Communicable diseases: Managing the malaise

As communicable diseases are showing an increasing trend with each passing year, medical experts are calling for a multi-pronged strategy to deal with the situation
The lack of efforts to clean canals across Kochi could cause a major health hazard this monsoon season. A view of the garbage-filled Changadampokku Canal near JLN Stadium at Kaloor in Kochi
The lack of efforts to clean canals across Kochi could cause a major health hazard this monsoon season. A view of the garbage-filled Changadampokku Canal near JLN Stadium at Kaloor in KochiPhoto | A Sanesh

KOCHI: With ecological concerns brought on by human activity contributing to the worsening scourge of communicable diseases, the question needs to be asked: are we digging our own graves?

With incidence of Hepatitis A on the rise, Kerala is battling another epidemic. Just till May 16 of this year, there have been 2,048 confirmed cases and 15 deaths reported, with Malappuram and Ernakulam districts the worst affected. This compares adversely with the whole of last year, when 1,073 cases and seven deaths were confirmed.

“Hepatitis A outbreaks are commonly caused when sewage gets mixed with drinking water, especially when it is not adequately chlorinated afterwards. Illegal dumping of septic waste and improper food handling by infected persons can also lead to such situations. The ability of this virus to remain active for several weeks in wastewater helps worsen its spread,” says Dr Rajeev Jayadevan, chairman of the Indian Medical Association’s Kerala research cell.

“Among Hepatitis viruses, the ‘A’ variant is the least harmful. However, it has the capacity to affect a large number of people within a short period, and when that occurs its severity is amplified,” according to Dr Rajeev.

“A breakout occurs when there is an environmental issue. What is important is to identify the source. The outbreak of Hepatitis shows that our drinking water sources are still not safe,” points out Dr V Ramankutty, a leading epidemiologist and health economist.

However, the phenomenon is not new in the state, which has been battling several communicable diseases for several years. Recently, the West Nile virus caused two deaths – one in Thrissur and the other in Palakkad. Last year, the state witnessed a spike in the number of dengue cases spread by the Aedes mosquito.

“Kerala reports the most number of Hepatitis A cases in the country. However, according to an ICMR study, seroprevalence – the proportion of individuals within a population affected by disease at a specific time point – in the state is less than 50%, while at the national level it is more than 75%. More cases are reported here as a result of our extensive testing regime,” says Dr Anish T S, professor, Department of Community Medicine, Manjeri Government Medical College.

Dengue was first detected in Kerala in 1998. In 2017, the state experienced the worst outbreak. Cases of Zika, West Nile, Leptospirosis, Shigella and Nipah have also been reported in the state in the last two years.

Curbing spread

The total prevention of communicable diseases is not possible. “But we can limit the spread. The number of deaths increases in proportion to the number of cases. So limiting the number of infections is important,” Dr Anish stressed.

“The number of deaths increases with a rise in the number of people infected. The total number of deaths is proportionate to the number of cases in the community. Also, the condition can turn severe for people above 40 years of age or people who suffer from co-morbidities, especially liver disease that may or may not be previously known,” added Dr Rajeev.

The caseload can also affect the quality of patient care. “There is a difference in the care a patient receives when there are 100 cases, compared to when there are 1,000 cases. If a hospital is filled with dengue or leptospirosis cases, doctors and nurses may not be able to accord full attention to patients. This can affect recovery,” according to Dr Anish. The presence of lifestyle diseases, especially those which affect the liver, can worsen the condition and even lead to death.

Prevention is key

To prevent the further spread of diseases, ensuring clean drinking water, vector (mosquito) control measures, waste management, and cleaning prior to the monsoon season are important. “Neither hepatitis A nor dengue is officially a seasonal disease. However, they spread when the conditions are favourable,” says Dr Rajeev, adding that filtration and chlorination can help prevent hepatitis A. “Chlorinating water bodies without basic filtration is not beneficial as the virus can remain embedded in dirt,” he added.

“Pre-monsoon cleaning and mosquito-reduction activities are important. The state follows this every year. However, we need to intensify it,” said Dr Anish.

Canal and drain cleaning, as well as efficient waste management systems, can help reduce vector breeding and therefore, the spread of many diseases. As monsoon season arrives, it is important to take preventive measures early,” according to Dr Rajeev.

Vigilant system

Climate change has also been linked to the rise in cases of Hepatitis, Dengue and leptospirosis. “This is a worldwide phenomenon, and not specific to Kerala. Our system is sensitive to changes. Moreover, our health system has a stringent testing and diagnosis protocol, as a result of which positive cases rarely go unreported. The health machinery kicks into action looking for the cause whenever there is an unusual death,” said Dr Anish, adding that even private hospitals in the state are equipped to detect the presence of viruses, including Zika, Nipah, etc.

“It is positive that we are identifying the presence of even rare viruses. Now, we need to focus on identifying sources and eliminating them. Climate change is a factor that will also need to be addressed,” Dr Ramankutty said.

The public, too, has a role to play. “Over the years, people have become more aware of the presence of viruses and bacteria. They also know about prevention and containment measures. Such measures are important as they help reduce the size of the outbreak,” notes Dr Anish.

Dr Ramankutty added that common people should also make can effort to reduce the spread of Dengue. “Limiting the spread of dengue and other vector-borne diseases is not an easy task. Dengue is spreading even in advanced countries like Singapore. So we need to be more cautious,” he said.

Delayed treatment can lead to complications. Following home remedies and thereby delaying medical care and lack of supportive care can also be fatal. A multi-pronged strategy and approach is the need of the hour.

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