HEALTH: The Dengue Epidemic


A new war take hold of Sri Lanka as its casulty rates continue to rise as both adults and children fall victim. The battle is against the mosquitos and the fighters are the islands health setor officials. Shifani Reffai gives us an update from the forntline.

As a tropical island, Sri Lanka has fast become home to an excess of mosquitoes who pose a much larger threat today than mere insect bites. Dengue fever is a contagious infection spread by a Flavivirus carried by the Aedes mosquito. In 2004, the situation was declared an epidemic in Sri Lanka, and since then, the number of dengue victims has been steadyly on the rise.
"Up to date, there have been 8908 cases of dengue and 126 deaths of dengue victims, all cross the island," says Dr. Manori, a medical officer from the Epidemiology Unit, Ministry of Health. "The numbers have shot up drastically in 2009 alone from 1279 cases in January to 4114 in May" she adds. The rise in the level of the epidemic has forced the health authorities to carry out extensive public awareness campaigns to eradicate the mosquito based epidemic.
Households have been warned to keep their environment free of mosquitoes. Those who allow the mosquitoes to breed by allowing stagnating water face prosecution with a special hotline being made available for public information. A few prosecutions of people who had not paid heed to preventive measures have already taken place, say health officials. Dr Manori further goes on to say that in order to reduce the numbers, people have got to behave more responsibly with their garbage, as water can collect in cans and tires left out in the trash.
During the past few years, the characteristics of dengue in Sri Lanka appear to have changed. For instance, a decade ago, children were predominantly affected, but in recent years, clinicians have seen increasing numbers of adult dengue patients, with significant morbidity, and increasing numbers of adult deaths due to dengue. Similar trends are seen in some South Asian, South-East Asian and South American countries.
The rise in the incidence of dengue among Sri Lankan adults adversely affects the country’s developing economy and its health sector.

Dengue is the most prevalent mosquito-borne viral infection worldwide, and in Sri Lanka, it is most prevalent in major cities such as Colombo, Gampaha, Kandy and Kurunagala. Despite the statistics provided by the Ministry of Health, a study by members of the Department of Medicine and other scientific centres in Sri Lanka, S. A. M. Kuleratne and S. L. Seneviratne being two of the many professionals involved in the synopsis, claims there have been as many as 15,457 cases of dengue fever in Sri Lanka since the disease's reign as an epidemic.

The World Health Organization said some 2.5 billion people, two fifths of the world's population, are now at risk from dengue and estimated that there may be 50 million cases of dengue infection worldwide every year. Besides the obvious cans and shells left out in the open for water to stagnate in, in which mosquitoes breed, Colombo also has its garbage crisis to blame.

Dr. Sivarajah, a consultant for the World Health Organization, says, "People are not educated about it, or they simply do not care, when they throw their refuse into drainage systems outside their houses. This blocks the water flow and can become breeding ground for mosquitoes carrying dengue." In addition to drains, canals across Sri Lanka have also become very slow-moving breeding grounds for mosquitoes because of the blockage caused by the sludge and trash accumulating in the water.

An illness is most difficult to eradicate from a population when at its climax, and that is when it has reached the point of becoming an epidemic. However, if people are educated about the fatal consequences of dengue fever and methods of prevention, lives can be saved. "It is often due to the fact that people do not go for treatment during the early stages, that dengue is thriving among the masses," says Dr. Manori.

The symptoms of a patient with dengue are a rapid onset of marked drowsiness, lethargy or restlessness or the presence of shock as manifested by a rapid and weak pulse, low blood pressure and cold clammy skin. Such patients should be immediately referred to a good hospital for further management.

Dr. Haresh Jayakody of the Medical Research Institute says it is crucial that people are immediately informed of how they can prevent cases of dengue from prevailing. Some pointers are listed in the table below;

Prevention pointers to keep mosquitos away:
1. The use of mosquito deterrents in bedrooms is effective to reduce the number of mosquitoes in the room, although it may not prevent mosquito bites all together.
2. Correct use of mosquito nets (essential if accommodation is not air- conditioned). For added protection for up to three months or longer, mosquito nets can be soaked in Permethrin, or a similar repellent / insecticide).
3. Use of mosquito coils and "knockdown spray" (containing pyrethoids) - spray insecticide in cool dark places where mosquitoes lurk.
4. Avoid use of dark colored clothing, perfumes and colognes in the evening and at night, as all these attract mosquitoes.
5. Use of an effective mosquito repellent on exposed skin and clothing

An online Medical Journal compiled by a group of reputed medical professionals from Germany states the very simple fact that the best way to keep dengue from taking over your neighborhood is to destroy mosquitoes and their larvae. Some mosquito eradication tips here listed in the following table.

Eradication tips for the neighborhood:
• Clearing the neighborhood of ponds and pits,
• Covering all water containers and any objects that can trap rain water (tires, pots, etc.)
• Filling in or draining areas of stagnant water except for swimming pools and ornamental pools if they are aerated by a pump or fountain or similar.
• Use of mosquito larvicides or mosquito larvae-eating fish in waters that cannot be drained.
• Installing mosquito screens on doors and windows and mosquito nets on beds.
• Changing water in flowerpots once a week and washing them thoroughly. (Do not let plants stand in trays containing water. Scrub trays weekly to get rid of any mosquito eggs.)
• Covering all water containers and eliminating objects that can trap rainwater. This includes areas underneath elevated walkways and accommodations.

The dengue epidemic is no simple matter. Environmentalists, community workers, social workers, medical officers and authorities all agree that although we often hear precautions and warnings about the illness on the radio and on TV, the urgency of the situation is not being stressed enough.
It can be fatal if not treated soon, especially in children, and a great amount of discomfort and agony can be avoided if people do something as simple as put cans and shells and tires in bags, fastened closed, so as to prevent water from collecting in them, and if responsible behaviour in relation to garbage-dumping is adhered to. "It is hardly up to the authorities to eradicate dengue fever. It is the collective duty of citizens of Sri Lanka and the media, to come together and play a more active role in educating people on what they can do to remove the dengue menace from the island," says freelance social worker, Ajith Mithapala.