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Preventing the other preventable outbreak

27 Apr 2021

It would not be wrong to say that the Covid-19 pandemic is the main social and health concern the world is dealing with currently. A lot of other issues, including those that were the most pressing issues before the outbreak of the Covid-19 pandemic, are receiving less attention and seem to have almost been forgotten. However, in many cases, the issues the world was dealing with before Covid-19 remain as before, and in the mainstream efforts aimed at curbing Covid-19, those issues should not be subdued. A good example that shows that a country should not lose focus on other national issues during its fight against Covid-19 came to light recently. It is none other than dengue, and it became a topic of discussion again in the past few weeks, due to a surge in the number of dengue cases reported from various parts of the island.   Dengue According to some researchers, even though it is believed that there is an overall rise in dengue cases in the world, due to issues such as underreporting, a considerable number of cases being asymptomatic, and some people obtaining traditional medicine to cure the disease, a larger number of actual dengue cases are not recorded. The World Health Organisation (WHO), quoting one modelling estimate, said that there are 390 million dengue virus infections per year, of which 96 million manifest clinically. Another study on the prevalence of dengue, according to the WHO, estimates that 3.9 billion people are at risk of infection with dengue. The number of dengue cases reported to the WHO has increased over eightfold over the last two decades, from 505,430 cases in 2000, to over 2.4 million in 2010, and 4.2 million in 2019. Reported deaths between 2000 and 2015 have increased from 960 to 4,032. Despite the risk of infection prevailing in 129 countries, around 70% of the actual risk is being faced by Asia, the WHO said. However, dengue is endemic in Africa, the Americas, the Eastern Mediterranean, the Western Pacific, and in South-East Asia. According to the Health Ministry’s National Dengue Control Unit, dengue is becoming a major health problem both globally and locally, and dengue fever outbreaks have been documented on every continent except Antarctica. According to the WHO, countries in the South-East Asia region are stratified into four categories based on a number of criteria. Category I is a) where dengue has become a major public health problem with epidemics caused by multiple serotypes, b) where there is high morbidity and mortality in children, c) where cyclical epidemics occur in urban centres, d) where the disease is spreading to rural areas, and e) where multiple serotypes are co circulating (at present, the five countries in this group include Indonesia, Thailand, Myanmar, Sri Lanka, and Timor-Leste).   Dengue cases on the rise According to the Epidemiology Unit, a total of 31,162 suspected dengue cases have been reported last year, while a total of 6,389 suspected dengue cases have been reported since this January of this year from all districts. As per the statistics, from the first week of January to the third week of April ending on 16 April, the highest number of cases – 2,686 – had been reported from the Batticaloa District, while the lowest number of cases – three – had been reported from the Mullaitivu District. Although not uninterrupted, an overall increase in the total number of dengue cases in the country could be observed – a total of 1,496, 1,794, 849, and 1,320 dengue cases had been reported in January, February, March, and April, respectively. Batticaloa had reported the highest number of monthly dengue cases in January, February, and March. In the three months, the District had reported 895, 1,070, and 493 dengue cases, respectively. Colombo had reported the highest number of dengue cases – 305 – in April. Meanwhile, the lowest number of cases in the four months – one, one, five, and one – was reported from the Ampara (January), Mullaitivu (February), Ampara (March), and Vavuniya (April) Districts, respectively. Among other districts that recorded a higher number of cases within the same period were Gampaha, Kurunegala, and Kalutara, which reported 471, 368, and 324 dengue cases, respectively. However, last year’s dengue statistics showed different results as far as the district-wise prevalence of dengue cases is concerned. During the same period last year, i.e. from January to April, the highest number of dengue cases – 2,725 – had been reported from the Colombo District. The second highest number of cases was reported from the Batticaloa District. As per the yearly statistics too, these two districts had reported the highest and second highest number of cases in the island. The lowest number of cases had been reported from the Mullaitivu District, as it had reported only 90 cases. However, the Monaragala District had not reported any dengue cases for the entire year. The Epidemiology Unit statistics also showed that more dengue cases had been reported in January, February, and March of last year than in the same three months of this year. However, a total of 511 dengue cases had been reported last April as opposed to the 1,320 cases reported so far this April. In conclusion, more dengue cases have been reported in the first three weeks of April this year than the total number of cases reported last April. “Approximately 27.1% of dengue cases were reported from the Western Province. It is very important to seek medical attention in the event of fever and to get the relevant laboratory tests done at least by day three of the illness,” the Unit added.   