Epidemics in Kerala

One more cholera case reported

By Our Staff Reporter

THIRUVANANTHAPURAM Aug. 29. A 53-year-old woman was on Friday diagnosed with cholera from the Tiruvallam area in the city. According to health officials, the patient was referred to the Medical College today from the General Hospital. Meanwhile, an eight-year-old child was confirmed with typhoid, while six new cases of confirmed dengue fever cases were also reported in the city and suburbs.

Malaria case reported in city

By Our Staff Reporter

THIRUVANANTHAPURAM Aug. 28. A case of malaria has been confirmed in a 21-year-old youth from Palkulangara in the city.

According to health officials, the malaria was an `imported' case and not indigenous as the youth had recently been to Bangalore, from where he is suspected to have got the infection.

Meanwhile, four cases of dengue fever have been confirmed in laboratory tests conducted on patients being treated for viral fever.

The cases were reported from Murinjapalam, Vizhinjam, Koliyakode and Vilappil.

'Fever epidemic result of improper planning'

By Our Staff Reporter

KOLLAM Aug. 22. The Vice-Chancellor of the Kerala University, B. Ekbal, has said that improper planning would result in disaster. He was inaugurating the national-level seminar on "sustainable habitat'', organised by the Civil Engineering Department of the TKM College of Engineering, here today.

He said that the recent fever epidemic which had gripped the State was the disastrous outcome of the lack of proper garbage treatment coupled with society's irresponsible attitude towards maintenance of hygiene. SARS had claimed 700 lives the world over and the plague at Surat 50 lives. The authorities should seriously ponder over the fact that dengue fever had already claimed 150 lives in the State, he said.

Dr. Ekbal said uncontrolled economic growth and development would result in imbalances and that environmental pollution posed a threat to all living things. While evolving a plan, economists and environmentalists should sit together and find out avenues for cooperation.

The Principal Secretary for Higher Education, C.V. Ananadabose, delivered the keynote address and the president of the TKM College Trust, Shahal Hassan Musaliar, presided over the function..

State facing another epidemic outbreak

THIRUVANANTHAPURAM: Even as the State is limping back to normal after a series of epidemic attacks which claimed nearly 150 lives in just two months, the epidemiological report being prepared by the Health Directorate has predicted yet another outbreak, that too a more dangerous one by October.

The outbreak, according to the report, will be more severe as the second round will have more haemorrhagic cases which would result in increased casualties. It is expected to be spread over from October to December.
According to the epidemiological study, the vector density in the State is still at a dangerous level even after the much-hyped vector control activities. Most of the districts still remain the favourable breeding ground for vectors, especially for the ‘Aedis aegypti,’ the vector of dengue fever.

Experts had time and again pointed out the importance of the integration of various departments, mainly the Health and the Local Self-Government Departments, in the prevention and control of epidemic activities.
According to Kerala University Vice-Chancellor Dr B.Ekbal, the failure in checking the recent epidemic outbreak should be treated as a criminal offence considering the reach and strength of the State’s health institutions and LSGs.

Drawing parallels from Andhra Pradesh, which witnessed an epidemic outbreak recently, he said that Andhra Pradesh Chief Minister Chandra Babu Naidu had personally visited the area immediately along with his cabinet ministers and health experts and ordered a detailed report on each case.

‘‘It is only because of the absence of this kind of an integrated and coercive effort that the State is on the threshold of yet another epidemic outbreak,’’ he said.

This much needed conciliation is what is exactly lacking if one goes by the reactions of departments concerned.

Health Minister P.Sankaran claimed that his department had been doing everything it could. ‘‘We have alerted all departments concerned, especially the LSGs, on the impending danger. Now it is their responsibility to take up necessary measures. If they continue to sit on it, we must not be held responsible for the next round of epidemics,’’ he said.

Playing down the issue, Local Self-Government Minister Cherkalam Abdulla said, ‘‘The epidemics issue is a thing of the past. Why bother about it now.’’

When he was reminded about the epidemiology report and his department’s alleged failure in initiating measures to tackle it, he said, ‘‘We will take care of it at the time of the outbreak.’’
‘‘What has the media got to do with epidemics,’’ he did not forget to ask.

Not surprisingly, the LSGs are also following a wait and watch policy in vector management. Though the local bodies have been allowed to utilise Plan funds for various epidemic control activities, only 10 percent of LSGs have initiated steps in this regard.

The crisis management committee set up to tackle the epidemic threat had issued certain guidelines and accordingly, every panchayat was asked to buy three fogging machines each as a preliminary step of vector control activity.

