Tuesday, September 27, 2011

Are outbreaks of Dengue and Chikungunya in Kerala just a garbage issue?

Whenever the state of Kerala reports an outbreak of vector-borne diseases like Dengue and Chikungunya, the media goes on an overdrive and as usual looks for culpable scapegoats. Following public, political, and media pressure, on September 24, 2011, the Kerala chief minister held an emergency meeting and directed waste management measures on a war footing among others.

Here comes my discomfort. It may be because I am ignorant. Vector-borne diseases and contagious diseases are different ball games. What we are witnessing in Kerala is outbreaks of vector-borne diseases such as Dengue and Chikungunya, and the state’s total failure to either control, anticipate, or study the issue at hand. Knee-jerk reactions like more doctors in affected areas, urgent waste disposal measures, and local body meetings (a group totally incapable of dealing with the situation) follow suit from various quarters, and for the media this is just an issue to up the TRP ratings.
This is simply not a “Garbage Issue”. This is a serious environmental and entomological issue resulting from deforestation, land use changes, and possible jumping of microbes from forests or animals to human habitations, and population movement.
 
And the most important fact is that the humid and hot climate of Kerala along with the presence of thick vegetation (including plantations and stagnant water (ponds) near households provide the best conditions for the disease causing Aedes mosquitoes to breed. Mosquitoes cannot ask for a much better environment to breed and create havoc than the present situation in Kerala.
Moreover, there are reports and studies saying that “concurrent infections” can occur-this means the mosquito bites can cause both Dengue and Chikungunya. This means that a mosquito and a human being can be infected with more than one disease. This also means that in an ill-equipped medical hospital and clinic what can be the diagnosis, treatement, recording of symptoms.
While garbage and solid waste need to be removed and safely disposed of, this is not a measure that should be taken during vector-borne disease outbreaks. Waste disposal does not become critical when there is a medical emergency or when there is an epidemic like situation. But controlling vector-borne diseaes goes beyond waste disposal as it requires long-term studies and monitoring of existing infectious diseases and vectors and emerging threats. I feel each of these episodes are not the final ones and lack of scientific vision will lead to a big epidemic sooner or later. 

The media does not have the same level of knowledge it has when it comes to reporting political breaking news, backroom intrigues, and cinema. They have no idea about the difference between the terms, contagious diseases and vector-borne diseases. According to one definition:
Contagious means infectious by direct contact, but in common usage the word usually applies to diseases that are highly infectious and dangerous, implying something more serious than a common cold. 
Vector-borne diseases require a pathogen, a vector, and the human host.  Here the pathogen is the virus and the vector is the mosquito.
So, were sitting on a medical volcano and believing that if there is no garbage and household waste, there will no diseases. How naive have we become!

FACTSHEET
Dengue Virus: Dengue is a viral infection caused by Flaviviruses,  a group of viruses that can cause a number of diseases such as Dengue and Hepatitis C in humans. These viruses arev spread by mosquitoes and ticks and can reproduce in their vector.  Click here to know more about the Dengue hemorrhagic fever .
Chikungunya: Chikungunya is caused by Alphaviruses and is spread by mosquitoes. It has the distinction of having jumped from monkeys to humans.

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