Rainy season and dengue To get more insights into the matter, The Morning spoke to National Dengue Control Unit (NDCU) Director Dr. Aruna Jayasekera. While acknowledging that there is in fact an increase in the number of dengue cases reported so far in April, Dr. Jayasekera said that the increase, however, is not significant. He added: “In the first four months of this year, around 6,000 dengue cases had been reported from around the Island, whereas during the same period of last year, about 18,000 cases had been reported.” Adding that even though the increase is slight, he cautioned that there is, however, a risk of dengue cases increasing in the foreseeable future. When queried as to what reasons could potentially lead to an increase in dengue cases, he added that the prevailing rainy condition has been identified as the main reason. He advised that taking into account the rainy condition, the public should take every precaution including keeping their residences clean whenever possible, destroying any place where the dengue mosquito can breed, and clearing any place and removing any container that can collect water unnecessarily.   Colombo’s dengue situation Despite being one of the most populated districts, Colombo reported a lesser number of dengue cases than the Batticaloa District; however, the District’s dengue cases are on an upward trajectory. So far this year, the District had reported a total of 939 cases – 106, 162, and 366 dengue cases in January, February, and March, respectively, and in the first three weeks of April alone, a total of 305 cases. According to the Epidemiology Unit statistics, during that period, a total of 275 dengue cases had been reported within the area of the Colombo Municipal Council (CMC), while other areas of the Colombo District had recorded a total of 664 cases. When contacted, the CMC’s Medical Officer of Health (Epidemiology and Statistics) Dr. D.A. Guruge told The Morning that there is a slight rise in dengue cases. She added that the CMC, taking this situation into account, is continuing its dengue prevention programmes on a daily basis. She added: “A dengue prevention programme is being carried out in addition to the Covid-19 prevention programme. In the morning and in the evening, two teams are deployed for dengue prevention activities which include fogging.” Dr. Guruge also said that as part of these programmes, dengue cases are being identified on a regular basis.   Prevention is key When it comes to dengue, unlike other diseases, it can be successfully prevented by adhering to exceedingly simple precautions, and it is one of the biggest advantages. Dengue transmission is predominantly seen in urban areas and among people living in close neighbourhoods. In order to prevent the spread of dengue, the health authorities recommend using physical barriers such as screening doors and windows of premises using mosquito proof meshes; wearing protective clothes to cover the body, especially that of children and those who engage in outdoor activities in the mornings and afternoons; applying natural repellents such as citronella oil, lemongrass oil, neem oil, and chemical repellents containing DEET (N,N-Diethyl-m-toluamide) (the effects of repellents are short term, lasting between half an hour up to six hours and the use of the repellent should be done in accordance with the instructions indicated on the product label). According to those who spoke with The Morning, even though the rise in dengue cases this month is still at a mild level, due to the prevailing rainy condition, there is a risk that dengue cases may further climb in the coming few weeks. In a context where the country, especially the health authorities and the public, are trying to contain the Covid-19 pandemic, Sri Lanka, or any country for that matter, certainly does not need another outbreak. In order to prevent the slight increase in dengue cases from morphing into an outbreak, like in the case of Covid-19, the public needs to take their responsibility for their own wellbeing seriously. The public also needs to understand that what the health authorities can do is limited, and that during the pandemic, the country can provide only a limited amount of resources.


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