Even after two months, 90 percent of the local bodies, especially panchayats, are at the preparatory stage of buying them. Similarly, spraying activities also have taken a back seat once the epidemic cases started showing a decreasing trend.

Solid waste management measures also have not reached anywhere as nearly half of the municipalities are still in the process of acquiring land for waste disposal.

According to the LSG officials, the delay in epidemic control activities is due to the various bottlenecks in procurement of required equipment and land.

Refuting this excuse, the health officials said that the local bodies had the right to seek exemption from tendering and other procedures citing grounds of emergency and added that the local bodies will be solely responsible for the next round of epidemics.

Epidemic: vector reduction steps mooted

By M. Dinesh Varma

THIRUVANANTHAPURAM Aug. 17. Vector reduction strategies to check the spread of infectious diseases transmitted by mosquitoes have to be specific to the behavioural peculiarities of the agents of transmission, A. Joseph, Technical Consultant to the Departments of Health and Local Administration on malaria and other parasitic diseases, has said.

``The strategy to tackle Anopheles stephensi, the primary agent of spreading malaria, should be different from combating the Aedes species behind the recent outbreak of dengue fever,'' Dr. Joseph, former Professor of the Community Medicine at the Thiruvananthapuram Medical College, told The Hindu.

The entomologist said the resurgence of eradicated diseases like malaria and relatively new threats like dengue was due to the unscientific mosquito-control methods adopted by various departments. Moreover, a combination of poor inter-departmental coordination and insufficient number of medical officers with technical knowledge about vector control in the Local Self-Government Department had hampered the efficiency of a concerted response to the dengue outbreak, he said.

Vector control of the Aedes aegypti and the Aedes albopictus, the main agents of dengue, required a strategy that took into account the peculiarities of the species, Dr. Joseph said. The Aedes species, also called `container breeders', are known to have their blood meal during day-time as opposed to the habit of the Anopheles species of entering households between 5 p.m. and 9-30 p.m. and preying on humans at night or during the wee hours.

``Therefore, a blanket vector reduction strategy for various species of mosquitoes is bound to fail,'' the malariologist said.

According to the expert, larvicidal operations as well as resorting to rotation of pesticides to offset adult vectors gaining resistance form an important part of vector reduction programmes.

Rapid urbanisation and densely populated habitats marked by poor environment hygiene had set up the perfect stage for an explosion in the density of the vector population responsible for diseases ranging from malaria, dengue and Japanese encephalitis, he said.

The entomologist, who played a key role in eradicating malaria from the State in 1965, also offered technical assistance to control malarial resurgence of the disease in Valiathura in 1994. He was also in charge of filaria control programme in Thiruvananthapuram, Kollam, Alappuzha and Ernakulam.

According to Dr. Joseph, the malarial epidemic in the coastal ward in the mid-90s was also significant in that the disease, historically and etymologically associated with the hill-tracts, had surfaced in a contrasting habitat.

Dr. Joseph, who is a guest lecturer at the Liverpool of Tropical Medicine, U.K., said that urbanisation in tropical countries had resulted in both the proliferation of the Aegypti species as well as increase in the number of susceptible human hosts. Moreover, in cities, the movement of virus carriers could be a more important means of transmissions of the dengue viruses, especially given the short flight range of about 1.5 km of the typical vector.

Places where people congregate during the daytime could be potential sites of dissemination of dengue viruses; schoolchildren bitten by infected mosquitoes may take the virus home and to other parts of the city. Most importantly, dengue viruses may also spread in hospitals, if other patients or staff were bitten by infective mosquitoes, he said.

Moreover, being a freshwater breeder, vector control strategies should involve source reduction measures through a denial of breeding sites. ``The community should realise that the villain is lurking right inside the household,'' he said.

The Aedes species could make breeding sites in flowerpots, discarded tyres, cups, coconut shells and concrete slabs of construction sites where water collects. ``Moreover, the `plastic culture' has been a major contributor to the explosion in the density of the vector population,'' he said.

The entomologist highlighted the importance of community participation alongside the formulation of a package of serological, epidemiological surveillance, contingency plans, control and prevention, he said.

In fact, the World Health Organisation (WHO) advisories for the community included active participation by undertaking the disposal of unused objects that may collect water and by routinely changing the water in flower vases. Water jars and large drums that cannot be disposed of should be adequately covered to prevent egg-laying by the species, or cleaned and scrubbed weekly, he said.

Seven more dengue cases

By Our Staff Reporter

THIRUVANANTHAPURAM Aug. 17. At least seven cases of confirmed dengue were reported from the city and suburbs on Sunday.

