Dengue Raises Head Amid COVID Pandemic
By Dilanthi Jayamanne
While all cannons and artillery have been aimed at SARS CoV-2-the Coronavirus during the past two years, the local community has kept a halfopened eye on the single positivestranded RNA virus of the Flaviviridae family; more commonly known as Dengue.
Consultant Community Physician affiliated to the National Dengue Control Programme (NDCP) of the Health Ministry, Dr. Shilanthi Seneviratne said the inclement weather experienced islandwide had given rise to the number of dengue cases. Besides being inconvenient, the intermittent rains throughout the day is also a benediction (not to be sacrilegious) for our old winged friend Aedes aegypti and Aedes albopictus mosquitoes who transmits the dengue virus. A total 13,984 dengue cases have been recorded from January till 13 October 2021, according to the Epidemiological website.A total of ten dengue deaths were recorded within this period.
Although this may seem a minute figure compared to the number of COVID-19 casualties piling up, there were years when dengue took over 300 lives not too long ago. From January to September end, last year, a total of 28,025 cases were recorded with a dengue death toll of 36 from January to end December last year. Dr. Seneviratne said there were more and more cases being reported compared to last year. In the Western Province, 20 Medical Officers of Health (MOH) areas were identified as ‘Priority High Risk areas,’ while there were about 158 of them in the entire country.
Epidemiology figures show that the highest number of dengue cases were recorded from Colombo (3,551), Batticaloa in the Eastern Province (3,001), Gampaha (1,545), Kalutara (1,088) and Kurunegala (815). Also the highest numbers were recorded from Colombo (4,257), Batticaloa (3,717) Kandy (3,443), Gampaha (2,666), Trincomalee (2,296) and Kalutara (1,810) from January to December last year. She said that the comparatively high numbers seen in Batticaloa early as well as towards the latter part of 2020 had led to the increase. The situation was similar this year as well when Batticaloa recorded over 1,132 cases in January 2021 alone but was brought under control towards the latter part of this year.
Aedes aegypti has a history
The website of the NDCP shows that “dengue fever and the more severe Dengue Haemorrhagic fever (DHF) became prominent in the island in 1996.”The information prior to that is based on the outbreak reporting. The website revealed that, clinical denguelike illness had been recorded in Sri Lanka from the early 20th century, and it was serologically confirmed in 1962.” According to the Programmes website, there was an island-wide dengue epidemic with 51 cases of DHF and 15 deaths during the 1965-1968 period.
Thereafter, from 1969 up to 1988, multiple similar outbreaks with endemic dengue fever were reported in urban areas, but there were only occasional reporting of DHF. Sri Lanka has been battling dengue “over 40 years of dengue fever” and possibly dengue haemorrhagic fever also for almost the same period of time being reported, since the early 1990s progressively large outbreaks of epidemic proportions have been witnessed in the country with more severe and fatal DHF have occurring. One of the worst years the country has seen in its recent past was during 2017 when numbers reached an epic proportion of 186,101 and 440 deaths in a single year.
A gentle reminder
With the current fear of being diagnosed with COVID-19 patients should remember that all fevers are not COVID and that dengue too shows very similar symptoms minus the respiratory issues. “Seek medical advice if fever settles in. Abdominal pain, vomiting, increased thirst, drowsiness, refusing food and drink, abnormal bleeding manifestations (e.g. bleeding gums premature menstruation etc.), reduced urine output. If the following features are present seek medical attention immediately. Also be on the lookout for cold clammy skin and extremities, restlessness and irritability, skin mottling, behaviour changes such as confusion or using foul language should also ring alarm bells.
Early detection of Dengue illness
The Consultant Community Physician observed that not just Sri Lanka but countries of the South Asian Region of the World Health Organisation (WHO) hoped to achieve ‘zero’ deaths by 2030. “Early identification and management of Dengue illness can minimise morbidity and mortality, “Delay in seeking medical help could lead to DHF which was harder to treat and a possible cause of death,” Dr. Seneviratne observed. Therefore, at this juncture any patient with fever should not shy away from either of the diagnostic tests which should be decided by a qualified medical practitioner. A rapid antigen test or a full blood count could help save lives.
Watch out for the vector
The dengue vector breeds in any receptacle found inside or outside homes. Dr. Seneviratne said that schools, religious places and construction sites which remain closed due to travel restrictions and the prohibition of public gatherings have proved to be the entomologist’s nightmare. Aedes, requires just one teaspoon of water to lay eggs. That amount alone is adequate for the larvae to develop into an adult mosquito.
Therefore, from wet concrete slabs to debris lying about like plastic containers, polythene bags, coconut shells, discarded tyres, and old vehicle yards, gutters, stagnant drains where water could retain, are open invitations for the dengue mosquito. Even cemeteries can be a breeding place for the dengue mosquito. Dr. Seneviratne said the tanks in which water is stored in the dry zone, wells, tube wells and broken toilet cisterns that have been discarded are all breeding grounds for the mosquito with the deadly sting.
Social distancing and house to house inspections
The requirement for social distancing and the prevailing situation has not made it easy for the NDCP. With demands for social distancing being in place, entomologists, PHIs and staff have been called on to exercise more caution and curtail some of the inspection work being carried out owing to the COVID-19 situation. What once was carried out as teams and given wide-scale publicity should now be carried out on a lower key.
“Inspection teams have had to avoid neighbourhoods owing to the presence of COVID infected patients or persons being quarantined. In some instances people have requested inspection teams not to enter their premises for health safety reasons. Those persons have been instructed on how to keep their premises free of receptacles that could provide free breeding grounds for the dengue mosquito. People are also encouraged to breed fish that consume mosquito larvae in tanks and wells that are not used for drinking purposes.
The wells could be covered with netting to keep mosquitoes away. Chemicals are used in spaces used as dumping grounds with advice from the MoHs’s and Public Health Inspectors, she said. Dr. Seneviratne said that long distance meetings had been carried out on zoom in areas where the case load had been comparatively high. While a team visited high risk Batticaloa and surrounding areas when the cases in those areas shot up, she said. Patient numbers have been low during last year and 2021. With people being distanced and restricted to their homes; giving them ample time to clean up their backyards and homes.
Taking this into account the Health Ministry, Police and armed forces, who have been a part of the inspections for the past number of years till the first wave of the Coronavirus hit Sri Lanka in 2020,were only required to enter bare and abandoned lands used by locals and passing motorists alike as garbage dumps. The Health Ministry’s NDCP and the armed forces are often required to inspect of common areas and bare lands, but it would only take an attitude change on the part of the people to keep their premises and their immediate surrounding area clean and free of breeding grounds. Perhaps this change would come about with the “new normal” behaviour that is expected from the public to battle COVID-19, such as wearing the mask and maintaining a one meter distance. Likewise, the people could also be relied on to maintain an environment free of mosquito breeding sites.