Addressing the dengue crisis

Mosquito-borne diseases have always been prevalent in Sri Lanka, but the ongoing battle with dengue is perhaps the most serious challenge faced by Sri Lanka's health system. Worldwide too, dengue infects at least 50 million people every year - second only to malaria. In Sri Lanka, however, malaria has taken a backseat to dengue in recent times.

Nearly 160 people have succumbed to the mosquito-borne disease this year while 21,677 cases have been reported so far. A surge has been observed this month with 20 deaths reported in the first three weeks. Children seem to be especially vulnerable.

These are alarming numbers by any standard and urgent action is required at national level to prevent more deaths. The Government has declared a Dengue Prevention Week in August to widen awareness on the disease and to step up prevention efforts. It is our belief that every day should be a 'dengue prevention day'.

The authorities must also resolve the BTI (Bacillus thuringiensis israelensis) bacteria issue without delay so that prevention efforts could move into a higher gear. The aerial spraying of BTI has been a success in countries such as Cuba, which has been cited as a source for importing BTI. Such biological control has the potential to be a long-term viable solution, with none of the environmental problems associated with chemical (spray) control.

In this country, there is a tendency to blame the authorities for everything that goes wrong. The dengue epidemic is no exception to this norm. There have been many calls for the resignation of those at the helm of the health service on the dengue issue. Yes, there are areas where the authorities could and should have fared better, but their stepping down would not necessarily solve the dengue problem. The wider society should turn the searchlight inwards to probe the very roots of this serious problem.

The dengue epidemic has exposed a lot of shortcomings in a variety of sectors. But at least part of the blame should go to local bodies and householders who do not clean up. The truth is that we have neglected the upkeep of our surroundings, at a personal level. Mosquitoes are allowed to breed in every nook and corner, giving rise not only to dengue but malaria and filaria as well. It is clear that neglect on the part of certain provincial and local authorities to clear garbage dumps and mosquito breeding sites has also contributed to this status quo. The Local Government authorities should get their act together if they are honestly committed to eradicate dengue and other such diseases.

Individual residents and owners of business premises too must be held responsible. Many householders have neglected cleaning their compounds, which have turned into ideal breeding sites for disease carrying mosquitoes. Public cooperation is essential to minimise, if not eliminate, mosquito-borne diseases. The regular cleaning of household compounds and throwing away water accumulating in bottles, pots and used tyres are just two of the steps that can be taken without almost any cost to minimise the risk of dengue. The dengue vector mosquito has an affinity for clear water and daylight hours. Taking protective measures only at night will be of little help.

The public should be vigilant. Those who experience fever even for a day or two should undergo blood tests for dengue at the nearest public or private hospital, though it is advisable to seek treatment at a public hospital. It should be borne in mind that if detected in the early stages, dengue can be cured easily. Any delay in seeking medication could thus prove to be fatal. Children are especially vulnerable and it is up to parents to rush their children having fever to the nearest medical facility. It is better to be safe, rather than sorry. The health authorities must provide all necessary facilities for the hospitals to address the heavy influx of dengue cases. An extraordinary crisis deserves an extraordinary response, after all.

Is there any other hope on the horizon ? Yes, a dengue vaccine is on the way. But production is not due to begin at least until 2013, after extensive clinical trials which are now under way. But widespread use may be many more years away. Our universities and research institutes too must be involved in vaccine research in collaboration with the World Health Organisation (WHO). The Third World must initiate collective vaccine research programs, as some vaccines manufactured by multinational drug companies are very expensive.

We have seen reports of another development. We may one day spend less time swatting mosquitoes if researchers succeed in their efforts to produce a repellent that works longer, with less odour, than most of today's sprays and lotions. Scientists produced 23 new compounds after teaching a computer to recognise which chemicals would do the best job of warding off mosquitoes. Ten of the compounds gave almost 40 days' protection, more than twice the amount from DEET, the most common product in repellents. In other words, the new repellants will give 24 hours protection if worn on garments as opposed to the 12 hours possible with today's best ones. More regional and local companies must be involved in efforts of this nature. In fact, a Sri Lankan company now produces a treated mosquito net.

In the meantime, nothing works better than tried and tested preventive measures such as clearing garbage, stagnant water, blocked water etc. These cost little or no money and often a Shramadana effort can show positive results. Stern action must be taken against local authorities and householders who do not clean their environs. The media must play a pro-active role in educating the public on the benefits of such steps. Public cooperation and participation will be vital in eradicating dengue and other such diseases. If the public is not keen on keeping disease at bay, we cannot expect the authorities alone to do it for us. It should be a collective effort of the authorities and the public.