According to staff at the DMO's control room, there were three confirmed cases from the Corporation area- Peroorkada, Paruthikuzhy and Aramnada.

While two cases were reported from Karakulam, one case each were from Vilappilsala and Malayinkeezh. The results of laboratory tests of 10 suspected dengue cases is awaited.

The progressive total of confirmed dengue cases reported in the district between January and August aggregates 492, of which 96 cases were reported in August alone. The number of suspected dengue cases totals 111.

There have been 11 dengue-related deaths in the district so far.

According to officials, there were no reports of cholera or diarrhoeal disorders.

Two more cholera cases

By Our Staff Reporter

THIRUVANANTHAPURAM Aug. 13. Two more cases of cholera were reported from the Tiruvallam area in the city.

So, far there have been 13 cases of confirmed cholera during the outbreak of diarrhoeal disorders. Meanwhile, 11 confirmed cases of dengue were reported from various parts of the city and suburbs.

Govt. probing foeticide incidents

By Our Staff Reporter

THIRUVANANTHAPURAM Aug. 11. The reported increase in incidents of foeticide in the State was being looked into by the Government and if it was found to assume a social dimension, appropriate action would be taken to prevent it, said P.K. Kunhalikutty, Minister for Industries and Social Welfare.

Replying to a series of questions and supplementaries in the State Assembly during Question Hour today, he said stringent action would be taken against private hospitals if it was found that there was a deliberate attempt on their part to encourage foeticide.

The Government was viewing with concern reports that around 39,000 incidents of foeticides had taken place over a one-year period. If need be, the Government would even bring about a legislation to prevent foeticide in the State, he added.

Insurance for girl child

The State Government was considering an insurance cover for the girl child, taking into account several Centrally-sponsored schemes. The Juvenile Justice Act would be implemented in toto in the State which would ensure that certain stringent guidelines were followed in the matter of arrest of children by police, Mr.Kunhalikutty said.

The Government was committed to providing better facilities in the `anganwadis'. It had come to the attention of the Government that anganwadi workers were being deputed for works of a miscellaneous nature like surveys and other related jobs, to the extent that the normal functioning of the anganwaids was being affected. This would be put an end to, the Minister said.

There was an allocation of Rs. 61.10 crores in the State budget for the current year, for various schemes under the Department of Social Welfare, Mr.Kunhalikutty said. Additional funds could be provided through supplementary grants, if required, he added.

The KINFRA has received Central assistance to the tune of Rs. 5.24 crores for the promotion of the food processing industry in the State. The State Government was committed to providing a fillip to the food processing industry. It had been decided to present more branded processed products from Kerala at the Trade Festival in Dubai, Mr.Kunhalikutty informed.

Tiruvallam emerges as hotspot for cholera

By Our Staff Reporter

THIRUVANANTHAPURAM Aug. 8. Tiruvallam has emerged as a new hotspot for an outbreak of diarrhoeal disorders, with most of patients with cholera-like symptoms being reported from the area.

Of the nine new admissions of patients with cholera-like symptoms on Friday, five were from Tiruvallam. The other patients were from Poonthura, Vellayani, Vattiyoorkavu and Koduvazhanoor. And 21 of the 41 suspected cases of cholera with symptoms of acute diarrhoea have also been reported from Tiruvallam as well.

On Thursday, a team of health official had visited Tiruvallam and adjoining areas to supervise preventive measures and coordinate door-to-door awareness campaigns.

The District Medical Officer, E.K. Madhavan, who visited the affected site, told The Hindu that sanitary conditions at the Tiruvallam area were conducive to an outbreak of epidemics. The residential colonies were highly congested and lacked basic sanitary facilities and access to safe drinking water.

As many as 8,620 families depended on only 20 community wells for drinking water. The deep wells were also on the verge of drying up shortly.

At the Lankadweep colony in the neighbourhood, where 110 families lived in poor hygienic conditions, there was a critical dearth of latrines and access to safe water supply.

Locals told visiting health officials that they could depend on well water for only two days a week. Their main source of potable water was sourced from the Vellayani Lake. The water from the lake was subjected to chlorination at a treatment plant in Vandithadom before it was made available to the residents in the area.

Staffers at the treatment plant told officials that at least 2 kg of bleaching powder was being used to treat the water pumped in from the lake at two-hour intervals. Following the outbreak of diarrhoeal disorders, they had been asked to increase the chlorination dosage.

