Runaway Dengue menace stirs controversial reactions
The Western Province which has the dubious distinction of heading the
list of dengue-hit regions , last month showed a slight decline in the
accumulated cases ( 46.74%). Nonetheless, the numbers of suspected cases
in June are worrying, health officials said. For example, according to
the Epidemiology Unit, the Colombo Municipality area this June recorded
a spike of 379 compared to 154 suspected cases in May. With a parallel
increase in other areas in Colombo, the score now stands at 414 at June
end compared to 229 in May in the CMC metropolis. .
Judging from these figures, it is evident that dengue is currently
soaring towards epidemic levels, raising questions as to who is
responsible, and why.
"The trouble is, there seems to be too many cooks inside the Dengue
soup," an unnamed informed source told the Sunday Observer. "No one is
willing to take the blame."
Does this include the general public as well?
Recent raids during the National Mosquito Control Week shows it does.
"Dengue Control Unit officers who visited nearly 7,000 premises
including 2,017 schools and 4,288 government institutes as well as
construction sites and religious places, had identified 26% of
government institutes , 42% of construction sites and 34% of religious
places as potential breeding sites for the dengue mosquito", Consultant
Community Physician , Dengue Control Unit, Dr Preshilla Samarawseera
said. "Schools , construction sites, religious places as well as
government buildings are among the worst offenders," she noted. " We
still have no vaccine against the disease", she added.
To encourage the public to take on the responsibility of cleaning
their neighbourhoods, the Dengue Unit and the Colombo Municipal Council
(CMC) has now introduced a Rewards Scheme in the form of green stickers
which indicate they are dengue free, and which they should paste on
their front entrance. "They are continuously monitored and officers
revisit their premises to ensure they remain clean", Head, Dengue
Control Unit, Dr Hasitha Tissera said. He said, since schools and
construction sites were among the biggest offenders, a special program
to fumigate such institutions identified as ' high risk' had been
initiated during the three day Anti Dengue Campaign held from June 30,
islandwide. In parallel, he said, special campaigns had also been
conducted in identified high risk regions which included Colombo,
Gampaha, Kalutara , Kandy and Matale towns.
Commenting on the steps taken to keep the heavily congested CMC area
free of mosquitoes, the Chief Medical officer Dr Ruwan Wijeyamuni said,
"Whenever Dengue epidemic occurs during rainy months as at present,
all our PHIs are immediately dispatched to houses where dengue cases are
reported, and they fumigate every house within 100 metres of the dengue
affected household. They instruct the affected houses to clean the
premises and mend any broken taps and drains. If they fail to do so,
they could be taken to court".
Meanwhile, Minister of Provincial Councils and Local Government
Faiszer Mustapha at a recent meeting at the Dehiwela Divisional
Secretariat Office on Tuesday ( June 28), was quoted as saying, Dehiwala
had the highest number of dengue cases, and called for an accelerated
eradication program , and for legal action to be taken against owners of
construction sites with dengue breeding grounds.
Paediatrician , Epidemiologiy Unit, Dr Jayantha Weeramuni observed,
those likely to be worst affected by a dengue outbreak, were children
under one year, those over 70 years, obese persons and those with
chronic diseases . He said, there were two types of dengue that children
could get; 1) Dengue fever and 2) Dengue haemorrhagic fever.
"Watch out for the second type. If not treated in a hospital
immediately, the child can go into shock and have internal bleeding.
Take the patient immediately to be examined by a qualified western
doctor at the nearest hospital, if his/her fever has not come down two
days after onset."
Health Ministry sources said, five strategies had been adopted to
bring down the current morbidity levels and maintain the low mortality
rate, namely, Vector Surveillance and Integrated Vector Management,
Disease Surveillance, Disease management, Inter-sectoral Coordination
and Social Mobilization with Outbreak response communication.
Adding to the confusion as to who is to blame for the runaway health
hazard, another disturbing issue has emerged: of suspected dengue
patients now being given non steroid anti-inflammatory drugs ( NSAID) to
relieve them of joint pains in the first two days of the fever, despite
the fact that the prescribing physicians were fully aware of the grave
long term consequences, if the disease progresses.
Clinical Head and Paediatrician of the new Dengue Ward at the Negombo
Base Hospital, Dr Lakkumar Fernando even went to the extent of declaring
that NSAID was the main reason for the increasing deaths (over 50 at
present,) from dengue related diseases.
"Due to people now getting high fever from various illnesses, some
general physicians and even government doctors are prescribing NSAID
drugs as a quick relief measure for joint pain, etc.
All these have long term consequences, which I believe at least 90
percent of doctors prescribing them, are aware of," he said.
If it is only dengue fever it can be managed by sponging and with a
paracetamol . If the fever turns out to be Dengue Haemorrhagic Fever,
there will be two impacts; systemic and local , which together can
impair platelet aggregation and cause coagulation as well as gastric
erosions which can lead to further bleeding complications", he warned.
My personal view is, they be charged in a court of law," he opined.
Lack of regulations
He laments, we don't have enough regulations to take legal action
against such persons
" What we have are recommendations and guidelines, warning against
the use of NSAIDs on dengue suspected cases, by the Health Ministry even
though in 2012 the Sri Lanka College of Paediatricians identified NSAID
as leading to bleeding in children.", he said." If a child has dengue
fever protect him from exposure to mosquito bites as he could spread the
disease", he added.
"We need a mechanism to punish people who cause these deaths. We need
to encourage the public to ask their doctors why they are prescribing
these drugs and their adverse effects, and for the doctors to respond
honestly in a transparent manner," he emphasized. " Answers to questions
on this issue could be discussed . Call us on 2368416", he said
On alternative medicines for treating dengue, he said, "Till we have
enough concrete evidence to prove or disprove the effectiveness of
papaya juice on dengue patients based on scientific clinical trials, we
cannot accept this or any other alternative technique."
He said the High Dependency Dengue Unit at the Negombo Base Hospital
which had excellent records since its inception in 2013, could offer
such patients with the best possible care."
He added that most hospitals now have an information service where
information on dengue and other patients are shared from hospital to
Dengue Control Unit Head Dr Hasitha Tissera, when asked if papaya
juice was acceptable as an alternative method to treat dengue suspected
patients, said , " Don't try it.
It is dangerous and could cause serious complications as many
patients brought here after using this treatment are in a critical
Unless they have scientific evidence based on clinical trials to show
us, any unconventional modality is unacceptable".
Dengue Control Unit now has a website www.healthedu.gov. lk offering
information on dengue.