 the water is acid

  • If the pH is above 7, the water is alkaline

Cases of amoebic meningitis, caused by Naegleria fowleri, commonly known as brain-eating amoeba, reported in state

  • Two fatal cases of reported in the Kozhikode & Malappuram districts this year

  • A 12-year-old boy admitted to private hospital in critical condition with infection

  • 15-year-old boy died due to primary amoebic meningitis, also known as primary amoebic meningoencephalitis (PAM), in 2023

  • First detected in Alappuzha municipality in 2016

  • First infections in Malappuram were reported in 2019 and 2020

  • Infection was also detected in Kozhikode in 2020 and in Thrissur in 2022

What to watch out for when using swimming pools

Dos

  • Use Properly Chlorinated Pools: Ensure the swimming pool is well-maintained with appropriate chlorine levels and pH balance

  • Shower Before Swimming: Take a shower before entering the pool to reduce the introduction of contaminants.

  • Wear Nose Clips: Use nose clips to prevent water from entering nasal passages, especially when diving or submerging the head

  • Follow Pool Maintenance Guidelines: Ensure the pool undergoes regular cleaning and maintenance, including monitoring chlorine levels and pH balance

  • Educate & Inform: Raise awareness about the risks and preventative measures among pool users and staff

Don’ts

  • Avoid Swimming in Poorly Maintained Pools: Do not swim in pools that are not properly chlorinated or appear to be poorly maintained

  • Avoid Diving in Warm Freshwater: Be cautious about diving or submerging your head in warm freshwater lakes, hot springs, and poorly maintained swimming pools where the amoeba is more likely to thrive

  • Do Not Let Water Enter Your Nose: Avoid actions that can force water up the nose, such as vigorous swimming or diving without proper protection

  • Do Not Swim When Sick: Avoid swimming if you have nasal congestion or any open wounds, as this can increase the risk of infection

  • Avoid Ignoring Pool Warnings: Pay attention to and follow any posted warnings or guidelines at a swimming facility

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