Meanwhile, it could take at least a week to isolate and culture the micro-organism at the Public Health Laboratory. Water samples from the Vellayani Lake besides piped water and well water had been collected for testing for presence of the `Ogawa' strain of vibriocholera, which was detected in the seven confirmed cholera cases. The Corporation health squads had also seized food samples for testing.

Meanwhile, at least seven patients have been confirmed with infection with vibriocholera organism during tests conducted at the Microbiology Department of the Thiruvananthapuram Medical College. In all, there have been 41 diarrhoeal cases reported in the city and suburbs so far. At present, there are 33 patients under treatment at the General Hospital and four patients at the Medical College.

Cholera has become the newest concern for district health authorities who had been tackling an upsurge of dengue fevers, leptospirosis and malaria.

So far, there have been 11 dengue-related and two- leptospirosis-triggered deaths in the January-August period. The number of patients who tested positive for dengue has been 464, 100 for malaria and 31 for leptospirosis.

Meanwhile, four new case of confirmed dengue cases have been reported in the district. Feedback from health centres in the district indicate a slight reduction in the proportions of patients reporting with viral fever. On Friday, 480 patients sought treatment for viral fever at various health institutions in the district.

One more cholera case confirmed

By Our Staff Reporter

THIRUVANANTHAPURAM Aug. 7. One more case of cholera was confirmed in a 27-year-old patient who was under treatment at the Medical College on Wednesday.

According to health officials, it was not clear whether the infection was an indigenously acquired one as the patient had a travel history of visiting Bangalore recently.

So far, five patients had been infected with `Ogawa' strain of vibriocholera.

Meanwhile, 25 suspected cholera cases were under observation at the General Hospital. As many as 12 cases had been referred from Tiruvallam alone. The other cases were sourced from Vazhithadam (2), Vellayani (3), and one each from Vizhinjam, Karickakam, Kuttichal, Pangappara, Poonthura and Malayinkeezh.

The stool samples of the patients were being investigated at the Microbiological Department of the Medical College.

District health officials had also collected nine water samples, which included water from the Vellayani lake, a borewell, stored water and pipe water from affected areas.

The samples had been handed over to the Public Health Laboratory for identifying the pathogen.

A team comprising K. Ramamoorthi, Health Secretary, V.K. Rajan, Director of Health Services, and E.K. Madhavan, District Medical Officer, is scheduled to visit Tiruvallam on Thursday as the bulk of the suspected cholera cases have been reported from there.

100 seats sanctioned in Jubilee Mission medical college

THIRUVANANTHAPURAM: The government has sanctioned 100 seats to the newly-sanctioned medical college of the Jubilee Mission Medical and Research Institute, Thrissur, for the academic year 2003-04.

An official statement said here on Tuesday that the admission to 50 percent seats in the college would be made from the list prepared by the Commissioner for Entrance Examinations.

Letter of permission issued to Amala Institute of Medical Sciences

THRISSUR: The Union Ministry of Health and Family Welfare has issued a letter of permission (LoP) to Amala Institute of Medical Sciences, set up under the management of Amala Cancer Hospital Society at Amalanagar, near here.

Sources said the LoP is for admitting 100 students for the first year MBBS course to be held during 2003 to 2004.

Diabetes among children makes schools proactive

KOCHI: A gradual rise in the number of children afflicted with diabetes in the city has forced medical experts and school authorities to revamp the curriculum, with more focus on healthy lifestyle with balanced diet and regular exercise.

The programme, organised by Amrita Institute of Medical Sciences (AIMS) in the city schools to educate the children on health habits, has found that a sedentary lifestyle is proving disastrous for the new generation who are addicted to junk food and long hours of TV watching.

And on the recommendations of the expert team, many schools like Chinmaya Vidyalaya and Bhavan’s Vidya Mandir have started special exercise programmes for their students.

The doctors had found that many students don’t watch their diet closely or live a healthy lifestyle. And it is a strict no-no to exercise. Even though there is a big trend to eat right and exercise, generally it does not catch on until people are in their 30s.

Considered once a true medical oddity in city, children with adult diabetes are becoming common now.

‘‘Obesity also plays a major role in these cases as children tend to over eat, especially sitting before the television,’’ says Dr Harish Kumar, Consultant Endocrinologist of AIMS, who is leading this project initiated by members of the Diabetics Welfare Association of the hospital.

‘‘So far, there have been no cases of Type I Diabetes, which require insulin therapy, in the city schools. But we found many students with the Type II variety,’’ says Dr Harish.

Type II has always been a disease of the people in their 50s, 60s and beyond, but now more cases of children with this variety are being reported from the city.

