Dengue - jammu's continuous nightmare

Rajan Gandhi Dengue is one of the most rapidly spreading mosquito-borne viral diseases in the world. The last 50 years has witnessed a 30-fold increase with rapid expansion to new countries

and, in the present decade, from urban to rural settings. An estimated 50 million dengue infections occur annually and about 2.5 billion people live in dengue endemic areas. One of the

commonly cited reasons for the poor health scenario in India is insufficient spending on health by the Central and state governments. Public expenditure on health in India is a meager 1.1%

of GDP, which is among the lowest in the world against globally accepted practice to spend 3-6% of GDP on health by government. Dengue fever is a viral infection and its carrier – the female

Aedes aegypti mosquito – spreads the virus by biting a person already infected with dengue fever. An infected mosquito can continue to transmit the virus for the rest of its life. One bite

is enough to infect a person. The virus usually takes five to eight days to incubate before symptoms begin to appear. Dengue NS1 test has to be done in first four days and after that IgM

antibody based tests should be done to diagnose dengue and all these kits are available in sufficient quantity in GMC, Jammu. There is no antibiotic, anti-viral medication or vaccine to cure

dengue fever. Treatment is mainly to alleviate the symptoms. The usual symptoms of dengue are sudden and acute onset of high fever (104°F) for up to a week, followed by any of the following

symptoms – chills, severe headache, pain behind the eyes, muscle and joint pain, nausea and vomiting, as well as fatigue. Rashes may appear a few days later. These symptoms will last for

two to seven days. Most people will recover completely within two weeks, but may continue to feel tired and depressed for a little longer before they feel normal again. In some people,

complications can set in – dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS). In DHF, the symptoms are high or very high fever, spontaneous bleeding, especially from the gums,

bleeding under the skin, bleeding in the gut, and liver damage. The symptoms of DSS include very high fever, severe bleeding, weak pulse, drop in blood pressure, restlessness, and cold

clammy skin . At this stage, fatality rates can be as high as 50%. Two-thirds of all DSS fatalities occur in children. Dengue in infants and toddlers presents symptoms similar to the flu –

fever, running nose, cough and mild skin rash. Older children may have high fever, pain behind the eyes and joints, headache and backache. Once diagnosed, blood tests will be done every day

to check on platelet and haematocrit levels. If there is spontaneous bleeding and the platelet level decreases to below 20,000 and continues dropping, a platelet or blood transfusion will be

given. Delhi topped the graph in 2016 for dengue cases and our Jammu is not far behind. Dengue, being a seasonal disease, arrives with the rainy season, but the authorities have mostly

failed to curb the spread of the disease that can be fatal. Fogging of mosquitoes started in October this year after the menace of dengue has already gripped the entire city and at the end

of monsoon. Fogging has been done only at a superficial level and the efforts will be intensified only when the situation will get more serious. They don’t have enough machines to cover the

whole city and fogging is done only on main roads while interior parts of the colonies are neglected. Moreover areas under various local bodies are left without fogging as they don’t have

equipment for fogging. Repeated fogging at regular intervals should be done throughout the summer season. As the number of cases climb up, the immediate response of the government is to

provide more hospital beds and doctors. The occurrence of dengue indicates a lack of sufficient and timely preventive and public health efforts by the local health administration. Rather

than restricting to curative and diagnostic services, a systematic and concerted strategy is required that would incorporate all components of the health system. A partial approach is not

likely to succeed. JMC and all local bodies shall immediately ensure availability of sufficient public health staff to visit communities to check mosquito breeding sites, conduct fogging and

take other preventive measures. Adequate supplies of insecticides, spray machines etc. should be provided. On curative side, clinics and other health facilities should be equipped with

trained manpower and regents for conducting tests for dengue virus, and human resources for counseling patients etc. Apparently, it is all too little, too late. It is expected that the

number of cases would go down in October and no case will be reported in November; however, the reason is more likely be lower temperatures rather than effective government actions. This is

the tragic tale of public health measures and population-level efforts, which have traditionally not received sufficient attention by the authorities. The current approach to crisis

management in the context of dengue focuses excessively on treatment via clinical care and hospitals; equal if not more attention needs to be given to public health functions for prevention

of the disease. Detailed mosquito control plans should be developed prior to the dengue season. Prevention is better than cure- there is a need for public awareness generation to prevent

mosquito breeding. Local bodies should undertake regular assessments and checks, including punitive measures such as fines for violation of suggested processes. The different government

departments should coordinate to ensure sanitation and avoid mosquito breeding. The existing health facilities including district hospitals and medical colleges need to be involved in the

process. It is the responsibility of local health authorities to generate awareness regarding the disease, take measures to prevent mosquito breeding and the spread of dengue, and ensure

availability of health services for those infected. The yearly occurrence of dengue indicates a lack of sufficient and timely preventive and public health efforts by the local health

administration. Hence, when cases start occurring, the initial reaction of the health officials is to deny the occurrence of dengue cases and deaths. Health facilities need to be kept ready

for surge capacity at the out-patient and in-patient levels so that patients can visit and consult doctors in a timely manner. There should be more focus on population services including

awareness generation prior to the disease season, mosquito control etc. As for all diseases, the mechanisms for reporting of dengue cases are poor. There is a need for strengthening disease

reporting systems and to use the information on cases/ deaths as a basis for action. Policies should be informed by learning from local experiences, and accountability mechanisms should be

put in place to ensure that planned public health actions are implemented in a timely manner. It is important to mention how many checks and challans municipality has done in the whole area

in the entire season. One’s casual visit to Jammu city will reveal huge accumulation of water behind SRTC workshop adjacent to Kala Kender and JDA parking along river Tawi bank , open water

tanks and tyres at Mubarak Mandi to name a few during entire rainy season but who cares. No contact number is available right now for lodging complaints with JMC as only web logging of

complaints is possible right now. Five municipal commissioners have been changed during last three years which shows government’s seriousness on the issue. Year after year, authorities claim

that adequate preventive measures are being taken and dengue keeps returning to haunt the poor and rich alike. Lip service and knee jerk reactions are not going to mitigate the sufferings

of masses. Sustained efforts from all are required at every level to defeat this menace. “Cleanliness and prevention is not a function of how rich or poor you are but that of mentality and

principle.” [email protected]