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Community must be conscious about their environment to prevent dengue: Dr. Lahiru Kodituwakku

25 May 2022

  • National Dengue Control Unit Medical Officer Dr. Lahiru Kodituwakku talks about the challenges of dengue prevention
The Sri Lankan public struggles with the battle against inflation, staying in queues all through days and nights just to have a single meal on the table. Amidst this economic and political crisis, the monsoons too have added yet another crisis to the list. The number of dengue cases are on the rise along with the ongoing monsoonal rains, nurturing the breeding places of mosquitoes. With a high population density, the Western Province acts as a dengue hub in the country while cases are reported in almost all districts. To battle this crisis, The National Dengue Control Unit (NDCU) has taken steps to prevent an outbreak of dengue. National Dengue Control Unit  Medical Officer  Dr.Lahiru Kodituwakku spoke to The Morning regarding the upcoming crisis.  Following are excerpts from the interview. With the commencing of monsoon rains, we generally have to expect a rise in the dengue trend. So, how is the situation at the moment? As of 19 May 2022, 21,030 dengue cases have been reported throughout the island. The Western Province bears the larger share of the burden with nearly 50% of the total cases. Apart from the Colombo, Gampaha, and Kalutara districts, outbreaks have been reported in the Kandy, Galle, Jaffna, and Trincomalee districts as well. With the onset of monsoonal rains, cases are further expected to rise with potential for outbreaks as well. Have you identified any high-risk areas at present and can you explain to us how you identify such high-risk areas? The NDCU has a real-time, web-based surveillance system, where more than 100 hospitals across the country feed in details of dengue patient admissions on a daily basis. Further, we collect midnight totals of fever patients from major hospitals in the country which provides us an idea on the disease burden. More than 350 Medical Officers of Health (MOH) offices conduct field investigations on every single dengue case reported, which are communicated to the NDCU and Epidemiology Unit as well. Through this robust surveillance system, we have identified 49 MOH areas as “Priority High Risk” for dengue, whereas 99 MOH areas are deemed “High Risk”.   What are the dengue viral types prevailing in the country and have you seen any changes in the viral types? Is there any potential for an outbreak? All four viral types have been found in Sri Lanka, but lately we have seen the predominance of dengue virus types 2 and 3 (DENV-2 and DENV-3). We have observed the emergence of DENV-3 during the third and fourth quarters of 2021 as the predominant viral serotype. However, in early 2022, DENV-2 has emerged as the predominant type. There is always a potential for a larger outbreak when a dengue viral type remains concealed or dormant for some time and reemerges as the predominant type in a particular area. We have experienced this phenomenon during the dengue epidemic of 2017. Some viral types present with peculiar clinical symptoms as well. Therefore, the NDCU together with the Medical Research Institute (MRI), Centre for Dengue Research, University of Sri Jayewardenepura, and other reference laboratories has established a National Dengue Viral Surveillance to monitor these trends. The NDCU initiated an islandwide, special mosquito control week. Can you briefly talk about this programme? To mitigate possible dengue outbreaks and to inculcate dengue prevention and control practices among the general public, the NDCU initiated an islandwide, special mosquito control campaign from 18-23 May 2022. Public Health Officers (PHO) with the help of the tri-forces, Police, Disaster Management Centre (DMC), and community-based organisations such as “Sarvodaya” conducted door-to-door campaigns in identified high risk districts and localities. During this programme, the public were encouraged to actively look for dengue breeding sites and clean their environment to make them dengue-free. Further, premise inspections and source reduction programmes were conducted in vulnerable sites such as construction sites, schools, religious places, and government institutions. A public awareness campaign was launched simultaneously to educate the general public regarding the best practices for dengue prevention.  It is a challenging time for all Sri Lankans with the current economic and political crisis. In this context, what are the difficulties you faced when carrying out this programme? We are all going through the most difficult times we have ever experienced in our lifetime. Public health programmes like ours are no exception. Due to the unavailability of fuel, we found it difficult to mobilise our field cadre. Field investigations and control activities such as fumigation were significantly challenged as well.  Similar hardships were experienced by our counterparts at the grassroot levels, as well. However, with support from the public and our trusted stakeholders, we are trying to overcome these difficulties. After all, saving lives no matter how difficult the situation, is our prime responsibility as health workers. We all know that there is a severe shortage of medicines. Do you have any idea about the availability of drugs which are needed to manage complicated dengue cases? Since dengue has no definitive treatment, the main focus is on the patient’s fluid management. This requires fluids given through veins such as normal saline and Dextran. Adequate stocks of these fluids are currently available. The NDCU, with the help of the Medical Supplies Division, Ministry of Health is closely monitoring the availability of essential medications to treat dengue. When any deficiency is noticed, urgent actions to replenish the stocks are being initiated. We have continued the distribution of essential equipment and beds for High Dependency Units (HDU) in hospitals with much difficulty, as well. However, it is a very difficult situation to predict.  Generally, schools tend to be hotspots for dengue spread. Is there a special reason for that and what are your arrangements regarding dengue prevention in schools? Yes, out of all dengue patients reported in Sri Lanka, nearly 25% are of school-going age. During their school time and after school, children are exposed to bites of the dengue mosquito. During the peak biting hours of the dengue mosquito between 6-9 a.m. in the morning and 4-7p.m. in the evening, schoolchildren tend to remain mostly outdoors. Therefore, their vulnerability is comparatively high. Further, our entomological teams have identified many mosquito breeding sites within schools. Water storage tanks, discarded and temporarily removed items, play areas exposed to the environment, and toilets often unused during vacation times are most vulnerable to dengue breeding. Construction sites within schools are a major concern as well. Therefore, the NDCU strongly advocates the cleaning of school premises at least twice per week and the application of mosquito repellents and wearing garments that cover exposed areas of the body while at school.   Finally, what do you expect from the community to prevent dengue? The community must be conscious about their own environment to prevent the spread of dengue through mosquito breeding. People should be vigilant about areas that collect water, which support dengue breeding within their households and home gardens. It is important to clean their environments at least once a week.   If you have a fever for 24 hours, please consult a qualified doctor or visit the nearest hospital, especially if you are living in a dengue high-risk area. Further, look out for the warning symptoms of dengue, including continuous vomiting; abdominal pain; bleeding in gums, via vomitus, urine or stool; irritability; and reduced or lack of urine output. These could be symptoms of Dengue Hemorrhagic Fever (DHF), and you should go to a hospital without delay.  The public should not take any over-the-counter drugs such as painkillers for symptomatic relief in dengue, as it could sometimes lead to complications and grave consequences. They should only take paracetamol in the recommended dose and correct interval. Finally, it’s all about exercising your citizen’s responsibility towards a dengue-free Sri Lanka, for the betterment of yourself and your fellow citizens.  

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