Students in the classes VI, VII and VIII are involved in this programme as experts feel that they are more receptive to such ideas than their juniors and seniors. Through a comprehensive programme, doctors make students aware of the challenges of being a teen with diabetes and the problems of living with this disease.

Earlier it was believed that diabetes cannot be prevented. But now, it is proven that with controlled diet and regular exercise it is possible not to let the disease affect you. And the doctors feel that parents have a much bigger role in making the children healthy instead of obese and avoiding many a health problem.

And keeping in mind the suggestions made by these doctors, schools have started healthy food-exercise packages. Bhavan’s Vidya Mandir, Elamakkara, has banned junk food in its canteen and there is a compulsory weekly exercise programme for the children.

‘‘We also focus on yoga and meditation apart from the mass PT and the students are now more aware of the problems caused by over-eating and inactivity,’’ says Meena Viswanathan, principal of the school.

‘‘Yes, we are also concerned about the health problems of students. And these exercise programmes are really good for them,’’ says Paulose, principal of Delta Study, Fort Kochi.

The project is being carried out on Fridays and the team has covered a good portion of the city schools, both Government and private. ‘‘The time to act is over for our generation, but we want to ensure that the new generation gets a chance to lead a healthy life, right from the beginning,’’ says Dr Harish.

Vector study identifies 19 'high-risk' areas

By M. Dinesh Varma

THIRUVANANTHAPURAM Aug. 1. A vector study undertaken by the district medical administration has identified 19 `high-risk' and three `moderate- risk' areas for dengue fever which is transmitted by the aedes species of mosquitoes.

The areas with high vector presence included proper city locations such as Thycaud, Vanchiyoor, Central Prison in Poojappura, Kunnukuzhy and Goureesapattom as well as contiguous urban-rural zones such as Thozhuvancode, Vattiyoorkavu, Vellanad, Nemom and Vizhinjam.

The other risk-areas in the district for dengue were Arasu Parambu (Nedumangad), Kanchira (Kanyakulangara), Cheeranikkara (Vembayam), Sisilipuram (Vizhinjam), Parasuvakkal, Kottukal, Anad, Manamboor, Russelpuram and Oorottumbalam.

The affected areas include Malayinkeezh, Pallichal, Vilavoorkal, Vamanapuram, Vellarada, Kallara, Athiyanoor, Parassala, Karumkulam, Venganoor and Chettivilakam.

There have been 11 dengue deaths and around 400 confirmed cases of dengue reported in the city so far this year. Vector biologists say that one-third of the confirmed cases of dengue have been sourced to Corporation areas, which has an abundance of aedes aegypti species of mosquitoes.

The vector study, undertaken during June-July by a team comprising a biologist, insect collector, field assistant and field workers, examined 1,388 potential vector breeder containers at 752 households in as many as 22 Corporation and district centres.

The classification as `high-risk' and `moderate risk' areas was done based on the classical House index and Bretaeu index as mandated by the National Anti-Malarial Programme. The immediate vicinity of a household with a House index above 20 and a Bretaeu index value of 50 or above is classified as `high-risk'.

The larvae samples collected from containers were later identified during laboratory investigations as belonging to the aedes aegypti (the primary vector for dengue) and aedes albopictus (a secondary vector). Significantly, 431 of the 1,388 containers tested positive for presence of aedes larvae.

``Public awareness is the best safeguard against dengue,'' said the District Medical Officer, E. K. Madhavan, speaking to The Hindu. House-to-house visits undertaken by a team of health promotion volunteers form an important component of the dengue-control measures.

However, even though the awareness campaigns have stressed the point that preventive measures against dengue should start at the household-level, the public tends to fall back on the false security of the more `visible' operations such as spraying of organo-phosphorous chemicals on polluted water bodies or fogging measures, a health worker said.

``Ideally, the fight against dengue should focus on larvicidal operations,'' said Unnikrishnan, district malaria officer. Targetting an aquatic breeding source ensures elimination of a large number of larvae which are confined to a limited area and are more vulnerable than their adult counterparts. It is futile to target the adult aedes species which has a life span of around three weeks and a flight range of 500 metres, he pointed out.

Sprucing up environmental hygiene would be more effective in mitigating the threat of diseases like malaria which are spread by a different mosquito species.

According to experts, the best source reduction method is deprive the vector of breeding sites. Fresh water should not be allowed to collect in discarded cups, coconut shells and other transient water receptacles such as stagnant pools of water near quarries. The biological measures include the introduction of the Guppie variety of fish into motor-fitted as well as abandoned wells.